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Posted on December 25, 2018 at 11:33 AM

Advance directives have been employed in the United States for forty years. But what is the status of the incapacitated objection?

Suppose that the individual carefully completes an advance directive after thorough reflection and deliberation. She clearly specifies no food or fluid by mouth when she reaches advanced dementia. Let’s call this a “VSED directive.”

Here is the challenge. Years later, when the individual is in advanced dementia, she appears to make some gesture indicating thirst or some gesture expressing acceptance of food or fluid. Is that a revocation of the earlier advance directive? Do we honor the capacitated advance refusal? Or do we honor the present ambiguous incapacitated gesture?

I am preparing arguments that clinicians should honor VSED directives just as Odysseus’ men honored his instructions when sailing past the Sirens.

Waterhouse (1891)

Draper (1909)

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