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Posted on June 19, 2020 at 4:00 AM

Peter Eastman and colleagues describe in the Medical Journal of Australia how they honored an advance directive for stopping eating and drinking (AD for SED). 

The patient’s AD stated that if he was “in advanced stages of Alzheimer’s disease or other incurable, advanced dementing disease and if my appointed health care agent concludes after consultation with my primary health care provider that I am unable to make informed decisions about my health care, and I am unable to feed myself, continuing life would have no value for me”

The AD provided in that situation all life‐prolonging therapies should be withdrawn, including “the provision of nutrition and hydration whether provided artificially or medically or by hand or by assisted feeding.”

The AD continued: “if I am suffering from advanced dementia and appear willing to accept food and fluid by hand offered by assisted or hand feeding, my instructions are that I do NOT want to be fed by hand even if I appear to cooperate in being fed by opening my mouth.”

The case study authors explain that Victoria law did not require compliance. But it permitted compliance with this AD. In consultation with the patient’s wife, the clinicians decided to respect the AD because of its detail and clarity. Compliance would also be permitted in most U.S. and Canadian jurisdictions.

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