Decision Aid on Goals of Care in Dementia
Watch University of North Carolina’s video Decision Aid on Goals of Care with Patients with Dementia
Describes dementia and its complications, how goals of care can be at odds with each other (e.g. prolonging life vs maintaining function vs comfort), specific treatments to consider within a goals of care evaluation; the video was created for the layperson family member, so things are explained at a very basic level, making it easy to understand, and going through three patient/family cases with three different goals of care
It’s hard to uphold patient’s previously expressed wishes
Listen to the following All Things Considered podcast on Patient Refusal of Nutrition and Hydration (PRNH) a.k.a. Voluntary Stopping of Eating and Drinking (VSED):
Interesting article on the difficulty enforcing a patient’s previously expressed wishes to be permitted to die by withholding artificial nutrition and hydration because by the time it comes to enforce that, the patient is no longer the guardian upholding the decision, the family is, and even then (as in the case of Margaret Bentley), even if family’s want to enforce a patient’s previously expressed wishes, nursing homes and/or courts step in to reverse that wish.
The Medical Ethics Debate in the Case of Terry Schiavo
Read the transcript of a debate on the medical ethics of Terry Schiavo featuring Dr. Russell Portenoy, a neurologist and the chair of the Department of Pain Medicine and Palliative Care at Beth Israel Medical Center in New York, and Robert George, a member of the President’s Council of Bioethics, and a professor of jurisprudence at Princeton University.
https://www.pbs.org/newshour/show/medical-ethics-of-schiavo-case
There are often no absolutes in medicine, and reasonable and expert opinions can disagree on a particular topic or outcome. Case in point, the above debate covering both sides of Terry Schiavo’s famous case regarding artificial nutrition and hydration, this time not in a patient with dementia, but in a patient in a Persistent Vegetative State (PVS).
References:
Wessell, K. (2017, November 28). A Decision Aid about Goals of Care for Patients with Dementia. Retrieved from https://www.youtube.com/watch?v=CsrbS_xtv98 Also Retrieved from https://www.med.unc.edu/pcare/resources/goals-of-care/
Marantz Henig, R. (2015, February 10). If You Have Dementia, Can You Hasten Death As You Wished? Retrieved from https://www.npr.org/sections/health-shots/2015/02/10/382725729/if-you-have-dementia-can-you-hasten-death-as-you-wished
PBSNewsHour. (2005, March 25). Medical Ethics of Schiavo Case. Retrieved from https://www.pbs.org/newshour/show/medical-ethics-of-schiavo-case