Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
New York Medical College, Valhalla, NY, USA.
Am J Hosp Palliat Care. 2020 Nov;37(11):974-979. doi: 10.1177/1049909120912951. Epub 2020 Mar 13.
Increased attention is being paid to "dementia directives," advance directives tailored to persons with dementia that outline what treatments an individual with dementia might wish to receive or forgo should they lose capacity. Particular focus has been placed on the request to have assisted oral feedings withheld, the so-called Stopping of Eating and Drinking by Advance Directive (SED by AD), the purpose of which is to hasten death. This article reviews the available literature regarding the practice of SED by AD and explores the clinical and ethical aspects as they present at the bedside. Our review aims to show that practical, clinically applicable ways to approach such requests must be developed in order to balance the fundamental principles at play.
人们越来越关注“痴呆指令”，即针对痴呆症患者的预先指示，概述了如果痴呆症患者丧失能力，他们可能希望接受哪些治疗或放弃哪些治疗。特别关注的是拒绝接受辅助口服喂养的请求，即所谓的通过预先指示停止进食和饮水（SED by AD），其目的是加速死亡。本文回顾了关于通过预先指示停止进食和饮水的实践的现有文献，并探讨了床边出现的临床和伦理方面。我们的综述旨在表明，为了平衡所涉及的基本原则，必须制定切实可行的、临床适用的方法来处理这些请求。
