J Leg Med. 2021 Jan-Jun;41(1-2):29-46. doi: 10.1080/01947648.2021.1919252.
Progressive dementia afflicts millions of people, ultimately entailing precipitous mental decline and years of complete dependence on others. Many people deem the prospect of serious cognitive dysfunction, helplessness, and dependence to be intolerably degrading (as well as overly burdensome on others). To avoid being mired in prolonged dementia, they prefer to hasten death by advance instructions rejecting life-sustaining medical intervention at a point of decline they define as unacceptable.Some health care providers resist implementation of such advance instructions, especially as applied to patients with dementia who are not ostensibly suffering in their demented states and no longer recall their prior instructions and the dignity concerns that underlay them. The clash between advance wishes to hasten death and some health care providers' preference to maintain the well-being of nonsuffering patients will be surfacing, in coming years, in institutional ethics committees, professional disciplinary forums, and the courts. This article defends the legal and moral status of advance instructions seeking to shorten the unwanted limbo of deep dementia.
进行性痴呆症影响着数以百万计的人，最终导致严重的智力下降和多年完全依赖他人。许多人认为严重的认知功能障碍、无助和依赖是无法忍受的屈辱（也给他人带来了过重的负担）。为了避免长期痴呆的困扰，他们宁愿通过预先指示来加速死亡，即在他们认为无法接受的衰退点拒绝维持生命的医疗干预。一些医疗保健提供者反对实施这些预先指示，尤其是对于那些在痴呆状态下没有明显痛苦、不再记得先前指示以及这些指示所依据的尊严问题的痴呆症患者。提前希望加速死亡的意愿与一些医疗保健提供者维持非痛苦患者健康的意愿之间的冲突，将在未来几年内在机构伦理委员会、专业纪律论坛和法院中显现出来。本文为寻求缩短深度痴呆症不必要的困境的预先指示的法律和道德地位辩护。
