Terman Stanley A
Caring Advocates Sausalito California USA.
Alzheimers Dement (Amst). 2024 Mar 15;16(1):e12528. doi: 10.1002/dad2.12528. eCollection 2024 Jan-Mar.
Many people dread prolonged dying with suffering in the terminal illness, advanced dementia. To successfully facilitate a timely dying, advance directives must be effective and acceptable. This article considers whether authorities, including treating physicians, can accept as moral, the effective intervention that ceases caregivers' assistance with oral feeding and hydrating. The article presents eight criticisms and "alternate views" regarding ceasing assisted feeding/hydrating. It draws on perspectives from clinical medicine, law, ethics, and religion. The conflict is between (A) people's core beliefs that reflect cultural norms and religious teachings regarding what is moral versus (B) patients' autonomous right of self-determination and claim right to avoid suffering. The article presents each side as strongly as possible. Accepting the intervention as moral could allow patients a peaceful and timely dying from patients' underlying disease. Confidence in future success can deter patients and their surrogates from considering a hastened dying in earlier stages of dementia.
许多人害怕在绝症、晚期痴呆症中痛苦地长期死亡。为了成功地促进适时死亡,预先指示必须有效且可接受。本文探讨包括主治医生在内的权威人士是否能将停止护理人员提供的经口喂食和补液的有效干预视为道德行为。本文提出了关于停止辅助喂食/补液的八项批评和“不同观点”。它借鉴了临床医学、法律、伦理和宗教的观点。冲突存在于(A)反映文化规范和宗教教义中关于道德的核心信念与(B)患者自主的自决权以及避免痛苦的主张权之间。本文尽可能有力地呈现了双方观点。将这种干预视为道德行为可以让患者因潜在疾病而平静、适时地死亡。对未来成功的信心可以阻止患者及其替代决策者在痴呆症早期阶段考虑加速死亡。