Treading into ethically and legally uncertain territory, a New York end-of-life agency has approved a new document that lets people stipulate in advance that they don't want food or water if they develop severe dementia.
The directive, finalized this month by the board for End Of Life Choices New York, aims to provide patients a way to hasten death in late-stage dementia, if they choose.
Dementia is a terminal illness, but even in the seven U.S. jurisdictions that allow medical aid-in-dying, it's not a condition covered by the laws. Increasingly, patients are seeking other options, says Dr. Timothy Quill, a palliative care specialist at the University of Rochester School of Medicine and longtime advocate of medical aid-in-dying.
"Developing incapacitating dementia is certainly my and a lot of people's worst nightmare," he says. "This is an aggressive document. It's a way of addressing a real problem — the prospect of advanced dementia."
The document offers two options. One option is a request for "comfort feeding" — providing oral food and water if a patient appears to enjoy or allows it during the final stages of the disease. Another alternative would halt all assisted eating and drinking, even if a patient seems willing to accept it.
But critics say it's a disturbing effort to allow withdrawal of basic sustenance from the most vulnerable in society.
"I think oral feeding is basic care," says Richard Doerflinger, an associate scholar with the Charlotte Lozier Institute, which opposes abortion and euthanasia. "It's what they want here and now that matters. If they start taking food, you give them food."