Advanced dementia is especially challenging.
People living with advanced dementia cannot speak for themselves. They cannot tell others what treatments they want or do not want. The reason is that dementia has caused them to lose mental capacity to make medical decisions and to be unable to speak clearly. This usually happens years before they reach advanced dementia.
Traditional living wills that refuse only high-tech medical treatment may not help since advanced dementia patients may have “No plug to pull.”
If caregivers assist with spoon-feeding and spoon-hydrating, dying with suffering can be prolonged. Worse, suffering can increase but not be detected or treated.
But every competent adult has the right to refuse any invasive treatment, especially if the treatment will prolong their dying with suffering.
"Natural Dying" (ND) is a "treatment of last resort." It offers one way to have a timely and peaceful dying that is legal, ethical, and can be considered moral. It refuses assisted oral feeding and hydrating, although food and fluid are always put within patients’ reach. ND is only for patients whose suffering is severe.
Some people living with advanced dementia (PLADs) present a challenge in addition to “No plug to pull”: they can still eat and drink independently. Newer “dementia-specific” living wills that rely on refusing assisted feeding/hydrating cannot reduce how much or how long they will suffer.
Before continuing, consider the goal depicted below, and optionally, tell us as much as you want about you (which will be kept confidential and used only for your advance care planning).