PURPOSE OF REVIEW I review ethical and legal challenges for end of life (EOL) care in dementia. Is access to hospice care for dementia patients impacted by Medicare's terminal prognosis requirement? Are dementia-specific advance directives warranted? How does state legislation affect dementia patients' EOL options? Should dementia patients' be able to refuse orally ingested food and fluids by advance directive? RECENT FINDINGS The difficulty of predicting time to death in dementia inhibits access to Medicare hospice benefits. Efforts have been made to create dementia-specific advance directives. Advance refusal of artificial nutrition and hydration are common, but the issue of oral ingestion of food and fluids by dementia patients remains controversial. Medicare's hospice benefit should be made more accessible to dementia patients. State advance directive threshold definitions should be broadened to include dementia, and capacitated persons who refuse in advance orally ingested food and fluids should have their choices honored.

中文翻译：

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痴呆和生命终结中的医学伦理问题。

复习目的我复习痴呆症临终关怀（EOL）的伦理和法律挑战。Medicare的最终预后要求是否会影响痴呆患者的临终关怀服务？是否需要针对痴呆症的预先医疗指示？州立法如何影响痴呆患者的停产期选择？痴呆症患者是否应该能够按照预先指示拒绝口服食物和液体？最近的发现难以预测痴呆症的死亡时间会阻碍人们享受Medicare临终关怀福利。已经做出努力来创建针对痴呆症的提前指示。提前拒绝人工营养和水合作用很普遍，但是痴呆症患者口服食物和液体的摄入仍存在争议。老年痴呆症患者应更容易获得Medicare的临终关怀福利。