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Medical Ethics Issues in Dementia and End of Life

  • Geriatric Disorders (JA Cheong, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

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.

Summary

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.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville, FL, 32610, USA

    William Allen

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  1. William Allen
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Correspondence to William Allen.

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Allen, W. Medical Ethics Issues in Dementia and End of Life. Curr Psychiatry Rep 22, 31 (2020). https://doi.org/10.1007/s11920-020-01150-7

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