Advance Directive as Ulysses Contract: The Application of Stopping of Eating and Drinking by Advance Directive.

Increased attention is being paid to "dementia directives," advance directives tailored to persons with dementia that outline what treatments an individual with dementia might wish to receive or forgo should they lose capacity. Particular focus has been placed on the request to have assisted oral feedings withheld, the so-called Stopping of Eating and Drinking by Advance Directive (SED by AD), the purpose of which is to hasten death. This article reviews the available literature regarding the practice of SED by AD and explores the clinical and ethical aspects as they present at the bedside.

Speech-Language Pathologists' Views About Aspiration Risk and Comfort Feeding in Advanced Dementia.

Background: Speech-language pathologists (SLPs) are often called upon to assess swallowing function for older adults with advanced dementia at high risk of aspiration and make recommendations about whether the patient can safely continue oral nutrition.

Objective: To describe the circumstances under which SLPs recommend oral nutritional intake for these patients.

Methods: A mail survey of a national probability sample of SLPs (n = 731).

Tube feeding in patients with advanced dementia: knowledge and practice of speech-language pathologists.

Context: Speech-language pathologists (SLP) are often called on to evaluate eating difficulties in patients with dementia.

Objectives: To assess factors associated with SLPs' knowledge and recommendations about feeding tubes in patients with advanced dementia.

Methods: A mail survey was administered to a probability sample of 1500 SLPs from the American Speech-Language-Hearing Association mailing list; 731 usable surveys were received (response rate=53.

Tube feeding in advanced dementia: an exploratory survey of physician knowledge.

The administration of artificial nutrition by means of a percutaneous endoscopic gastrostomy (PEG) tube in older persons in the advanced stages of dementia is commonplace, yet the treatment is associated with significant treatment burdens and unclear benefits in this population. In addition, there is wide and unexplained geographic variability in the use of PEG in advanced dementia, which may stem partly from physicians' lack of understanding about its indications, risks, benefits, and effect on quality of life in advanced dementia. This study was a mail survey undertaken to assess physician knowledge regarding tube feeding in advanced dementia and explore whether certification in geriatrics or other physician characteristics are associated with physician knowledge.

Refusing artificial nutrition and hydration: does statutory law send the wrong message?

Ethical consensus and appellate court decisions view artificial nutrition and hydration (ANH) as medical treatment that can be refused like other treatments. However, advance directive statutes may produce obstacles for refusal of ANH, as distinct from other life-sustaining treatments, in patients who lack capacity. This paper reviews state statutes and appellate case law regarding medical decision making for patients who lack decisional capacity.