Commentary: Can an effective end-of-life intervention for advanced dementia be viewed as moral?

IF 4 Q1 CLINICAL NEUROLOGY

Alzheimer''s and Dementia: Diagnosis, Assessment and Disease Monitoring Pub Date : 2024-03-15 eCollection Date: 2024-01-01 DOI:10.1002/dad2.12531

Trijntje M Scheeres-Feitsma, Petruschka Schaafsma, Jenny T van der Steen, Johannes J M van Delden

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引用次数: 0

Abstract

We comment on Dr. Terman's considerations on the moral justification of ceasing assisted feeding and hydration for people with advanced dementia. The core idea of his paper is that an advance directive can solve future dilemmas regarding assisted feeding. We submit that this static instrument is unfit for the complex and dynamic nature of assessing how to deal with refusals to eat, in particular for people with dementia. It overvalues the past in relation to the present situation and leaves no room for the possibility of changing wishes. Moreover, the perspectives of professional caregivers and families are not addressed because the focus is entirely on individual autonomy in early dementia. Multiple perspectives should be considered in interpreting directives and the actual situation in light of the patient's view of life in order to realistically account for what is morally justifiable in care in advanced dementia.

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评论：针对晚期痴呆症的有效临终干预能被视为道德行为吗？

我们对特曼医生关于停止对晚期痴呆症患者进行辅助喂食和水合治疗的道德理由的思考进行了评论。他论文的核心观点是，预先指令可以解决未来有关辅助喂食的困境。我们认为，这种静态工具不适合评估如何处理拒绝进食问题的复杂性和动态性，尤其是对痴呆症患者而言。它高估了过去与当前情况的关系，没有为改变愿望的可能性留有余地。此外，由于重点完全放在早期痴呆症患者的个人自主性上，因此没有涉及专业护理人员和家人的观点。在根据患者的生命观解释指令和实际情况时，应考虑多角度因素，以现实的方式说明晚期痴呆症患者的护理在道义上的合理性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Alzheimer''s and Dementia: Diagnosis, Assessment and Disease Monitoring Medicine-Psychiatry and Mental Health

CiteScore

7.80

自引率

7.50%

发文量

101

审稿时长

8 weeks

期刊介绍： Alzheimer''s & Dementia: Diagnosis, Assessment & Disease Monitoring (DADM) is an open access, peer-reviewed, journal from the Alzheimer''s Association® that will publish new research that reports the discovery, development and validation of instruments, technologies, algorithms, and innovative processes. Papers will cover a range of topics interested in the early and accurate detection of individuals with memory complaints and/or among asymptomatic individuals at elevated risk for various forms of memory disorders. The expectation for published papers will be to translate fundamental knowledge about the neurobiology of the disease into practical reports that describe both the conceptual and methodological aspects of the submitted scientific inquiry. Published topics will explore the development of biomarkers, surrogate markers, and conceptual/methodological challenges. Publication priority will be given to papers that 1) describe putative surrogate markers that accurately track disease progression, 2) biomarkers that fulfill international regulatory requirements, 3) reports from large, well-characterized population-based cohorts that comprise the heterogeneity and diversity of asymptomatic individuals and 4) algorithmic development that considers multi-marker arrays (e.g., integrated-omics, genetics, biofluids, imaging, etc.) and advanced computational analytics and technologies.