Dispelling Medico-Legal Misconceptions Impeding Use of Advance Instructions to Shorten Immersion in Deep Dementia.

Pub Date : 2021-01-01 DOI:10.1080/01947648.2021.1919252
Norman L Cantor
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Abstract

Progressive dementia afflicts millions of people, ultimately entailing precipitous mental decline and years of complete dependence on others. Many people deem the prospect of serious cognitive dysfunction, helplessness, and dependence to be intolerably degrading (as well as overly burdensome on others). To avoid being mired in prolonged dementia, they prefer to hasten death by advance instructions rejecting life-sustaining medical intervention at a point of decline they define as unacceptable.Some health care providers resist implementation of such advance instructions, especially as applied to patients with dementia who are not ostensibly suffering in their demented states and no longer recall their prior instructions and the dignity concerns that underlay them. The clash between advance wishes to hasten death and some health care providers' preference to maintain the well-being of nonsuffering patients will be surfacing, in coming years, in institutional ethics committees, professional disciplinary forums, and the courts. This article defends the legal and moral status of advance instructions seeking to shorten the unwanted limbo of deep dementia.

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消除妨碍使用预先指导缩短深度痴呆患者浸入时间的医疗法律误解。
进行性痴呆症折磨着数百万人,最终导致智力急剧下降,并且多年来完全依赖他人。许多人认为严重的认知功能障碍、无助和依赖的前景是难以忍受的退化(以及对他人的过度负担)。为了避免陷入长期痴呆的泥潭,他们宁愿提前接受指示,在他们认为不可接受的衰退点上拒绝维持生命的医疗干预,从而加速死亡。一些卫生保健提供者拒绝执行这种预先指示,特别是当这些指示适用于痴呆症患者时,这些患者表面上并没有处于痴呆状态,也不再记得他们先前的指示,也不记得它们背后的尊严问题。在未来的几年里,在机构伦理委员会、专业纪律论坛和法庭上,加速死亡的预先愿望与一些医疗服务提供者倾向于维护无痛苦病人的福祉之间的冲突将会浮出水面。这篇文章为寻求缩短深度痴呆的危险状态的预先指示的法律和道德地位进行了辩护。
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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