Voluntarily Stopping Eating and Drinking
A Compassionate, Widely-Available Option for Hastening Death
Herausgeber: Quill, Timothy E; Schwarz, Judith K; Pope, Thaddeus; Menzel, Paul T
Voluntarily Stopping Eating and Drinking
A Compassionate, Widely-Available Option for Hastening Death
Herausgeber: Quill, Timothy E; Schwarz, Judith K; Pope, Thaddeus; Menzel, Paul T
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Many people who are experiencing unacceptable suffering or deterioration in the present, or who fear them in the near future, do not know their full range of options to hasten death. This is particularly true if they live in jurisdictions that do not allow a physician assisted death - over forty jurisdictions in the U.S. and most countries across the world. Though VSED is readily available, and not illegal, most people are unaware of it as an option. The information in this book is vital to those considering their options either hypothetically or in real time, providing an integrated,…mehr
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Many people who are experiencing unacceptable suffering or deterioration in the present, or who fear them in the near future, do not know their full range of options to hasten death. This is particularly true if they live in jurisdictions that do not allow a physician assisted death - over forty jurisdictions in the U.S. and most countries across the world. Though VSED is readily available, and not illegal, most people are unaware of it as an option. The information in this book is vital to those considering their options either hypothetically or in real time, providing an integrated, balanced, and nuanced exploration of VSED with contributions from legal, medical, and ethical experts.
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Hinweis: Dieser Artikel kann nur an eine deutsche Lieferadresse ausgeliefert werden.
Produktdetails
- Produktdetails
- Verlag: Hurst & Co.
- Seitenzahl: 312
- Erscheinungstermin: 10. August 2021
- Englisch
- Abmessung: 243mm x 167mm x 25mm
- Gewicht: 579g
- ISBN-13: 9780190080730
- ISBN-10: 0190080736
- Artikelnr.: 61856594
- Herstellerkennzeichnung
- Libri GmbH
- Europaallee 1
- 36244 Bad Hersfeld
- gpsr@libri.de
- Verlag: Hurst & Co.
- Seitenzahl: 312
- Erscheinungstermin: 10. August 2021
- Englisch
- Abmessung: 243mm x 167mm x 25mm
- Gewicht: 579g
- ISBN-13: 9780190080730
- ISBN-10: 0190080736
- Artikelnr.: 61856594
- Herstellerkennzeichnung
- Libri GmbH
- Europaallee 1
- 36244 Bad Hersfeld
- gpsr@libri.de
Timothy E. Quill, MD is Professor of Medicine, Psychiatry, Medical Humanities and Nursing at the University of Rochester Medical Center (URMC). He was Past President of the American Academy of Hospice and Palliative Medicine, the Founding Director of the URMC Palliative Care Program, and the initial Director of the URMC Schyve Center for Biomedical Ethics. Dr. Quill is the author of "Death with Dignity: A Case of Individualized Decision Making" (1991) in the New England Journal of Medicine, and he was the lead physician plaintiff in the New York legal case challenging the law prohibiting physician-assisted death heard in 1997 by the U.S. Supreme Court (Quill v. Vacco). He is the author of 8 books and over 150 peer reviewed articles on various aspects of palliative care, hospice, primary care, medical ethics, and end-of-life policy. Paul T. Menzel, PhD is Professor of Philosophy emeritus, Pacific Lutheran University. He has published widely on moral questions in health economics and health policy, including Strong Medicine: The Ethical Rationing of Health Care (OUP, 1990), and (as co-editor) Prevention vs. Treatment: What's the Right Balance? (OUP, 2011). He has been a visiting scholar at Kennedy Institute of Ethics, Rockefeller Center-Bellagio, Brocher Foundation, Chinese University of Hong Kong, and Monash University. He is a member of the Advisory Board of The Completed Life Initiative and serves on The Hastings Center's work group for its project on Dementia and the Ethics of Choosing When to Die. Thaddeus M. Pope, JD, PhD, HEC-C is Professor of Law at Mitchell Hamline School of Law in Saint Paul, Minnesota. A foremost expert on medical law and clinical ethics, he maintains a special focus on patient rights and healthcare decision-making. Ranked among the Top 20 most cited health law scholars in the United States, Professor Pope has over 225 publications in leading medical journals, bioethics journals, and law reviews. He co-authors the definitive treatise The Right to Die: The Law of End-of-Life Decisionmaking (Wolters Kluwer, 2020), and he runs the Medical Futility Blog (with over four million page-views). Prior to joining academia, he practiced at Arnold & Porter and clerked on the U.S. Court of Appeals for the Seventh Circuit. Judith K. Schwarz, PhD, RN is the Clinical Director of End of Life Choices, New York. She has for many years provided end-of-life consultation to New Yorkers and callers from other states who seek information about options and choices that permit personal control of the circumstances and timing of death. In addition to publishing in nursing and ethics journals, she provides frequent lectures about end of life decision making to lay and professional audiences. Working with legal and palliative care colleagues, she developed the End of Life Choices New York Dementia Directive which has been completed by hundreds of New Yorkers.
* Foreword
* Preface
* Acknowledgments
* Contributors
* Introduction
* Part I. Voluntarily Stopping Eating and Drinking (VSED) by People
with Decision-Making Capacity
* 1. Illustrative Cases
* 1.1 Al (Amyotrophic Lateral Sclerosis): Looking for Options to Hasten
Death
* 1.2 Bill (Breast Cancer): Preference for Medical Aid in Dying
* 1.3 Mrs. H. (Early Alzheimer's Disease): How Best to Time VSED
* 1.4 G.W. (Lung Cancer): Family and Staff Conflict
* 2. Clinical Issues
* 2.1 Background Issues-Palliative Care and Hospice
* 2.2. Background Issues-Unacceptable Suffering and Deterioration
* 2.3 Evaluation of Requests for VSED
* 2.4 VSED-Key Practical Matters to Consider in Advance
* 2.5 Requirements to Initiate VSED for Patients with Decision-Making
Capacity
* 2.6 Formal Advance Care Planning
* 2.7 Managing Symptoms and Complications Once VSED Is Initiated
* 2.8 Impact of Culture on VSED
* 2.9 Advantages of VSED as an Option to Achieve a Desired Death
* 2.10 Disadvantages and Challenges of VSED as an Option to Achieve a
Desired Death
* 2.11 Revisiting the Initial Cases
* 3. Ethical Issues
* 3.1 Introduction
* 3.2 Refusing Lifesaving Treatment
* 3.3 Suicide
* 3.4 A Different Comparison: Medical Aid in Dying
* 3.5 Information, Encouragement, Persuasion
* 3.6 Conclusions
* 3.7 Ethical Issues Review of Initial Cases
* 4. Legal Issues
* 4.1 Introduction
* 4.2 VSED Is Widely Perceived to Be Legal
* 4.3 A Patient's Right to VSED Is Settled Law
* 4.4 Right to Refuse Includes the Right to VSED
* 4.5 Assisted Suicide Laws Generally Do Not Apply
* 4.6 Abuse and Neglect Laws Generally Do Not Apply
* 4.7 Other Issues for Patients and Families-Life Insurance
* 4.8 Other Issues for Clinicians-Informed Consent
* 4.9 Other Issues for Clinicians-Conscience- Based Objections
* 4.1 Revisiting the Initial Cases
* 5. Institutional Issues
* 5.1 Introduction
* 5.2 Published Data on Patient Experience of VSED in Institutional
Settings
* 5.3 Institutional Barriers to VSED
* 5.4 Variations in State Laws around Resident Rights
* 5.5 Role of Hospice in Buffering Conflicts Between Interests of
Resident and LTC Facility
* 5.6 Approach to Care of Persons Requesting VSED in Institutional
Settings
* 5.7 Specific Care Issues for Residents Who VSED in Institutional
Settings
* 5.8 Moral Distress and Conscience-Based Objections
* 5.9 Conclusion-Institutional Care Issues
* 5.10 Case Comments from an Institutional Perspective
* 6. Best Practices, Enduring Challenges, and Opportunities for VSED
* 6.1 Best Practices
* 6.2 Enduring Challenges
* 6.3 Opportunities
* Part II. Stopping Eating and Drinking by Advance Directive (SED by
AD) for Persons Without Decision-Making Capacity
* 7. Illustrative Cases
* 7.1 Mrs. H. (Early Alzheimer's): Speculation about the Challenge of
Waiting
* 7.2 Steve (Early Dementia): Patient and Family Challenges
* 7.3 Patricia (Moderate Dementia): Hastening Death by SED versus
Preemptive Suicide
* 7.4 Charles (Severe Dementia): No Assistance with Oral Feeding
* 8. Clinical Issues
* 8.1. General Approach When Capacity Is Lost
* 8.2. Background Issues
* 8.3. Advance Care Planning
* 8.4. Practical Aspects of Stopping Eating and Drinking by Advance
Directive (SED by AD) and Comfort Feeding Only (CFO)
* 8.5. Limits of Palliation with Comfort Feeding Only (CFO)
* 8.6. Advantages of SED by AD
* 8.7. Disadvantages of SED by AD
* 8.8. Return to the Cases
* 9. Ethical Issues
* 9.1 Introduction
* 9.2 Change of Mind
* 9.3 Is Feeding Fundamentally Different?
* 9.4 Burdens of Survival on Family and Family Caregivers
* 9.5 Caregiver and Proxy Distress
* 9.6 The Odds of Implementation and the Attraction of Preemptive
Measures
* 9.7 Comparison with Comfort Feeding Only
* 9.8 Conclusions
* 9.9 Ethical Issues Review of Initial Cases
* 10. Legal Issues
* 10.1 Introduction
* 10.2 There Is Little On-Point Precedent
* 10.3 Draft the Advance Directive Carefully
* 10.4 Non-Statutory Advance Directives Potentially Allow SED by AD
* 10.5 Some Advance Directive Statutes Permit SED by AD
* 10.6 Many Advance Directive Statutes Require Triggering Conditions
* 10.7 Circumventing Home State Law with Reciprocity Rules
* 10.8 Inadvertent Revocations and Vetoes
* 10.9 Ulysses Clauses May Solve the Incapacitated Revocation Problem
* 10.10 Appointed Health Care Agents
* 10.11 Default Surrogates and Guardians
* 10.12 Conscience Based Objection
* 10.13 Conclusion
* 10.14 Return to the Cases
* 11. Institutional Issues
* 11.1. Introduction
* 11.2. "Dementia Worry" Is Common in Older Adults
* 11.3. Challenges of SED by AD in Advanced Dementia Are Most Apt to
Manifest in Institutional LTC Settings
* 11.4. Resistance to Implementation of Dementia Directives Limiting
Oral Nutrition and Hydration in LTC Settings
* 11.5. Ethical Rationale for Dementia Directives Limiting Oral
Nutrition and Hydration in LTC Settings
* 11.6. Conclusion-ADs for SED in Institutional LTC Settings
* 11.7. Case Comments from an Institutional Perspective
* 12. Best Practices, Enduring Challenges, and Opportunities for SED by
AD
* 12.1 Best Practices
* 12.2 Enduring Challenges
* 12.3 Opportunities
* Appendices
* A. Recommended Elements of an Advance Directive for Stopping Eating
and Drinking (AD for SED)
* B. Sample Advance Directives for SED
* C. Cause of Death on Death Certificates with VSED or SED by AD
* D. Position Statements and Clinical Guidance
* E. Personal Narratives
* F. Glossary
* Index
* Preface
* Acknowledgments
* Contributors
* Introduction
* Part I. Voluntarily Stopping Eating and Drinking (VSED) by People
with Decision-Making Capacity
* 1. Illustrative Cases
* 1.1 Al (Amyotrophic Lateral Sclerosis): Looking for Options to Hasten
Death
* 1.2 Bill (Breast Cancer): Preference for Medical Aid in Dying
* 1.3 Mrs. H. (Early Alzheimer's Disease): How Best to Time VSED
* 1.4 G.W. (Lung Cancer): Family and Staff Conflict
* 2. Clinical Issues
* 2.1 Background Issues-Palliative Care and Hospice
* 2.2. Background Issues-Unacceptable Suffering and Deterioration
* 2.3 Evaluation of Requests for VSED
* 2.4 VSED-Key Practical Matters to Consider in Advance
* 2.5 Requirements to Initiate VSED for Patients with Decision-Making
Capacity
* 2.6 Formal Advance Care Planning
* 2.7 Managing Symptoms and Complications Once VSED Is Initiated
* 2.8 Impact of Culture on VSED
* 2.9 Advantages of VSED as an Option to Achieve a Desired Death
* 2.10 Disadvantages and Challenges of VSED as an Option to Achieve a
Desired Death
* 2.11 Revisiting the Initial Cases
* 3. Ethical Issues
* 3.1 Introduction
* 3.2 Refusing Lifesaving Treatment
* 3.3 Suicide
* 3.4 A Different Comparison: Medical Aid in Dying
* 3.5 Information, Encouragement, Persuasion
* 3.6 Conclusions
* 3.7 Ethical Issues Review of Initial Cases
* 4. Legal Issues
* 4.1 Introduction
* 4.2 VSED Is Widely Perceived to Be Legal
* 4.3 A Patient's Right to VSED Is Settled Law
* 4.4 Right to Refuse Includes the Right to VSED
* 4.5 Assisted Suicide Laws Generally Do Not Apply
* 4.6 Abuse and Neglect Laws Generally Do Not Apply
* 4.7 Other Issues for Patients and Families-Life Insurance
* 4.8 Other Issues for Clinicians-Informed Consent
* 4.9 Other Issues for Clinicians-Conscience- Based Objections
* 4.1 Revisiting the Initial Cases
* 5. Institutional Issues
* 5.1 Introduction
* 5.2 Published Data on Patient Experience of VSED in Institutional
Settings
* 5.3 Institutional Barriers to VSED
* 5.4 Variations in State Laws around Resident Rights
* 5.5 Role of Hospice in Buffering Conflicts Between Interests of
Resident and LTC Facility
* 5.6 Approach to Care of Persons Requesting VSED in Institutional
Settings
* 5.7 Specific Care Issues for Residents Who VSED in Institutional
Settings
* 5.8 Moral Distress and Conscience-Based Objections
* 5.9 Conclusion-Institutional Care Issues
* 5.10 Case Comments from an Institutional Perspective
* 6. Best Practices, Enduring Challenges, and Opportunities for VSED
* 6.1 Best Practices
* 6.2 Enduring Challenges
* 6.3 Opportunities
* Part II. Stopping Eating and Drinking by Advance Directive (SED by
AD) for Persons Without Decision-Making Capacity
* 7. Illustrative Cases
* 7.1 Mrs. H. (Early Alzheimer's): Speculation about the Challenge of
Waiting
* 7.2 Steve (Early Dementia): Patient and Family Challenges
* 7.3 Patricia (Moderate Dementia): Hastening Death by SED versus
Preemptive Suicide
* 7.4 Charles (Severe Dementia): No Assistance with Oral Feeding
* 8. Clinical Issues
* 8.1. General Approach When Capacity Is Lost
* 8.2. Background Issues
* 8.3. Advance Care Planning
* 8.4. Practical Aspects of Stopping Eating and Drinking by Advance
Directive (SED by AD) and Comfort Feeding Only (CFO)
* 8.5. Limits of Palliation with Comfort Feeding Only (CFO)
* 8.6. Advantages of SED by AD
* 8.7. Disadvantages of SED by AD
* 8.8. Return to the Cases
* 9. Ethical Issues
* 9.1 Introduction
* 9.2 Change of Mind
* 9.3 Is Feeding Fundamentally Different?
* 9.4 Burdens of Survival on Family and Family Caregivers
* 9.5 Caregiver and Proxy Distress
* 9.6 The Odds of Implementation and the Attraction of Preemptive
Measures
* 9.7 Comparison with Comfort Feeding Only
* 9.8 Conclusions
* 9.9 Ethical Issues Review of Initial Cases
* 10. Legal Issues
* 10.1 Introduction
* 10.2 There Is Little On-Point Precedent
* 10.3 Draft the Advance Directive Carefully
* 10.4 Non-Statutory Advance Directives Potentially Allow SED by AD
* 10.5 Some Advance Directive Statutes Permit SED by AD
* 10.6 Many Advance Directive Statutes Require Triggering Conditions
* 10.7 Circumventing Home State Law with Reciprocity Rules
* 10.8 Inadvertent Revocations and Vetoes
* 10.9 Ulysses Clauses May Solve the Incapacitated Revocation Problem
* 10.10 Appointed Health Care Agents
* 10.11 Default Surrogates and Guardians
* 10.12 Conscience Based Objection
* 10.13 Conclusion
* 10.14 Return to the Cases
* 11. Institutional Issues
* 11.1. Introduction
* 11.2. "Dementia Worry" Is Common in Older Adults
* 11.3. Challenges of SED by AD in Advanced Dementia Are Most Apt to
Manifest in Institutional LTC Settings
* 11.4. Resistance to Implementation of Dementia Directives Limiting
Oral Nutrition and Hydration in LTC Settings
* 11.5. Ethical Rationale for Dementia Directives Limiting Oral
Nutrition and Hydration in LTC Settings
* 11.6. Conclusion-ADs for SED in Institutional LTC Settings
* 11.7. Case Comments from an Institutional Perspective
* 12. Best Practices, Enduring Challenges, and Opportunities for SED by
AD
* 12.1 Best Practices
* 12.2 Enduring Challenges
* 12.3 Opportunities
* Appendices
* A. Recommended Elements of an Advance Directive for Stopping Eating
and Drinking (AD for SED)
* B. Sample Advance Directives for SED
* C. Cause of Death on Death Certificates with VSED or SED by AD
* D. Position Statements and Clinical Guidance
* E. Personal Narratives
* F. Glossary
* Index
* Foreword
* Preface
* Acknowledgments
* Contributors
* Introduction
* Part I. Voluntarily Stopping Eating and Drinking (VSED) by People
with Decision-Making Capacity
* 1. Illustrative Cases
* 1.1 Al (Amyotrophic Lateral Sclerosis): Looking for Options to Hasten
Death
* 1.2 Bill (Breast Cancer): Preference for Medical Aid in Dying
* 1.3 Mrs. H. (Early Alzheimer's Disease): How Best to Time VSED
* 1.4 G.W. (Lung Cancer): Family and Staff Conflict
* 2. Clinical Issues
* 2.1 Background Issues-Palliative Care and Hospice
* 2.2. Background Issues-Unacceptable Suffering and Deterioration
* 2.3 Evaluation of Requests for VSED
* 2.4 VSED-Key Practical Matters to Consider in Advance
* 2.5 Requirements to Initiate VSED for Patients with Decision-Making
Capacity
* 2.6 Formal Advance Care Planning
* 2.7 Managing Symptoms and Complications Once VSED Is Initiated
* 2.8 Impact of Culture on VSED
* 2.9 Advantages of VSED as an Option to Achieve a Desired Death
* 2.10 Disadvantages and Challenges of VSED as an Option to Achieve a
Desired Death
* 2.11 Revisiting the Initial Cases
* 3. Ethical Issues
* 3.1 Introduction
* 3.2 Refusing Lifesaving Treatment
* 3.3 Suicide
* 3.4 A Different Comparison: Medical Aid in Dying
* 3.5 Information, Encouragement, Persuasion
* 3.6 Conclusions
* 3.7 Ethical Issues Review of Initial Cases
* 4. Legal Issues
* 4.1 Introduction
* 4.2 VSED Is Widely Perceived to Be Legal
* 4.3 A Patient's Right to VSED Is Settled Law
* 4.4 Right to Refuse Includes the Right to VSED
* 4.5 Assisted Suicide Laws Generally Do Not Apply
* 4.6 Abuse and Neglect Laws Generally Do Not Apply
* 4.7 Other Issues for Patients and Families-Life Insurance
* 4.8 Other Issues for Clinicians-Informed Consent
* 4.9 Other Issues for Clinicians-Conscience- Based Objections
* 4.1 Revisiting the Initial Cases
* 5. Institutional Issues
* 5.1 Introduction
* 5.2 Published Data on Patient Experience of VSED in Institutional
Settings
* 5.3 Institutional Barriers to VSED
* 5.4 Variations in State Laws around Resident Rights
* 5.5 Role of Hospice in Buffering Conflicts Between Interests of
Resident and LTC Facility
* 5.6 Approach to Care of Persons Requesting VSED in Institutional
Settings
* 5.7 Specific Care Issues for Residents Who VSED in Institutional
Settings
* 5.8 Moral Distress and Conscience-Based Objections
* 5.9 Conclusion-Institutional Care Issues
* 5.10 Case Comments from an Institutional Perspective
* 6. Best Practices, Enduring Challenges, and Opportunities for VSED
* 6.1 Best Practices
* 6.2 Enduring Challenges
* 6.3 Opportunities
* Part II. Stopping Eating and Drinking by Advance Directive (SED by
AD) for Persons Without Decision-Making Capacity
* 7. Illustrative Cases
* 7.1 Mrs. H. (Early Alzheimer's): Speculation about the Challenge of
Waiting
* 7.2 Steve (Early Dementia): Patient and Family Challenges
* 7.3 Patricia (Moderate Dementia): Hastening Death by SED versus
Preemptive Suicide
* 7.4 Charles (Severe Dementia): No Assistance with Oral Feeding
* 8. Clinical Issues
* 8.1. General Approach When Capacity Is Lost
* 8.2. Background Issues
* 8.3. Advance Care Planning
* 8.4. Practical Aspects of Stopping Eating and Drinking by Advance
Directive (SED by AD) and Comfort Feeding Only (CFO)
* 8.5. Limits of Palliation with Comfort Feeding Only (CFO)
* 8.6. Advantages of SED by AD
* 8.7. Disadvantages of SED by AD
* 8.8. Return to the Cases
* 9. Ethical Issues
* 9.1 Introduction
* 9.2 Change of Mind
* 9.3 Is Feeding Fundamentally Different?
* 9.4 Burdens of Survival on Family and Family Caregivers
* 9.5 Caregiver and Proxy Distress
* 9.6 The Odds of Implementation and the Attraction of Preemptive
Measures
* 9.7 Comparison with Comfort Feeding Only
* 9.8 Conclusions
* 9.9 Ethical Issues Review of Initial Cases
* 10. Legal Issues
* 10.1 Introduction
* 10.2 There Is Little On-Point Precedent
* 10.3 Draft the Advance Directive Carefully
* 10.4 Non-Statutory Advance Directives Potentially Allow SED by AD
* 10.5 Some Advance Directive Statutes Permit SED by AD
* 10.6 Many Advance Directive Statutes Require Triggering Conditions
* 10.7 Circumventing Home State Law with Reciprocity Rules
* 10.8 Inadvertent Revocations and Vetoes
* 10.9 Ulysses Clauses May Solve the Incapacitated Revocation Problem
* 10.10 Appointed Health Care Agents
* 10.11 Default Surrogates and Guardians
* 10.12 Conscience Based Objection
* 10.13 Conclusion
* 10.14 Return to the Cases
* 11. Institutional Issues
* 11.1. Introduction
* 11.2. "Dementia Worry" Is Common in Older Adults
* 11.3. Challenges of SED by AD in Advanced Dementia Are Most Apt to
Manifest in Institutional LTC Settings
* 11.4. Resistance to Implementation of Dementia Directives Limiting
Oral Nutrition and Hydration in LTC Settings
* 11.5. Ethical Rationale for Dementia Directives Limiting Oral
Nutrition and Hydration in LTC Settings
* 11.6. Conclusion-ADs for SED in Institutional LTC Settings
* 11.7. Case Comments from an Institutional Perspective
* 12. Best Practices, Enduring Challenges, and Opportunities for SED by
AD
* 12.1 Best Practices
* 12.2 Enduring Challenges
* 12.3 Opportunities
* Appendices
* A. Recommended Elements of an Advance Directive for Stopping Eating
and Drinking (AD for SED)
* B. Sample Advance Directives for SED
* C. Cause of Death on Death Certificates with VSED or SED by AD
* D. Position Statements and Clinical Guidance
* E. Personal Narratives
* F. Glossary
* Index
* Preface
* Acknowledgments
* Contributors
* Introduction
* Part I. Voluntarily Stopping Eating and Drinking (VSED) by People
with Decision-Making Capacity
* 1. Illustrative Cases
* 1.1 Al (Amyotrophic Lateral Sclerosis): Looking for Options to Hasten
Death
* 1.2 Bill (Breast Cancer): Preference for Medical Aid in Dying
* 1.3 Mrs. H. (Early Alzheimer's Disease): How Best to Time VSED
* 1.4 G.W. (Lung Cancer): Family and Staff Conflict
* 2. Clinical Issues
* 2.1 Background Issues-Palliative Care and Hospice
* 2.2. Background Issues-Unacceptable Suffering and Deterioration
* 2.3 Evaluation of Requests for VSED
* 2.4 VSED-Key Practical Matters to Consider in Advance
* 2.5 Requirements to Initiate VSED for Patients with Decision-Making
Capacity
* 2.6 Formal Advance Care Planning
* 2.7 Managing Symptoms and Complications Once VSED Is Initiated
* 2.8 Impact of Culture on VSED
* 2.9 Advantages of VSED as an Option to Achieve a Desired Death
* 2.10 Disadvantages and Challenges of VSED as an Option to Achieve a
Desired Death
* 2.11 Revisiting the Initial Cases
* 3. Ethical Issues
* 3.1 Introduction
* 3.2 Refusing Lifesaving Treatment
* 3.3 Suicide
* 3.4 A Different Comparison: Medical Aid in Dying
* 3.5 Information, Encouragement, Persuasion
* 3.6 Conclusions
* 3.7 Ethical Issues Review of Initial Cases
* 4. Legal Issues
* 4.1 Introduction
* 4.2 VSED Is Widely Perceived to Be Legal
* 4.3 A Patient's Right to VSED Is Settled Law
* 4.4 Right to Refuse Includes the Right to VSED
* 4.5 Assisted Suicide Laws Generally Do Not Apply
* 4.6 Abuse and Neglect Laws Generally Do Not Apply
* 4.7 Other Issues for Patients and Families-Life Insurance
* 4.8 Other Issues for Clinicians-Informed Consent
* 4.9 Other Issues for Clinicians-Conscience- Based Objections
* 4.1 Revisiting the Initial Cases
* 5. Institutional Issues
* 5.1 Introduction
* 5.2 Published Data on Patient Experience of VSED in Institutional
Settings
* 5.3 Institutional Barriers to VSED
* 5.4 Variations in State Laws around Resident Rights
* 5.5 Role of Hospice in Buffering Conflicts Between Interests of
Resident and LTC Facility
* 5.6 Approach to Care of Persons Requesting VSED in Institutional
Settings
* 5.7 Specific Care Issues for Residents Who VSED in Institutional
Settings
* 5.8 Moral Distress and Conscience-Based Objections
* 5.9 Conclusion-Institutional Care Issues
* 5.10 Case Comments from an Institutional Perspective
* 6. Best Practices, Enduring Challenges, and Opportunities for VSED
* 6.1 Best Practices
* 6.2 Enduring Challenges
* 6.3 Opportunities
* Part II. Stopping Eating and Drinking by Advance Directive (SED by
AD) for Persons Without Decision-Making Capacity
* 7. Illustrative Cases
* 7.1 Mrs. H. (Early Alzheimer's): Speculation about the Challenge of
Waiting
* 7.2 Steve (Early Dementia): Patient and Family Challenges
* 7.3 Patricia (Moderate Dementia): Hastening Death by SED versus
Preemptive Suicide
* 7.4 Charles (Severe Dementia): No Assistance with Oral Feeding
* 8. Clinical Issues
* 8.1. General Approach When Capacity Is Lost
* 8.2. Background Issues
* 8.3. Advance Care Planning
* 8.4. Practical Aspects of Stopping Eating and Drinking by Advance
Directive (SED by AD) and Comfort Feeding Only (CFO)
* 8.5. Limits of Palliation with Comfort Feeding Only (CFO)
* 8.6. Advantages of SED by AD
* 8.7. Disadvantages of SED by AD
* 8.8. Return to the Cases
* 9. Ethical Issues
* 9.1 Introduction
* 9.2 Change of Mind
* 9.3 Is Feeding Fundamentally Different?
* 9.4 Burdens of Survival on Family and Family Caregivers
* 9.5 Caregiver and Proxy Distress
* 9.6 The Odds of Implementation and the Attraction of Preemptive
Measures
* 9.7 Comparison with Comfort Feeding Only
* 9.8 Conclusions
* 9.9 Ethical Issues Review of Initial Cases
* 10. Legal Issues
* 10.1 Introduction
* 10.2 There Is Little On-Point Precedent
* 10.3 Draft the Advance Directive Carefully
* 10.4 Non-Statutory Advance Directives Potentially Allow SED by AD
* 10.5 Some Advance Directive Statutes Permit SED by AD
* 10.6 Many Advance Directive Statutes Require Triggering Conditions
* 10.7 Circumventing Home State Law with Reciprocity Rules
* 10.8 Inadvertent Revocations and Vetoes
* 10.9 Ulysses Clauses May Solve the Incapacitated Revocation Problem
* 10.10 Appointed Health Care Agents
* 10.11 Default Surrogates and Guardians
* 10.12 Conscience Based Objection
* 10.13 Conclusion
* 10.14 Return to the Cases
* 11. Institutional Issues
* 11.1. Introduction
* 11.2. "Dementia Worry" Is Common in Older Adults
* 11.3. Challenges of SED by AD in Advanced Dementia Are Most Apt to
Manifest in Institutional LTC Settings
* 11.4. Resistance to Implementation of Dementia Directives Limiting
Oral Nutrition and Hydration in LTC Settings
* 11.5. Ethical Rationale for Dementia Directives Limiting Oral
Nutrition and Hydration in LTC Settings
* 11.6. Conclusion-ADs for SED in Institutional LTC Settings
* 11.7. Case Comments from an Institutional Perspective
* 12. Best Practices, Enduring Challenges, and Opportunities for SED by
AD
* 12.1 Best Practices
* 12.2 Enduring Challenges
* 12.3 Opportunities
* Appendices
* A. Recommended Elements of an Advance Directive for Stopping Eating
and Drinking (AD for SED)
* B. Sample Advance Directives for SED
* C. Cause of Death on Death Certificates with VSED or SED by AD
* D. Position Statements and Clinical Guidance
* E. Personal Narratives
* F. Glossary
* Index