Society Recommends Comfort Feeding over SED by AD for Residents with Advanced Dementia

November 12, 2019

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emullally@paltc.org

Although most conversations about stopping eating and drinking by advance directives (SED by AD) focus on patient autonomy and the right to determine one’s care, authors of a Society white paper in the November issue of JAMDA said that the ethical principle of justice is the decisive factor in this controversy. They noted: “We also suggest that implementing SED by AD can violate a physician’s obligation to beneficence and non-maleficence.”

The authors of Stopping Eating and Drinking by Advance Directives in Assisted Living and Nursing Homes, referred to discussions on this topic by AMDA – The Society for Post-Acute and Long-Term Care Medicine’s Ethics Subcommittee. They said, “The Society is convinced that no choice can be made here without practicing an injustice: if one refuses to implement SED by AD, one violates the autonomy of the person who drew up the advance directive.” In the end, the Society recommends against implementing SED by AD in residents who still accept food and fluids, implementing instead a policy of comfort feeding for those with advanced dementia.

While many lay people and some clinicians assume that SED by AD is identical to voluntarily stopping eating and drinking (VSED), the authors said, “the [Society] Ethics Subcommittee views the two as significantly different.” In VSED, they clarified, an individual with legal capacity will voluntarily stop all nutrition and hydration. Death generally occurs within several days to a few weeks after discontinuing intake. The authors stressed that SED by AD is not voluntary and that it “always entails stopping food and fluids for a person who is still accepting them.” The legality of VSED has been upheld in state and federal court, they explained, while SED by AD is “more fraught with legal, practical, and ethical complications.”

In summary, the authors said, “The Society affirms the right of all residents to receive comfort feeding until their behaviors indicates refusal or distress. We reject the notion that critical interests should be given more weight than experiential interests on the same grounds.” In addition, they stated, “We insist that staff in the homes in which we work should never be compelled to restrict a person’s access to food, a basic right for every human regardless of their physical or cognitive abilities.”

This paper was written by researchers at the SNF/LTC Partners of Virginia, Richmond, VA; Presbyterian Homes, Evanston, Illinois; Section of Geriatrics, Department of Medicine, NorthShore University Health System, Evanston, Illinois; and University of Rochester, Geriatric Medicine/Palliative Care, Rochester, NY.

Click here for more information on the recommendations above and more details about the paper. To contact the authors or JAMDA editors for an interview, please email emullally@paltc.org.

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About JAMDA

JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit www.jamda.com for more information.

About the Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit www.paltc.org for more information.

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November 17, 2023

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About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit www.paltc.org for more information.

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title Personality Changes Before Cognitive Impairment Aren’t Predictive of Dementia But Have Other Useful Implications

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FOR IMMEDIATE RELEASE: October 25, 2023

Contact: Ellen Mullally
emullally@paltc.org/410-992-3124

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title Personality Changes Before Cognitive Impairment Aren’t Predictive of Dementia But Have Other Useful Implications

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FOR IMMEDIATE RELEASE: October 25, 2023

Contact: Ellen Mullally
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This study was conducted by researchers at Florida State University, Tallahassee, FL; University of Montpellier, Montpellier, France; and Cornell University, Ithaca, NY.

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Wednesday, October 25, 2023

path: https://old.paltc.org/newsroom/personality-changes-cognitive-impairment-aren%E2%80%99t-predictive-dementia-have-other-useful-0

title Screening for EDS Helps Identify Nursing Home Residents At Risk of Adverse Outcomes, Mortality

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FOR IMMEDIATE RELEASE: October 17, 2023

Contact: Ellen Mullally
emullally@paltc.org/410-992-3124

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This study was conducted by researchers at Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, the Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia; and Aged and Extended care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, Australia.

Get more information on the findings above and more details about the study. To contact the researchers or JAMDA editors for an interview, please email emullally@paltc.org.

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About JAMDA

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Tuesday, October 17, 2023

path: https://old.paltc.org/newsroom/screening-eds-helps-identify-nursing-home-residents-risk-adverse-outcomes-mortality

title Prioritizing Resident Autonomy in Post-COVID Healthcare

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FOR IMMEDIATE RELEASE: September 28, 2023

Contact: Ellen Mullally
emullally@paltc.org/410-992-3124

The COVID pandemic made people take a new look at how patients are involved in their own care. A new article in the September issue of JAMDA suggests that government and healthcare organizations need to take the time to engage residents in decision-making and policy development that affects their care, treatment, and support systems.

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Governments and healthcare organizations have failed to support resident autonomy “due to their risk intolerance, silencing resident voices, and infringing on residents’ rights and freedoms during the last phase of their life,” the authors said. They added that residents need and deserve a caring home environment that “will uphold their right for autonomy and dignity to experience the positive outcomes that result from risk-taking, despite governments’ and healthcare organizations’ narrow and limited view of risk as a negative construct that requires an abundance of caution.”

This study was conducted by researchers at Athabasca University, Calgary, Alberta, Canada.

Get more information on the findings above and more details about the study. To contact the researchers or JAMDA editors for an interview, please email emullally@paltc.org.

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About JAMDA

date:

Thursday, September 28, 2023

path: https://old.paltc.org/newsroom/prioritizing-resident-autonomy-post-covid-healthcare

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