Stopping Eating and Drinking by Advance Directives (SED by AD) in Assisted Living and Nursing Homes

The Ethics Subcommittee of AMDA–The Society for Post-Acute and Long-Term Care Medicine (“The Society”) presents arguments for and against Stopping Eating and Drinking by Advance Directives (SED by AD). SED by AD is a type of advance directive in which a proxy is instructed to stop offering food and fluids to a person when they reach a certain stage of dementia. Although most conversations regarding SED by AD focus on patient autonomy and the right to determine one's care, we propose that the ethical principle of justice—the obligation to treat all individuals equally regardless of race, gender, and physical or cognitive ability—is the decisive principle in this controversy.