Nutrition, Hydration, and the Demented Elderly

Abstract

What I have argued is that the withdrawal of technologies that provide nutrition and hydration is not categorically distinct from the withdrawal of mechanical ventilation, dialysis, antibiotic therapy, or from the decision not to resuscitate. The competent terminally ill older patient will often decide against these interventions, and they should be encouraged to make these value statements before the onset of acute illness or dementia. We need to broach the value questions earlier on in caring for the elderly, and place greater emphasis on advance directives. For those who are severely demented, we must hypothesize a world in which advanced medical technology does not exist....Avoiding futile procedures in caring for the severely demented elderly patient can serve positively to undercut the age-based rationing proposals that are currently in vogue among some ethicists. Rationing according to age is a violation of equity and justice. If costs must be cut, this can be accomplished through eliminating waste and defining medical futility in much wider terms -- in an age-neutral manner. We need to return to a somewhat more natural medicine in order to avoid policies that make scapegoats of the elderly.