Tough Decisions About Dementia and End-of-Life Care

Below is a letter published today in the NYT’s Sunday edition. It relates to this article: “My Father Didn’t Want to Live if He Had Dementia. But Then He Had It,” by Sandeep Jauhar (Opinion guest essay, Oct. 28)

To the Editor:

Advance care planning is inherently problematic given that we cannot predict our future ailments and, importantly, cannot predict how we will feel about our quality of life when we’re afflicted with serious illness. Discussions with loved ones help, and the legal durable power of attorney is important. However, loving families may disagree about what your wishes are.

Dr. Barak Gaster has published a now widely used Advance Directive for Dementia, which addresses life-support choices in the various stages of dementia. Also, End of Life Washington has developed a more flexible and extensive set of Dementia Directives, allowing revocation and changes by the individual affected.

There ultimately comes a time to “let go” for all of us. Because advance directive documents are always nuanced, the deep discussions we have with our loved ones are critical to help them support our wishes at the end.

Jim deMaine
Seattle
The writer, a former pulmonary and critical care physician, is the author of “Facing Death: Finding Dignity, Hope and Healing at the End.”

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