图书简介

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

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