Sunday, January 21, 2018
I read a recent article in the New York Times as part of the New Old Age Series. Paula Span writes One Day Your Mind May Fade. At Least You’ll Have a Plan. The article is about advance directives for those with dementia as discussed in a recent article published in the Journal of the American Medical Association (JAMA). The idea of the dementia-specific advance directive is to express your wishes based on the specific "phase" of dementia you may enter in the future. The website for this directive is here from which the 5-page directive may be downloaded. The NY Times article describes the directive "In simple language, it maps out the effects of mild, moderate and severe dementia, and asks patients to specify which medical interventions they would want — and not want — at each phase of the illness."
In the JAMA article, the authors make the case that other existing advance directives aren't particularly helpful for those with dementia because of the way it progresses over time with corresponding diminishing cognitive function (a subscription is required to access the article). The NY Times article notes that "[a]lthough [dementia] is a terminal disease, dementia often intensifies slowly, over many years. The point at which dementia patients can no longer direct their own care isn’t predictable or obvious. ... Moreover, patients’ goals and preferences might well change over time. In the early stage, life may remain enjoyable and rewarding despite memory problems or difficulties with daily tasks."
The dementia-specific directive describes the person's wishes as "goals of care" and offers four options for each stage of dementia, directing the person to "[s]elect one of the 4 main goals of care listed below to express your wishes. Choose the goal of care that describes what you would want at this stage." The directive divides dementia into three stages, mild, moderate and severe.
There are already a number of types of advance directives, with recent pushes for POLST and other initiatives such as the Conversation Project. Then there is the Five Wishes document, which as been around for a number of years. Attorneys may be incorporating dementia-specific instructions into advance directives already.