By Wendy Schreurs
Working in a retirement home gives me a lot of new insights. Especially when I work with elderly who suffer from dementia. They told me I was Irish, I experienced the second World War, I have kids and that I have big feet. Of course this was nonsense; my feet are a normal size 6. But not everything they say is always gibberish. A while ago I was helping a woman with her dinner. She wasn’t too happy with me helping her. She looked at me with her grumpy face and said: “Why do I have to eat?” I answered: “You have to eat, or you’ll die.” She wasn’t satisfied with the answer and asked me the same question again: “Why do I have to eat?” I contemplated a bit longer about it, and I couldn’t give an answer anymore. This woman sat in her wheelchair, couldn’t remember a thing about her day, and was fed by a 21-year old student. Why should she still have to eat?
It’s amazing what science can do. We live a lot longer than we did in the Middle Ages. We are healthier, we can cure people, we can even give them new organs if theirs shut down. But what are the limits? And who determines the limits? The patient, the doctor, the law, or maybe a relative? It would be the most logical to let the patient determine whether he wants to be treated or not. But when it comes to patients with dementia, it’s difficult to establish whether they can still make an informed choice for themselves. A solution would be to let the patient make a choice before he gets dementia. A decision aid might be a good help in advance care planning. The ‘making your wishes known: planning your medical future’ decision aid translates an individual’s values and goals into advance directive. This directive explicitly reflects their healthcare wishes and outlines a plan for how they wish to be treated. (1) Although this might help the individual with future decisions, it remains hard to predict what medical decisions an individual would make in the future.
It’s very difficult to determine when to stop a treatment and thus quitting life. It’s even more difficult when it concerns the life of an individual who might not be able to choose himself. But if we can figure out how to transplant a kidney, we can also figure out what to do with these situations. Until we have figured this issue out, I’ll wait. I’ll wait about 10 minutes; and then ask the demented woman if she wants to eat again. Because I know she will forget what she just asked; and I can put another spoonful of food in her mouth.
- Levi BH, Green MJ. Too Soon to Give Up? Re-examining the value of advance directives. The American Journal of Bioethics. 2010 Apr; 10(4): 3-22.
