Tuesday’s (1/20/2015) New York Times article“Complexities of Choosing an End Game for Dementia” provides a good opportunity to reflect on the complex ethical questions surrounding dementia. The piece focuses on 88-year-old Jerome Medalie who has stipulated in his advance directive that if he develops dementia, he refuses “ordinary means of nutrition and hydration.” Once certain conditions set in—such as when he is no longer able to “articulate coherent thoughts and sentences”—Medalie directs that no one try to spoon-feed him or offer him liquids. “If I’m not me, I don’t want to be,” he declared.
The article uses Medalie’s choice as an entry point to discuss larger issues related to VSED, short for “voluntarily stopping eating and drinking,” and its application to persons with dementia. Dena Davis, a bioethicist cited in the article, proposes “pre-emptive suicide” as a viable solution to the problems of dementia. She explains the concept in more detail on her blog: