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Addendum to Advance Health Care Instructions v 8 (addresses cognitive impairment)

You may consider adding wording similar to the below to your advance directive ( you DO have one, right ?) if you are concerned about being kept alive with severe cognitive impairment.

I am not afraid of death, which will come to us all. However, it is very important to me that I do not linger in a twilight haze of confusion not being able to recognize loved ones or being unable to get out of bed, or incontinent of urine or stool, and/or requiring round-the-clock custodial care, or otherwise being a dependent burden to my family and an expense to them and society.

Therefore, if I develop dementia or incur a stroke or other neuro/muscular or other disorder to the extent I am not oriented to time and place, or it substantially affects my ability to live independently and am also judged by physician(s) to not be competent to refuse medical treatments on my own, I want no further medical treatments to treat or prevent any potentially lethal outcomes. Examples of such treatments include, but are not limited to:
1. Surgeries for conditions such as appendicitis, obstructed bowel, aortic or cerebral artery aneurysm, etc.
2. Blood transfusion
3. Antibiotics for serious infections
4. IV fluids or agents to treat shock from hemorrhage or sepsis, etc.
5. Steroids to reduce brain swelling or pericarditis, etc.
6. immunizations designed to prevent the annual flu or other conditions.

Withholding these treatments may cause more discomfort and suffering – such as pain, anxiety, confusion, nausea, depression, so I ask my physician(s) to use liberal dosages of sedative and pain medications including narcotics even if they may hasten my death.

If my mental and/or physical condition prevents me from living a reasonably independent life, even if I can breathe and drink and eat independently, I desire that nature be allowed to take its course so that any potentially lethal disorder I encounter is allowed to assist me in my final exit.

If my condition progresses so that I am unable to feed myself, I do not want to be hand-fed or offered any fluids of any kind (except for swabs to moisten my lips) and I do not want artificial hydration or nutrition. It is very possible that in my demented state that I may become agitated and even plead for liquids or food, but it is essential that I NOT be given either one. I do request that the physician in charge provide pain & sedation medication by patch, subcutaneously or intramuscularly to reduce my discomfort and agitation as much as possible even if it hastens my death. I fully understand that when I stop eating and drinking fluids, my body will slowly shut down over 10-20 days and I will die; which under these circumstances is what I clearly and without reservation want to happen.

Even if I can still feed myself, if I have become so confused and/or agitated or incontinent of stool so that I am not able to be cared for in my home, I want my Health Agent to implement my directive to withhold food and fluids. Once initiated, any pleas from me for liquids or food, must be compassionately ignored. As above, I do request liberal pain and sedation medications to minimize discomfort and agitation even if it hastens my death.

Signature _________________________________ Date __________________________

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