[WSBAPT] Alzheimer's advance directive

[Goffe, Wendy S.]

There is also the Dementia Directive, which breaks down decisions in stages.  Advance Directive for Dementia (dementia-directive.org)<https://dementia-directive.org/>

Wendy S. Goffe (she/her/hers) | Partner
Direct: (206) 386-7565

From: wsbapt-bounces at lists.wsbarppt.com <wsbapt-bounces at lists.wsbarppt.com> On Behalf Of Jeff Crollard
Sent: Wednesday, August 9, 2023 3:10 PM
To: WSBA Probate & Trust Listserv <wsbapt at lists.wsbarppt.com>
Subject: Re: [WSBAPT] Alzheimer's advance directive

With all due respect, I would be careful with language as broad as in the paragraph below.  A diagnosis of Alzheimer's or dementia encompasses all of its stages.  It's usually only in the end stages that one naturally loses interest in eating/drinking.  In earlier stages the lack of interest or refusal of food could be due to other causes, such as a UTI, gum infection, stressful environment, unappetizing food, etc.  Similarly with medications, one might refuse a pill because it's too large or now unrecognizable, but willingly ingest it when in powder or liquid form and mixed into applesauce or a smoothie.  I think we should encourage close assessments and medical referrals before taking as drastic a step as stopping nutrition or medications.  I understand the point of this paragraph-people don't want food or pills forced down their throat-but I would recommend it include a requirement to first get appropriate assessments/referrals.

The following article has some good tips about assessing dementia and appetite loss:  Dementia and appetite loss: Causes and management (medicalnewstoday.com)<https://www.medicalnewstoday.com/articles/dementia-patient-not-eating#causes-of-appetite-loss>

As to the "new law" Kate's client asked about, it might be our state's Mental Health Advance Directive law, RCW 71.32.  That was passed 20 years ago (and amended 2021).  It deals with behavioral health issues, not end-of-life or nutrition/hydration, see e.g., the required form. RCW 71.32.260: Form. (wa.gov)<https://app.leg.wa.gov/RCW/default.aspx?cite=71.32.260> .

It's possible Kate's client was referring to new work being done by End-of-Life Washington and Lisa Brodoff et al to incorporate dementia care into this advance directive.  Lori provided the link to this important stuff:  Dementia Directives - End of Life Washington<https://endoflifewa.org/tools-for-planning/dementia-directives/> They've created a directive about oral feeding that gets more into the nitty gritty details of how a person signals they're not interested in eating, see attached, p. 3.  It is a very thoughtful approach to this difficult topic.  (My one recommendation is that it also require an assessment/referral before stopping food.)

FYI, the POLST deals with "medically assisted nutrition"-previously called "artificially administered nutrition."  That's a different issue, covering peg tubes and other enteral feeding.  The above is about oral feeding where the person is swallowing.

Jeff

Jeff Crollard
Crollard Law Office, PLLC
1313 E. Maple St., Suite 225
Bellingham, WA 98225
Phone:  206-468-2192
Fax:  206-260-7357
jbc at crollardlaw.com<mailto:jbc at crollardlaw.com>


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From: wsbapt-bounces at lists.wsbarppt.com<mailto:wsbapt-bounces at lists.wsbarppt.com> <wsbapt-bounces at lists.wsbarppt.com<mailto:wsbapt-bounces at lists.wsbarppt.com>> On Behalf Of Claudia A Gowan
Sent: Wednesday, August 9, 2023 12:59 PM
To: WSBA Probate & Trust Listserv <wsbapt at lists.wsbarppt.com<mailto:wsbapt at lists.wsbarppt.com>>
Subject: Re: [WSBAPT] Alzheimer's advance directive

Kate, this is language that I include in my healthcare directives as an option for my clients to select if they want. It's probably not perfect but it conveys a client's intent and directions.

              DIAGNOSIS OF ALZHEIMER'S OR OTHER DEMENTIA. Where I am living with a diagnosis of Alzheimer's or other dementia, I hereby expressly state that I do want food and water where I am voluntarily taking such food or water, however where I refuse food or water, administration of such food or water shall cease except as may be provided for under the terms regarding hydration above. Further, if I am refusing medications, no medications shall be administered unless necessary to relieve pain or anxiety and maintain reasonable comfort. Consistent with the above provision regarding resuscitation, no resuscitation shall be performed where I am incapacitated by Alzheimer's or other dementia, and I direct that no machines providing medical related treatment shall be used to maintain my life where I am incapacitated by Alzheimer's or other dementia.

Best, Claudia

Claudia A. Gowan

Claudia A. Gowan, PLLC
2212 Queen Anne Avenue No., # 338 (Mailing only)
Seattle, WA 98109
(206) 443-2733 (T)
claudia at cagowanlaw.com<mailto:claudia at cagowanlaw.com>

From: wsbapt-bounces at lists.wsbarppt.com<mailto:wsbapt-bounces at lists.wsbarppt.com> <wsbapt-bounces at lists.wsbarppt.com<mailto:wsbapt-bounces at lists.wsbarppt.com>> On Behalf Of Kate Szurek
Sent: Wednesday, August 9, 2023 12:17 PM
To: WSBA Probate & Trust Listserv <wsbapt at lists.wsbarppt.com<mailto:wsbapt at lists.wsbarppt.com>>
Subject: [WSBAPT] Alzheimer's advance directive

An elderly estate planning client of mine just asked me about "some new law" allowing for withdrawal of hydration and nutrition should a person be suffering from Alzheimer's.  Nothing I have heard even one whisper about.

Do any of you know of any such thing????

Thanks in advance.

Kate

Kate Szurek, J.D., LL.M. (in Taxation)
kate at skagitlaw.com<mailto:kate at skagitlaw.com>

[SkagitLaw_Signature (2)]
Skagit Law Group, PLLC
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Mount Vernon, WA  98273
360.336.1000
360.336.6690 (fax)
http://www.skagitlaw.com<http://www.skagitlaw.com/>


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