<html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns:x="urn:schemas-microsoft-com:office:excel" xmlns:m="http://schemas.microsoft.com/office/2004/12/omml" xmlns="http://www.w3.org/TR/REC-html40">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=us-ascii">
<meta name="Generator" content="Microsoft Word 15 (filtered medium)">
<!--[if !mso]><style>v\:* {behavior:url(#default#VML);}
o\:* {behavior:url(#default#VML);}
w\:* {behavior:url(#default#VML);}
.shape {behavior:url(#default#VML);}
</style><![endif]--><style><!--
/* Font Definitions */
@font-face
{font-family:"Cambria Math";
panose-1:2 4 5 3 5 4 6 3 2 4;}
@font-face
{font-family:Calibri;
panose-1:2 15 5 2 2 2 4 3 2 4;}
@font-face
{font-family:"Cataneo BT";}
@font-face
{font-family:ParkAvenue;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{margin:0in;
font-size:11.0pt;
font-family:"Calibri",sans-serif;
mso-ligatures:standardcontextual;}
a:link, span.MsoHyperlink
{mso-style-priority:99;
color:#0563C1;
text-decoration:underline;}
span.EmailStyle20
{mso-style-type:personal-reply;
font-family:"Calibri",sans-serif;
color:windowtext;}
.MsoChpDefault
{mso-style-type:export-only;
font-size:10.0pt;
mso-ligatures:none;}
@page WordSection1
{size:8.5in 11.0in;
margin:1.0in 1.0in 1.0in 1.0in;}
div.WordSection1
{page:WordSection1;}
--></style><!--[if gte mso 9]><xml>
<o:shapedefaults v:ext="edit" spidmax="1026" />
</xml><![endif]--><!--[if gte mso 9]><xml>
<o:shapelayout v:ext="edit">
<o:idmap v:ext="edit" data="1" />
</o:shapelayout></xml><![endif]-->
</head>
<body lang="EN-US" link="#0563C1" vlink="#954F72" style="word-wrap:break-word">
<div class="WordSection1">
<p class="MsoNormal"><span style="font-size:12.0pt">There is also the Dementia Directive, which breaks down decisions in stages.
</span><a href="https://dementia-directive.org/">Advance Directive for Dementia (dementia-directive.org)</a><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt"><o:p> </o:p></span></p>
<div>
<p class="MsoNormal"><b><span style="color:#4A6A8B;mso-ligatures:none">Wendy S. Goffe
</span></b><span style="mso-ligatures:none">(she/her/hers) | Partner <br>
<span style="color:black">Direct: (206) 386-7565 </span><o:p></o:p></span></p>
</div>
<p class="MsoNormal"><span style="mso-ligatures:none"> </span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<div>
<div style="border:none;border-top:solid #E1E1E1 1.0pt;padding:3.0pt 0in 0in 0in">
<p class="MsoNormal"><b><span style="mso-ligatures:none">From:</span></b><span style="mso-ligatures:none"> wsbapt-bounces@lists.wsbarppt.com <wsbapt-bounces@lists.wsbarppt.com>
<b>On Behalf Of </b>Jeff Crollard<br>
<b>Sent:</b> Wednesday, August 9, 2023 3:10 PM<br>
<b>To:</b> WSBA Probate & Trust Listserv <wsbapt@lists.wsbarppt.com><br>
<b>Subject:</b> Re: [WSBAPT] Alzheimer's advance directive<o:p></o:p></span></p>
</div>
</div>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif">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.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif">The following article has some good tips about assessing dementia and appetite loss:
<a href="https://www.medicalnewstoday.com/articles/dementia-patient-not-eating#causes-of-appetite-loss">
Dementia and appetite loss: Causes and management (medicalnewstoday.com)</a><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif">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.
<a href="https://app.leg.wa.gov/RCW/default.aspx?cite=71.32.260">RCW 71.32.260: Form. (wa.gov)</a> .
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif">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: <a href="https://endoflifewa.org/tools-for-planning/dementia-directives/">Dementia Directives - End of Life Washington</a> 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.)
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif">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.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif">Jeff
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif"><o:p> </o:p></span></p>
<div>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif;mso-ligatures:none">Jeff Crollard<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif">Crollard Law Office, PLLC<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif">1313 E. Maple St., Suite 225<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif">Bellingham, WA 98225<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif">Phone: 206-468-2192<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif">Fax: 206-260-7357<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif"><a href="mailto:jbc@crollardlaw.com">jbc@crollardlaw.com</a>
<o:p></o:p></span></p>
<p class="MsoNormal"><b><o:p> </o:p></b></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span style="font-family:"Times New Roman",serif;mso-ligatures:none">This email is confidential and may contain information or documents that are protected by attorney-client, work product or other privileges. If you are not the intended
recipient, any dissemination, use or reliance upon its contents is prohibited. If you received this email in error, please notify me and then delete the email and any attachments.</span><span style="mso-ligatures:none"><o:p></o:p></span></p>
</div>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif"><o:p> </o:p></span></p>
<div>
<div style="border:none;border-top:solid #E1E1E1 1.0pt;padding:3.0pt 0in 0in 0in">
<p class="MsoNormal"><b><span style="mso-ligatures:none">From:</span></b><span style="mso-ligatures:none">
<a href="mailto:wsbapt-bounces@lists.wsbarppt.com">wsbapt-bounces@lists.wsbarppt.com</a> <<a href="mailto:wsbapt-bounces@lists.wsbarppt.com">wsbapt-bounces@lists.wsbarppt.com</a>>
<b>On Behalf Of </b>Claudia A Gowan<br>
<b>Sent:</b> Wednesday, August 9, 2023 12:59 PM<br>
<b>To:</b> WSBA Probate & Trust Listserv <<a href="mailto:wsbapt@lists.wsbarppt.com">wsbapt@lists.wsbarppt.com</a>><br>
<b>Subject:</b> Re: [WSBAPT] Alzheimer's advance directive<o:p></o:p></span></p>
</div>
</div>
<p class="MsoNormal"><o:p> </o:p></p>
<div>
<p class="MsoNormal"><span style="color:#1F3864;mso-ligatures:none">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.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F3864;mso-ligatures:none"><o:p> </o:p></span></p>
<p class="MsoNormal" style="text-align:justify;text-indent:.5in;text-autospace:none">
<u> </u>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.<span style="font-family:"Times New Roman",serif;mso-ligatures:none"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F3864;mso-ligatures:none"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="color:#1F3864;mso-ligatures:none">Best, Claudia<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F3864"><o:p> </o:p></span></p>
<p class="MsoNormal"><b><i><span lang="ES" style="font-size:12.0pt;font-family:ParkAvenue;color:#1F3864">Claudia A. Gowan<o:p></o:p></span></i></b></p>
<p class="MsoNormal"><b><i><span lang="ES" style="color:#1F3864"><o:p> </o:p></span></i></b></p>
<p class="MsoNormal" style="line-height:9.0pt;mso-line-height-rule:exactly"><b><span lang="ES" style="color:#1F497D">Claudia A. Gowan, PLLC<o:p></o:p></span></b></p>
<p class="MsoNormal"><b><span style="color:#1F497D">2212 Queen Anne Avenue No., # 338 (Mailing only)<o:p></o:p></span></b></p>
<p class="MsoNormal"><b><span style="color:#1F497D">Seattle, WA 98109<o:p></o:p></span></b></p>
<p class="MsoNormal"><b><span style="color:#1F497D">(206) 443-2733 (T)<o:p></o:p></span></b></p>
<p class="MsoNormal"><b><span style="color:#1F4E79"><a href="mailto:claudia@cagowanlaw.com"><span style="color:#1F4E79">claudia@cagowanlaw.com</span></a> <o:p></o:p></span></b></p>
</div>
<p class="MsoNormal"><o:p> </o:p></p>
<div>
<div style="border:none;border-top:solid #E1E1E1 1.0pt;padding:3.0pt 0in 0in 0in">
<p class="MsoNormal"><b><span style="mso-ligatures:none">From:</span></b><span style="mso-ligatures:none">
<a href="mailto:wsbapt-bounces@lists.wsbarppt.com">wsbapt-bounces@lists.wsbarppt.com</a> <<a href="mailto:wsbapt-bounces@lists.wsbarppt.com">wsbapt-bounces@lists.wsbarppt.com</a>>
<b>On Behalf Of </b>Kate Szurek<br>
<b>Sent:</b> Wednesday, August 9, 2023 12:17 PM<br>
<b>To:</b> WSBA Probate & Trust Listserv <<a href="mailto:wsbapt@lists.wsbarppt.com">wsbapt@lists.wsbarppt.com</a>><br>
<b>Subject:</b> [WSBAPT] Alzheimer's advance directive<o:p></o:p></span></p>
</div>
</div>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">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.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Do any of you know of any such thing????<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Thanks in advance.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Kate<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><b><i><span style="font-size:13.5pt;font-family:"Cataneo BT";color:blue;mso-ligatures:none">Kate Szurek</span></i></b><span style="font-size:12.0pt;font-family:"Times New Roman",serif;color:black;mso-ligatures:none">, J.D., LL.M. (in Taxation)<o:p></o:p></span></p>
<p class="MsoNormal"><span style="mso-ligatures:none"><a href="mailto:kate@skagitlaw.com"><span style="font-size:12.0pt;font-family:"Times New Roman",serif;color:blue">kate@skagitlaw.com</span></a></span><span style="font-size:12.0pt;font-family:"Times New Roman",serif;color:#1F497D;mso-ligatures:none"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="mso-ligatures:none"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif;color:#1F497D;mso-ligatures:none"><img border="0" width="193" height="51" style="width:2.0104in;height:.5312in" id="Picture_x0020_1" src="cid:image001.jpg@01D9D454.A2DCC8E0" alt="SkagitLaw_Signature (2)"></span><span style="font-size:12.0pt;font-family:"Times New Roman",serif;color:#1F497D;mso-ligatures:none"><o:p></o:p></span></p>
<p class="MsoNormal"><b><i><span style="font-size:14.0pt;font-family:"Times New Roman",serif;color:#1F497D;mso-ligatures:none">Skagit Law Group, PLLC<o:p></o:p></span></i></b></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif;color:#1F497D;mso-ligatures:none">P.O. Box 336 / 227 Freeway Drive, Suite B<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif;color:#1F497D;mso-ligatures:none">Mount Vernon, WA 98273<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif;color:#1F497D;mso-ligatures:none">360.336.1000<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif;color:#1F497D;mso-ligatures:none">360.336.6690 (fax)<o:p></o:p></span></p>
<p class="MsoNormal"><span style="mso-ligatures:none"><a href="http://www.skagitlaw.com/"><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:blue">http://www.skagitlaw.com</span></a></span><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:#1F497D;mso-ligatures:none">
</span><span style="font-size:12.0pt;font-family:"Times New Roman",serif;color:#1F497D;mso-ligatures:none"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;mso-ligatures:none"><o:p> </o:p></span></p>
<p class="MsoNormal"><o:p> </o:p></p>
</div>
</body>
</html>