Introduction: Patients who reach the advanced stage of dementia will have lost the capacity to express themselves in words. Yet sometimes, they can still non-verbally indicate their current desires.
Overview: The questions below focus on your observations of the patient’s behavior as caregivers put food and fluid in the patient’s mouth. Your observations may have led to your opinion: Does the patient seem to RESIST assistance of hand-feeding and hand-hydrating, OR does the patient seem DISTRESSED when fed?
“Sometimes” means resistance or distress is often enough for you to think the patient does not want this assistance to continue.
Answer based on your observations both NOW and in the PAST 6 months. Why?
Because some patients may feel resistant now, but have lost the ability to show their resistance since their dementia progressed, but did show resistance in the past. (There is another possibility: They may have changed their mind, if they can still make such decisions.)
If the patient is resistant, your observations (along with those of others) may help motivate people who know the patient to participate in the Protocol, "Now Care Planning," and motivate a physician to write orders to honor what you and others believe the patient would now want.
Important Caveat: In many jurisdictions, although physicians may not know the law, a patient cannot legally refuse life-sustaining treatment unless he or she has capacity (is competent) to make that decision.