Dr. Barak Gaster, a University of Washington internist, has developed a five-page dementia–specific advance directive whereby patients indicate what type of medical treatment they would want if they have mild, moderate or severe dementia. At each phase of dementia, the patients are given 4 options ranging from “full efforts to prolong my life” to keeping them comfortable and relieve suffering” to die as gently as possible. Similar to the Conversation Project which also presents different treatment decisions at different stages of dementia, the intent is to clarify a patient’s wishes when they have dementia, which is becoming more prevalent due to the silver tsunami (Americans are living longer and thus are more likely to have dementia than in the past).
Dr. Gaster thought it was important to develop a new advance directive since “standard directives” tend to focus on things a “permanent coma” or a “persistent vegetative state” and often they apply to “a person with less than six (6) months to live”. In Texas, the specific language set forth in Section 166.033 of the Texas Health and Safety Code, states “If, in the judgement of my physician, I am suffering with a terminal condition from which I am expected to die within six (6) months, even with life-sustaining treatment provided in accordance with prevailing standards of medical care…treatments other than those needed to keep me comfortable are discontinued or withheld” or “I be kept alive in this terminal condition”.
Texas defines three (3) different documents as an Advance Directive as follows:
1) A directive – which is an instruction to administer, withhold or withdraw life sustaining treatment in the event of a terminal or irreversible condition;
2) An out-of-hospital DNR order; and
3) A Medical power of attorney whereby authority is given to someone else to make medical decisions for you if you can no longer make them for yourself.
Whether Dr. Gaster’s dementia-specific directive would withstand scrutiny in Texas may depend on what state the document was signed. Section 166.005 of the Texas Health and Safety Code states “An advance directive or similar instrument validly executed in another state or jurisdiction shall be given the same effect as an advance directive validly executed under the law of this state”. This would seem to indicate if it was valid when signed in another state that it would be recognized in Texas. However, Section 166.164 of the Texas Health and Safety Code indicates a medical power of attorney must be substantially similar to the language provided under Texas law.
Nonetheless, clarification of a patient’s wishes before an event occurs is certainly a step in the right direction as it may make such medical decisions easier for the patient’s loved ones. Although Dr. Gaster’s form directive might not be recognized as a substitute for language approved under Texas law, one might consider incorporating the same in his or her directive to give physicians and families or loved ones a better understanding of the patient’s wishes. Do you want to lose your life when you lose your mind?