Latest news with #MaryTaylor
Medscape
7 days ago
- Health
- Medscape
Ethics of Artificial Hydration and Nutrition In Dementia
This transcript has been edited for clarity. Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at the NYU Grossman School of Medicine. I had a difficult case brought to me recently by someone who was trying to decide what to do with a patient with very bad dementia in terms of feeding. It's not the first time I've had this kind of case brought to me by physicians, and it probably won't be the last, but it remains a thorny, tough ethics quandary. I think everybody understands that there is a right — and we've had this affirmed since cases like Terri Schiavo or Nancy Cruzan — to not force artificial feeding (meaning by tube, in the nose, or in the stomach) or artificial hydration upon someone who doesn't want it. If you have the right to refuse treatment, it's been established — certainly in American law, and I would say by standards of care within the medical profession — that hydration and feeding, when they're done by mechanical means, tubes, or using artificial substances to supply nutrition, are medicine. As a medical intervention or a medical therapy, just like other interventions, such as dialysis or even refusing an amputation for a diabetic patient, the patient ultimately, if they're competent, has the right to refuse it. The challenge comes in the case that was presented to me. A woman, let's call her Mary Taylor, some years ago knew that she was at risk of getting Alzheimer's disease. She filled out her living will and discussed with her family that when she became demented, if she was unable to care for herself, if she couldn't recognize her family and friends, she did not want any medical interventions, including specifically hydration and nutrition. Sadly, she went through the course of declining and ended up at a nursing home. At the nursing home, the doctor who was treating her noticed that nurses were offering Mary food on a spoon and liquid on a spoon, that she was opening her mouth when the spoon was presented, and she was, if you will, eating and drinking. The physician, knowing that the family remembered this advance directive living will and knowing that they were the designated decision-makers, basically said stop the spoon-feeding. The nurses did not want to do it. They said it's ordinary care. It's not medical. It's just what you do as part of what one human being deserves from another human being — to offer them ordinary ways to drink water or to eat something. The case basically raises two tough ethics questions. Is feeding by spoon the same as medical intervention with artificial forms of hydration and nutrition? I believe it is. I believe that when you say 'no more food and nutrition,' it isn't just the equipment. I'll put it simply: It's who's on the end of the spoon. If nurses or doctors are feeding, it's medical. It's professional care, and you should be able to say no to that. Secondly, I do think if someone says 'I don't want to eat or drink anymore,' their intent and their values are clear. You could certainly rediscuss it with the family and say she seems to be accepting food and swallowing, and ask if that changes their mind or makes them think she might have decided differently. However, I think the wishes of the competent person, when they made the living will, are what should drive care if the person loses competency. They thought about it, they knew where they were headed, and I do think that's the value that ought to dominate thinking about whether we have to continue to try food and water for nutrition. Does that mean that you can't offer ice, lip balm, or other comfort means if someone is suffering because they're getting dehydrated and so on? Absolutely not. That isn't the same as feeding them. Here are some lessons to consider. It's important to pay attention when someone says they don't want food and water. Are nurses or anyone in a hospital or a nursing home trying to feed them anyway because they don't think of spoon-feeding as an artificial or medical intervention? I think they need education about that, and I think it's important to make sure that does not happen if that's what they said in their advance directives. I also believe advance directives and conversations with people, when they're competent or facing the potential loss of competency, should include discussions about whether they really mean everything, such as spoon-feeding or somebody offering you a glass of water. Is that included in what you are saying you do not want? We have to be thorough and comprehensive in making sure that we're clear so there really aren't disputes of what people did say no to and might say yes to if they no longer are able to tell us directly. I'm Art Caplan, at the Division of Medical Ethics at the NYU Grossman School of Medicine. Thank you for watching.
BBC News
02-07-2025
- Business
- BBC News
Kirklees Council to sell off more land to plug £47m deficit
A cash-strapped local authority is planning to offload more of its assets in order to bring in £ Council was faced with a £47m black hole in its budget in authority has already raised nearly £1m after four assets were sold off in May and June. Seventeen new assets have been earmarked for disposal including a plot of land at Grasscroft in Almondbury, despite several objections. A council report stated one letter of objection was received from residents of Grasscroft and surrounding areas and included a petition signed by 36 have raised concerns about the site, which is an open space, being used for anything other than grazing land, according to the Local Democracy Reporting sites earmarked for disposal include a plot at Walkley Lane/Sycamore Industrial Estate in Heckmondwike, which was previously featured in a highways scheme as well as Earlsheaton Cemetery Lodge and land in Mirfield, Huddersfield and the current financial year, the council wants to raise £6m from selling off property and land it said was surplus to requirements, with a £4m target set for has already auctioned off of the former Red House Museum at Gomersal, which sold for £650, Grade II listed property, which was once the home of Charlotte Brontë's friend Mary Taylor, was previously a museum which closed in 2016 and a plan to turn it into holiday accommodation and wedding venue fell through. Listen to highlights from West Yorkshire on BBC Sounds, catch up with the latest episode of Look North.
