Withholding and Withdrawing Life-Sustaining Treatment in Advanced Dementia: How and When to Make These Difficult Decisions
Dementia is a progressive incurable illness. In the advanced stages of the disease, decisions need to be made whether to withhold or withdraw life-sustaining treatment. This article reviews the principles of deciding a patient’s best interests when he or she lacks mental capacity, the role of advance statements, and principles for the practising physician to consider in common withholding/withdrawing treatment scenarios that arise in clinical practice, such as artificial feeding, cardiopulmonary resuscitation, and antibiotics for pneumonia.
Key words: dementia, palliative care, withholding and withdrawing treatment, artificial feeding, resuscitation, antibiotics.