Canadian case may rewrite standards on advanced directives

Family seeks to force a nursing home to stop spoon feeding their mother who has been diagnosed with Alzheimer's disease. Photo: Bessie Cooper/Associated Press

DALLAS, August 15, 2013 ― The British Columbia Supreme Court will hear a case this fall that may redefine the standard of care for people with disabilities. The family of Margaret Bentley, an 82 year old woman who has been diagnosed with Alzheimer’s disease, is suing her nursing home, arguing that spoon feeding her constitutes battery.

If the suit is successful, it will significantly change how people with disabilities are treated, specifically in withholding and withdrawing care. Currently, the law in Canada, as well as in the United States, allows patients or their surrogates to withhold or withdraw permission to administer medical care, including medically delivered nutrition and hydration, generally termed “artificial nutrition and hydration.”

Bentley’s family bases their request that the Maplewood House Nursing Home stop feeding Bentley on a 1991 “Statement of Wishes” signed by the patient. The document states, “If there is no expectation for recovery from extreme disability, I request to be allowed to die.”

Bentley’s daughter Katherine Hammond said, “End-of-life care directives are obviously in a grey zone if health providers are misinterpreting or misapplying laws. So yes, this will be precedent-setting.”

However, advanced directives generally deal with which medical interventions will be accepted or rejected. In a statement, Fraser Health official Keith McBain said health care workers are “obligated to provide the necessities of life for patients … that includes food and fluids.”

Katherine Duthie, an ethical consultant hired by Fraser Health to evaluate the situation, concluded, “The risk of feeding her is minimal whereas the risk of not doing so means that death will be imminent. This death would be viewed as premature and so would constitute harm to Mrs. Bentley.”

Advocates for people with disabilities worry about the precedent that would be set should spoon feeding be considered medical intervention instead of ordinary care. Canadian disabilities rights group Toujours Vivant-Not Dead Yet also believes that patients should have the right to change their minds after making advanced directives to refuse treatment.

Director Amy Hasbrouck said, “When there is a doubt, a presumption for life should be applied, because death is an irreversible step. When a person cannot communicate her wishes in any other way, her actions should be determinative as to her current wishes on the matter. Therefore, the fact that Ms. Bentley is accepting food and showing a preference demonstrates her will to live, whether it is instinctive or intentional, should be honored.”

The process of starvation and dehydration can take from one to three weeks, whether the patient’s food is delivered medically or not. Terri Schiavo, a disabled woman whose family’s legal battle over her care made national headlines, died after almost 14 days without food and water.

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April Thompson

April Thompson is a writer and home educator. She has a background in pro-life political work, including speaking to national, state and local groups on life issues. April lives near Dallas, Texas with her husband and four children.

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