When deciding whether to offer food and fluids to a resident with advanced dementia, clinicians have a greater responsibility to the resident in their current state than to those who originally drew up an advance directive that calls for food and drink to be withheld, according to the authors of a new white paper.

Contrary to some clinicians’ views on the subject, stopping eating and drinking by advance directive is not identical to voluntary stoppage by the resident themselves, argue members of The Society for Post-Acute and Long-Term Care Medicine, or AMDA. Instead, AMDA’s ethics subcommittee views the two decisions as “significantly different,” they wrote. 

With that in mind, AMDA recommends adopting a policy of comfort feeding for all nursing and assisted living facility residents with advanced dementia, “despite any advance directives to the contrary,” the authors wrote in the current paper. Comfort feeding involves providing food and fluids while residents continue to accept it.

There is no just resolution to these decisions, the authors wrote. Therefore, “[w]e are convinced that the greater injustice is that of ending the life of a person who wishes to continue to eat and drink and live.”

“In essence, the healthcare providers of AMDA are urged never to force food on anyone, but also never to engage in forced nonfeeding,” James Wright, M.D., Ph.D., CMD, vice chair of the AMDA Ethics Committee, told McKnight’s Senior Living in March, when the organization passed a resolution on the subject. 

“We realize that many people will have a negative reaction to this,” Wright said at the time. “Given the fact that healthcare providers typically view an advance directive as inviolable, this is a departure from our usual practice.”

The white paper follows AMDA’s article on the subject published in the October issue of The Journal of Post-Acute and Long-Term Care Medicine.