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How do caregivers evaluate a patient’s change of mind during the process, when the patient said at the beginning that if he demands food during the process not to honor it?

The response must be based upon a determination of the patient’s decisional capacity to ‘change’ his/her mind. It is almost always the case that, as the patient enters the stage of organ failure, capacity is lost & the patient can no longer make an informed decision. This must be discussed prior to the initiation of VSED so patient can inform family & caregivers of the desired response. The appointed health care agent should also be involved as a substitute decision-maker for the patient. The ideal response is to provide the smallest amount of oral intake of food/fluid in response to such requests to provide comfort AND increase the sedating medications. – Judy

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