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?

Ask EOLCNY

Q: 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?

A: 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