But one way for these people to ensure that they do not live for years with severe dementia is to use an advance directive to instruct caregivers to stop giving them food and water by mouth<\/strong>. This is an ethical and legal gray area explored in commentaries and a case study in the\u00a0Hastings Center Report<\/i><\/a>.<\/p>\n People with decision-making capacity have the legal right to refuse treatment of any kind and to voluntarily stop eating and drinking. In states where physician aid in dying is legal, people with decision-making capacity who are terminally ill can ask a doctor to help them end their lives<\/strong>. For people who lose decision-making capacity, an advance directive can express their wish to refuse life support, including a feeding tube. But it is questionable whether there is a legal right to use an advance directive to refuse food and water given by mouth when a person can still swallow but lacks decision-making capacity.<\/p>\n In the lead article in the May-June issue<\/a>, Paul T. Menzel and M. Colette Chandler-Cramer express support for such directives and say that they “are arguably already legal” because they follow logically from the legal rights to refuse life support and to voluntarily stop eating and drinking<\/strong>. Menzel, a professor of philosophy emeritus at Pacific Lutheran University, and Chandler-Cramer, a retired physician assistant and a member of a hospital hospice team in Washington State, propose guidelines for implementing such directives so as to guard against misunderstanding and abuse, and they offer a sample advance directive.<\/p>\n![\"hospital](\"http:\/\/therapytoronto.ca\/news\/wp-content\/uploads\/2013\/02\/hospital-stay.jpg\")
<\/a>Many of the legal and ethical options for refusing unwanted interventions are not available to people with dementia because they lack decision-making capacity<\/strong>.<\/p>\n