Advance directives have raised these long-standing issues again, such as withholding or withdrawing nutrition and hydration in terminally ill patients. This matter has been the object of lawsuits, debates and analysis, such as the one published by the Hastings Center last June (P.T. Menzel and M.C. Chandler-Cramer, Advance directives, dementia and withholding food and water by mouth). The focus of this discussion was not tube-feeding in dementia patients, but withholding of food and water by mouth. “Patient autonomy prevails to accept or reject treatment, but advance directives have their limits”.

Terminally ill patients argues Powell, director of the Bioethics Center at the Faculty of Medicine at Yeshiva University in New York, cannot reject a measure that is not a medical treatment, such as they cannot be bathed or kept warm. Oral food and drink belong in this category of basic human care. “An advance directive cannot appropriately ask that basic nourishment be withheld from a person in end-stage dementia.”