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Dying and Dementia

Joanne Lynn, MD
JAMA. 1986;256(16):2244-2245. doi:10.1001/jama.1986.03380160102030.
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Volicer et al,1 in this issue of The Journal, report a remarkably practical, commonsense experience in limiting potentially life-extending treatments for persons with advanced senile dementia of the Alzheimer's type. Debate about forgoing life-extending treatment has recently been impaired by the irrational pretense, especially evident with "Baby Doe,"2 that severe and permanent mental disability should not have a bearing on medical treatment choices. If future policy evidences more wisdom about this issue, we shall look back on this era as a temporary aberration during which it was easier to get resuscitation or extensive surgery for an older person than to provide a balanced meal or a pair of eyeglasses.

On the way to that better future, caution and thoughtful reflection are essential. Although Volicer and colleagues have made significant strides, their path includes some pitfalls. For example, they present the central issue as one of refusing certain modes


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