Limitations on the Precedent Autonomy

Abstract: Over the course of the next two decades an unprecedented number of Americans will be diagnosed with Alzheimer’s disease. In order that their consent to or rejection of medical treatment is truly informed, they need accurate and relevant information, including, but not limited to, the following: The functional impairment and loss caused by Alzheimer’s disease has a particular route of progression and thus generally predictable trajectory. Equally foreseeable are the medical treatment and care issues that will likely arise as a consequence of that trajectory, as are the treatment and care option for addressing those issues. Accordingly, individuals diagnosed with Alzheimer’s disease and their families can develop a reasonably accurate set of expectations, and can prepare accordingly. Prior to the loss of decisional capacity individuals diagnosed with Alzheimer’s disease possess the legal authority to reject life-sustaining medical treatment, including, but not limited to, artificial nutrition and hydration, subject only to constitutionally valid limitations on that authority imposed by state legislation, currently in force only in a handful of states. Subject to certain constitutionally valid limitations and/or evidentiary standards re: the determination of their previously expressed or implied intention, individuals diagnosed with Alzheimer’s disease, in anticipation of the possible loss of decisional capacity, have the legal authority to refuse, in advance, life-sustaining medical treatment, including artificial nutrition and hydration. Individuals diagnosed with Alzheimer’s disease also possess the moral authority to make such a rejection, when in their assessment; the life-sustaining medical treatment in question imposes a foreseeable harm(s) and/or continuing burden(s) that is, on balance, disproportionate to its foreseeable benefit, if any.