Abstract：
In a recent paper in JME, Shelton and Geppert use an approach by Menzel and Chandler-Cramer to sort out ethical dilemmas about the oral feeding of patients in advanced dementia, ultimately arguing that the usefulness of advance directives about such feeding is highly limited. They misunderstand central aspects of Menzel\'s and Chandler-Cramer\'s approach, and in making their larger claim that such directives are much less useful than typically presumed, they fail to account for five important elements in writing good directives for dementia and implementing them properly: (1) Directives should be paired with appointment of trusted agents. (2) Appointed agents\' authority can be greatly weakened without advance directives to guide them. (3) Directives\' implementation does not require clinically precise assessment of dementia\'s stage. (4) Palliative support is typically required for withholding of oral feeding to be compassionate. (5) The central purpose of stopping feeding is often not the avoidance of suffering but not prolonging unwanted life.
摘要：
在JME最近的一篇论文中，Shelton和Geppert使用Menzel和Chandler-Cramer的方法来解决晚期痴呆症患者口服喂养的道德困境，最终认为，关于这种喂养的预先指示的有用性非常有限。他们误解了门泽尔和钱德勒-克莱默方法的核心方面，并且在他们更大的主张中，这些指令比通常假定的有用得多，他们在撰写针对痴呆症的良好指令并正确实施时未能说明五个重要要素：（1）指令应与任命受信任的代理人配对。（2）指定代理人的权限可以大大削弱，而没有预先的指示来指导他们。（3）指令的实施不需要临床精确评估痴呆的阶段。（4）通常需要姑息支持，以保持同情的口服喂养。（5）停止进食的主要目的通常不是避免痛苦，而是延长不必要的寿命。
