Planning For When Your Mind Fades

As our population ages, age-related diseases, such as Alzheimer’s and other forms of dementia, will afflict an increasing number of people. Although irreversible and incurable, those diagnosed with these diseases can live for prolonged periods of time with treatment.

In the early stages of the disease, individuals with dementia can maintain a good quality of life. However, as the disease progresses, that changes. They lose their ability to recognize family members, become increasingly fearful and agitated, and are unable to take care of themselves.

If you receive a dementia diagnosis, what type of treatment would you want? Would your wishes change as the disease progresses?

Living Will: The Texas Directive to Physicians

A Texas Directive to Physicians allows you to specify what kind of life-sustaining treatment should be administered or withheld if your physicians diagnose you with:

1. A terminal condition from which you are expected to die within six months, even with available life‑sustaining treatment provided in accordance with prevailing standards of medical care; or
2. An irreversible condition that prevents you from caring for yourself or making decisions for yourself and will result in your death without life‑sustaining treatment provided in accordance with prevailing standards of care.

The statute defines a terminal condition as an incurable condition caused by injury, disease, or illness that according to reasonable medical judgment will produce death within six months, even with available life-sustaining treatment provided in accordance with the prevailing standard of medical care.

The statute defines an irreversible condition as a condition, injury or illness that may be treated, but:

• is never cured or eliminated,
• leaves a person unable to care for or make decisions for himself, and
• is fatal without life sustaining treatment provided in accordance with the prevailing standard of care.

The document gives individuals the option of indicating whether doctors should administer or withhold treatment depending on whether the patient is suffering from a terminal or irreversible condition.

It works well for acute situations, such as an accident or a stroke, but not for degenerative conditions where quality of life diminishes over time.

Living Will for Dementia

Dr. Barak Gaster, an internist at the University of Washington School of Medicine, believes that most advance directives are not appropriate for diseases that progress gradually because they do not adequately account for the fact that treatment wishes may change as the disease advances. So he worked with others to create a dementia-specific advance directive that allows those diagnosed with the disease to better express their wishes.

The Health Care Directive for Dementia provides information about the symptoms of mild, moderate, and severe dementia, and allows individuals to specify their treatment goals depending on the course of their disease. For example, someone could specify he would like to receive all treatment that prolongs his life, including rescusitation if his heart stopped beating, if his dementia is mild. However, that same person could also direct that all care to prolong his life should not continue when his dementia becomes severe.

The New York Times recently featured Dr. Gaster and one of his patients in an article titled: One Day Your Mind May Fade. At Least You’ll Have a Plan.

Many thanks to my friend, Kay Allen, a certified financial planner in Colleyville, Texas, for bringing this article to my attention.

This article was originally published on February 26, 2018, and updated on June 6, 2023.