On Avoiding Deep Dementia 
Norman L. Cantor

To avoid prolonged dementia, the author has written an advanced directive to prohibit the provision of life-sustaining interventions, including hydration and nutrition, should he reach a self-defined point of cognitive debilitation. But if that point is reached, he would be unable to comprehend the reasoning that motivated the advanced directive, and he might enjoy life despite having dementia. Still, surrogate decision-makers and caregivers would have a moral and legal obligation to implement his advanced directive, argues Cantor, a professor emeritus of law at Rutgers University School of Law. Competent individuals should be given control over directing the types of life-sustaining treatments they receive if they develop dementia.

Other Voices: Three commentaries raise concerns about advance directives that limit care for people with dementia.

Are Obese Children Abused Children?
Maura Priest

In 2010, a South Carolina mother was charged with criminal neglect after her 14-year-old son reached 555 pounds, in the first U.S. felony case involving childhood obesity. But this article discusses important ethical and legal distinctions between negligent and abusive caretakers and caretakers of obese children. The former intentionally harm or fail to protect the children under their care, while caretakers of obese children may act in well-intentioned though misguided ways. And environmental, social, and genetic factors are also significant contributors to childhood obesity. Since allowing a child to become obese falls into a different moral and legal category from abusing or neglecting a child, the solutions to protect obese children must be different from those to protect abuse and neglect victims. Priest is an assistant professor of philosophy at Arizona State University and an affiliate researcher at the University of Cologne.

Discriminatory Demands by Patients
Philip M. Rosoff

Many in health care are concerned, even appalled, when patients demand physicians, nurses, and other caregivers of a particular gender or race. While there is evidence that patients from groups that have been victims of discrimination may have better health outcomes if they have clinicians of the same background or gender, how does one distinguish requests that are potentially beneficial from those that are simply discriminatory? Which requests should be honored, and which should be denied? The answers are not straightforward, writes Philip M. Rosoff, a professor of pediatrics and medicine at Duke University School of Medicine and an adjunct professor of clinical science at North Carolina State University College of Veterinary Medicine.

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Also in this issue:

• Policy & Politics: “Describing Misprescribing to Inform Prescription Opioid Policy “
• At Law: “Proposed Regulations Favor Providers’ Conscience Rights over Patients’ Rights“
• Book review essay on Good Sport: Why Our Games Matter and How Doping Undermines Them, by Thomas H. Murray

Contact Susan Gilbert, director of communications
The Hastings Center
845-424-4040 x244
gilberts@thehastingscenter.org