Issues in Death and Dying A good death requires that the values of the person be integrated into the process of dying. AD is a terminal condition, although death usually results from pneumonia and other causes. This reality should be discussed with the affected person and family in time for the individual to participate in planning. The physician who provides continuing care for the person with dementia should initiate discussion with patients and families regarding the use of aggressive measures to prolong life. One way to empower individual choice while allowing family members to deal with unforeseen situations is through an advance directive that combines the living will with the durable power of attorney for health care, which is usually held by a trusted family member.
Hospice care is preferred by many physicians and family caregivers in cases of end-stage dementia.
One difficulty is the Medicare requirement that hospice eligibility be determined by physician certification that death will likely occur within six months. Used in combination with clinical judgment, this can certify patients for Medicare hospice coverage. Caregivers must observe the affected individual carefully and provide whatever forms of pleasure and comfort are possible, and, conversely, to resist interventions that diminish comfort. The touch of a hand will offer greater comfort than a feeding tube. Most of us assess the quality of life in AD-affected persons more negatively than is justified, largely because we hold cognitive skills in such high regard.