The finding:
A novel nutrition strategy dubbed “Minimal Comfort Feeding” (MCF) can prevent unintended life prolongation in people who have given clear advance directives aimed at limiting life prolonging measure in the context of dementia.

Strength and weaknesses:
The paper’s main strength is the ethically, medicolegally, and physiologically nuanced discussion around varying strategies for providing oral food and hydration in people with late-stage dementia who have, via advance directives made prior to loss of decisional capacity, given clear direction about their desires to avoid life prolonging measures as their dementia progresses. A case example helps to effectively ground the discussion. A lack of data describing the frequency of this problem is a weakness, although it is unclear if such data is available.

Relevance:
CL Psychiatrists are frequently involved in parsing of ethically difficult situations involving decisional capacity, end of life planning, and challenges to autonomy. The detailed discussion in this article around the specific concern of end-of-life nutrition/hydration involves excellent review of ethical and medicolegal principles around not only that specific problem, but relevant to questions about autonomy, surrogate decision making, family support, and threading the needle of minimizing suffering with minimal unnecessary intervention. These situations can be particularly challenging in the context where the medical team and family are tasked with creating a plan for a best death rather than intervention and attempted recovery.