Thank you for the question.
I do, absolutely, and there are two components to my answer. I'll be brief.
The first problem with advance consent is that if there is an issue of duress in advance, then after the person has become incompetent, you essentially can't figure that out, so if there is a problem with duress or there is some other family issue, by the time the person becomes incompetent, you can't go back, because you can't ask them anymore. You can't take them into a room separately and ask, “Did you really want to do this back then? How do you feel about it now?”
The other part of my answer is this. My wife and I care for her father, and he has advanced dementia. I don't know what he would have said if he had known this was going to happen, but there is a difference between making a decision that eventually you want to die and what you may feel when you're actually in the moment. He seems to be enjoying life, so would he want to make that same decision if he could go forward in time and vocalize it? When you have said that you would want to die, there is no point of reference to know whether in the future, when you are in those circumstances and have dementia, you're actually going to be so sick of life that you actually will want to die. That is the problem inherent with an advance directive.