Treading into ethically and legally uncertain territory, a New York end-of-life agency has approved a document that lets people stipulate in advance that they don’t want food or water if they develop severe dementia.

The directive, finalized by the board for End of Life Choices New York, aims to provide patients a way to hasten death in late-stage dementia, if they choose. The document offers two options: one that requests “comfort feeding” — providing oral food and water during the final stages of the disease — and one that would halt all assisted eating and drinking, even if a patient seems willing to accept it.

Supporters said it’s the strongest effort to date to allow people to make their final wishes known.

But critics say it’s a disturbing effort to allow withdrawal of basic sustenance from the most vulnerable in society. “I think oral feeding is basic care,” said Richard Doerflinger, an associate scholar with the Charlotte Lozier Institute, which opposes abortion and euthanasia.

Modified Pap test may find other cancers

The Pap test has reduced the incidence of cervical cancer by more than 60 percent. Now it may become a key step in the early detection of two other gynecological malignancies — ovarian and endometrial cancers — that have been notorious killers because they’re typically caught so late.

A study has found that by genetically analyzing the harvest of cells from a Pap smear, doctors could identify 81 percent of endometrial cancers and 33 percent of ovarian cancers. Some of those cancers were in their earliest stages.

When the Johns Hopkins University researchers tested an alternative means of collecting cells — a longer brush that sweeps cells from the lining of the uterus — they positively identified endometrial cancer in 93 percent of cases and ovarian cancer in 45 percent of cases. And when they added a blood test to the ovarian cancer screening regimen, they were able to detect that cancer in 63 percent of patients who had it.