WashU Expert: Ethical considerations of legalizing physician-assisted death for dementia

Surveys show dementia becoming second-most feared disease behind cancer

As Alzheimer’s disease and other forms of dementia continue to become more prevalent, it may not be long before there is a push for legalizing physician-assisted death (PAD) in dementia cases in the United States.

American officials must thoroughly consider the moral and social consequences of such an action, says an expert on medical ethics at Washington University in St. Louis.

“In the early 1990s, the first person to secure Jack Kevorkian’s life-ending services was Janet Adkins, a woman diagnosed with Alzheimer’s disease,” said Rebecca Dresser, the Daniel Noyes Kirby Professor of Law Emerita.

Dresser

“Surveys of the U.S. population suggest that dementia is beginning to rival cancer as the most-feared disease.”

Dresser tackled the issue of physician-assisted death for dementia in a piece published in the Hastings Center Report July/August issue.

“Supporters of legalizing PAD for dementia offer several reasons for their position,” Dresser wrote. “They contend that respect for individual autonomy and self-determination requires authorities to give people the freedom to choose an earlier death over the suffering and indignities of life with dementia. For them, the loss of intellectual abilities as well as the loss of valued relationships and activities that accompanies dementia can be a fate worse than death. Many also want to protect their loved ones from the psychological and financial burdens of caring for someone with dementia.”

But PAD in the context of dementia raises distinct issues that have so far received insufficient attention, she added.

“One set of issues applies to mildly affected individuals seeking PAD,” Dresser wrote. “Individuals choosing PAD are making one of the most significant medical decisions a person can make. All medical decisions should be competent and informed, but this is especially true of choices for PAD.”

The U.S. debate over legalization should give particular attention to two matters, Dresser said:

  1. The need for rigorous capacity assessment, as well as meaningful education, for dementia patients requesting PAD.
  2. The justification for allowing advance euthanasia directives, such as living wills and medical power of attorney.

“Public discussion should confront the threat that those directives present to the welfare of vulnerable patients. The directive’s potential negative impact on clinicians and families should also be acknowledged,” she wrote.

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