AEDs are problematic, but Mrs A is a misleading case

Menzel, Paul T.

doi:10.1136/medethics-2018-104780

Cited by 6 publications

(6 citation statements)

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“…These data suggest that evidence of suffering may have weighed more heavily in the respondents' support for extending MAID to the incompetent patient than her being at the end of life. Future surveys could formally test this hypothesis by including vignettes in which the two factors vary independently.The Dutch legislation on euthanasia requires unbearable suffering (as judged by physicians) but imposes no restriction on life expectancy.Stressing the difficulty for physicians to judge whether an uncommunicative patient is suffering unbearably, some commentators have argued that the Dutch legislation's emphasis on suffering as a necessary condition is not the appropriate legal framework in cases of advanced dementia [32][33][34]. According to Menzel,33 avoiding suffering is not the primary reason why most people decide to draft an advance MAID request.…”

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confidence: 99%

Comparing the attitudes of four groups of stakeholders from Quebec, Canada, toward extending medical aid in dying to incompetent patients with dementia

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Trottier

Rodrigue

et al. 2019

Int J Geriat Psychiatry

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Objective The Canadian province of Quebec has recently legalized medical aid in dying (MAID) for competent patients who satisfy strictly defined criteria. The province is considering extending the practice to incompetent patients. We compared the attitudes of four groups of stakeholders toward extending MAID to incompetent patients with dementia. Methods We conducted a province‐wide postal survey in random samples of older adults, informal caregivers of persons with dementia, nurses, and physicians caring for patients with dementia. Clinical vignettes featuring a patient with Alzheimer's disease were used to measure the acceptability of extending MAID to incompetent patients with dementia. Vignettes varied according to the stage of the disease (advanced or terminal) and type of request (written or oral only). We used the generalized estimating equation (GEE) approach to compare attitudes across groups and vignettes. Results Response rates ranged from 25% for physicians to 69% for informal caregivers. In all four groups, the proportion of respondents who felt it was acceptable to extend MAID to an incompetent patient with dementia was highest when the patient was at the terminal stage, showed signs of distress, and had written a MAID request prior to losing capacity. In those circumstances, this proportion ranged from 71% among physicians to 91% among informal caregivers. Conclusion We found high support in Quebec for extending the current MAID legislation to incompetent patients with dementia who have reached the terminal stage, appear to be suffering, and had requested MAID in writing while still competent.

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confidence: 99%

Comparing the attitudes of four groups of stakeholders from Quebec, Canada, toward extending medical aid in dying to incompetent patients with dementia

Bravo

Trottier

Rodrigue

et al. 2019

Int J Geriat Psychiatry

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“…These included: a lack of clarity in the woman's advance euthanasia directive (AED) regarding the circumstances in which she intended euthanasia to be performed, and in particular a suggestion that she wished to determine the time of death herself; doubts about the woman's competence at the time her AED was written; uncertainty about whether she was suffering intolerably (as Dutch law requires) at the time the euthanasia was carried out; and the doctor's use of covert sedation in the face of spoken and physical indications that the patient may not have wished for euthanasia at the time it was carried out. [1][2][3][4] The commentaries also relate these concerns to more general arguments about the moral legitimacy of AEDs given the limits of a person's insight into their uncertain future circumstances and the changes that can occur in their personality and preferences between the writing of a directive and its execution.…”

Section: Introductionmentioning

confidence: 99%

Advance euthanasia directives and the Dutch prosecution

Hughes

2020

J Med Ethics

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In a recent Dutch euthanasia case, a woman underwent euthanasia on the basis of an advance directive, having first been sedated without her knowledge and then restrained by members of her family while the euthanasia was administered. This article considers some implications of the criminal court’s acquittal of the doctor who performed the euthanasia. Supporters of advance euthanasia directives have welcomed the judgement as providing a clarification of the law, especially with regard to the admissibility of contextual evidence in interpreting advance euthanasia directives, but suggested that the law regarding advance euthanasia directives should be further relaxed to remove the requirement of current suffering and that an unfortunate consequence of the prosecution is that it is likely to deter doctors from performing euthanasia even in more straightforward cases. This article argues that the court’s endorsement of the use of contextual evidence is problematic, that the case for prioritising prior decisions over current interests has not been advanced by the discussion surrounding this case and that worries about the alleged deterrent effect are not well founded.

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“…The article by Miller et al raises a series of ethical questions concerning Advanced Euthanasia Directives (AEDs) and highlights weaknesses in the Dutch regulatory procedures. Also included in this edition are responses to the Miller et al article, by Menzel2 and Jongsma et al 3. These responses challenge some of implications that Miller et al seek to draw from the case.…”

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confidence: 99%

“…As Menzel explains, ‘[a]ny advance directive…needs to be clear about not only what is and is not to happen, but when’ 2. In the revision, Mrs A affirms her right to undergo euthanasia when she thinks ‘the right time is for this’.…”

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confidence: 99%

“…In the revision, Mrs A affirms her right to undergo euthanasia when she thinks ‘the right time is for this’. Menzel asks: “[i]f the right time is the time that she thinks is the right time for euthanasia, then what work is the advance directive doing?”2 The problem is that, even if the revised directive embodies a ‘prior preference’ or ‘critical interest’ that ought to be respected (at the expense of ‘experiential interests’ or the patient’s ‘current desires or feelings’), the revised directive does not identify the conditions for when that critical interest ought to be respected. On the language used in the revised document, Mrs A is attempting to preserve her legal ability to—when the time if right in the future—have her then-formulated critical interests respected.…”

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confidence: 99%

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