Euthanasia and related ethical issues in dementias of later life with special reference to Alzheimer's disease

Abstract

Increased public interest and concern regarding euthanasia have been aroused in recent years by a number of developments. A succession of judgments pronounced by Courts of Law in different parts of the world have, in recent years, sanctioned the withdrawal of life sustaining procedures in cases of prolonged and irreversible unconsciousness and in patients suffering from painful and distressing terminal diseases.They have, therefore, pronounced euthanasia in these circumstances to be legally and ethically justified.This has generated wide ranging debate regarding the ethics of management of those judged beyond hope of recovery or improvement and near the terminal phase of their lives.The practice of euthanasia in The Netherlands, which has been in progress for a number of years, has also served to focus the attention of the medical and legal professions, and the public at large, upon the ethical, legal and clinical aspects of euthanasia In the majority of patients, life had been terminated on request. But in a substantial minority, it had been undertaken on an involuntary basis.The scale of the practice of euthanasia in The Netherlands in recent years has yielded a vast body of information regarding the moral and practical dilemmas posed for doctors, families and society concerning patients who are chronically unconscious and ambiguously poised between life and death. As a high proportion of those whose lives were terminated were of advanced age, the lessons learned are closely relevant for the specific theme of this paper.

Coping with loss: Loss in late life

“…A new concern, as euthanasia becomes less theoretical and more real (as already in Holland and recently in the Northern Territory of Australia 8 9), may be overlong survival, where life draws on without quality and the burden of infirmity falls on the family. While euthanasia may seem a boon to some, it could be felt to be a duty by others—to stop being a drag on the family's emotional and financial resources.…”

Deliver us from evil: carer burden in Alzheimer's disease

“…What is more, in many cases the carers will see themselves confronted with the secret wish of a premature termination of the patient's (and their own) suffering 11 12. With the Dutch approval of euthanasia for a patient with Alzheimer's disease,13 euthanasia for those judged beyond hope as well as the related moral and practical dilemmas have moved to the centre of animated debate 14 15.…”

Should voluntary assisted dying in Victoria be extended to encompass people with dementia?

“…First, although advance care directives provide for people to express preferences about care, which may include binding decisions to refuse particular kinds of treatment, they cannot compel practitioners to provide specific treatments. Further, claims that a future medical condition, such as dementia, would be experienced as intolerable could not constitute proof of actual suffering at the time of the illness and, in addition, would raise the troubling possibility of preventing patients from changing their minds about previously stated preferences for VAD should their new circumstances incline them to do so 14‐16 …”