Medical Aid in Dying and Dementia Directives

Pope, Thaddeus Mason

doi:10.7202/1084454ar

Cited by 7 publications

(7 citation statements)

References 12 publications

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“…Like California, Hawaii, New Mexico, and Oregon, Washington State also has recently reduced its original 15-day waiting period (Table 1). 32 But it reduced it only down to 7 days. 31 That is still too long for a patient to transition from VSED to MAID.…”

Section: Expanded Opportunities To Access Maid Via Vsedmentioning

confidence: 98%

Medical aid in dying to avoid late‐stage dementia

Pope,

Brodoff

2024

J American Geriatrics Society

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Many patients with dementia want the option of using medical aid in dying (MAID) to end their lives before losing decision‐making capacity and other abilities that impact their desired quality of life. But, for over two decades, it has been widely understood that these patients cannot (solely because of their dementia diagnosis) satisfy three statutory eligibility requirements in all U.S. MAID laws: (1) decisional capacity, (2) the ability to self‐administer the life‐ending medications, and (3) a terminal condition with 6 months or less to live. Now, because of recent statutory amendments together with the use of voluntarily stopping eating and drinking (VSED) to quickly advance to a terminal condition, this dementia exclusion from MAID might no longer apply. If combining VSED and MAID is now a possibility for patients with dementia, then clinicians need more guidance on whether and when to support patients seeking to take this path. In this article, we begin to provide this guidance. First, we describe the recent case of an Oregon patient with early‐stage Alzheimer's dementia who successfully used VSED to qualify for and use MAID. Second, we discuss prior barriers to using VSED as a bridge to MAID for people with dementia. Third, we describe recent legal changes that might make this path now possible.

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Section: Expanded Opportunities To Access Maid Via Vsedmentioning

confidence: 98%

Medical aid in dying to avoid late‐stage dementia

Pope,

Brodoff

2024

J American Geriatrics Society

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“…They also want U.S. law to permit health professionals to administer life‐ending medication to patients unable to self‐administer the drugs. Some say individuals should be permitted to include MAID as part of their advance treatment directives as well 19 …”

Section: Looking To the Futurementioning

confidence: 99%

Residency Requirements for Medical Aid in Dying

Dresser

2024

Hastings Center Report

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In 1997, when Oregon became the first U.S. jurisdiction authorizing medical aid in dying (MAID), its law included a requirement that patients be legal residents of the state. Other U.S. jurisdictions legalizing MAID followed Oregon in adopting residency requirements. Recent litigation challenges the legality, as well as the justification, for such requirements. Facing such challenges, Oregon and Vermont eliminated their MAID residency requirements. More states could follow this move, for, in certain circumstances, the U.S. Constitution's privileges and immunities clause protects citizens' right to travel to secure medical care. Policy considerations could also motivate states to reexamine whether such requirements are justified in light of existing evidence of how MAID laws have been applied.

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“…In late-stage dementia, individuals are dependent upon others for feeding and hydration. In some jurisdictions, including most Canadian provinces (Downie, 2018;Mader and Apold, 2019), a competent person's advance directive can instruct others not to provide food and fluid by mouth or artificially when they can no longer eat or drink independently (Volicer et al, 2019;Pope, 2021). Death under those circumstances is generally thought to be peaceful and comfortable with proper oral care (Wax et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Informal care-givers' attitudes towards medical assistance in dying for persons with dementia

Bravo

Block²,

Downie³

et al. 2022

Ageing and Society

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Medical assistance in dying (MAID) is legal in Canada but cannot be accessed through an advance request. Some data suggest that informal care-givers of persons with dementia support the legalisation of advance requests for MAID. Opponents argue that care-givers' support is due to society's failure to address their well-documented burden and unmet needs. To our knowledge, this assumption has never been tested. To fill this knowledge gap, we conducted a survey among 204 Canadian informal care-givers of persons with dementia to (a) elicit their attitudes towards allowing no longer competent adults to access MAID through an advance request, and (b) test the hypothesis that attitudes are in part driven by the level of burden experienced by care-givers and unmet needs for support. Attitudes were elicited with a clinical vignette involving a woman with Alzheimer's disease who requests MAID while still competent, or through an advance request for the time after she would lose decisional capacity. Informal care-givers' support for MAID ranged from 60 per cent in the scenario where the person is still competent and likely has several more years to live, to 87 per cent when she is depicted as no longer competent, in severe distress and close to death. Quality-of-life considerations and the value of self-determination were key arguments in support of legalising advance requests for MAID. Using multivariable logistic regression, we found no evidence that burden and unmet support needs influence attitudes towards advance requests for MAID, after controlling for other determinants. These findings contribute new insights into people's attitudes towards the sensitive issue of whether MAID should be extended to persons with dementia-induced decisional incapacity.

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Medical Aid in Dying and Dementia Directives

Abstract: Although Canada recently expanded access to medical assistance in dying, intolerably suffering Canadians with dementia still face seven obstacles to qualify for MAID. Advance directives for VSED are an important, yet under-appreciated, alternative.

Cited by 7 publications

References 12 publications

Medical aid in dying to avoid late‐stage dementia

Medical aid in dying to avoid late‐stage dementia

Residency Requirements for Medical Aid in Dying

Informal care-givers' attitudes towards medical assistance in dying for persons with dementia

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