Euthanasia and Assisted Suicide of Persons With Dementia in the Netherlands. J. Geriatr. Med Health Care Philos. It is the purpose of this article to add to this debate surrounding this topic in two ways: first, by highlighting certain inherent paradoxes in global attitudes towards assisted dying, and second, by identifying the key areas of concern regarding the implementation of such policies, from the perspectives of caregivers, healthcare professionals and wider social structures, in the specific case of dementia. Entitled to any portion of your estate upon your death. The aim is to increase the light, and perhaps as well to reduce the heat, on this important subject by formulating and evaluating the central ethical arguments for and against voluntary active euthanasia and physician-assisted suicide. Bioethics 28, 9699. Besides these two cultural dimensions, the dimension of uncertainty avoidance was negatively correlated with approval of euthanasia. It is also possible that individuals may express approval of PAS as an abstract notion, but be more disapproving when presented with concrete cases. Federal government websites often end in .gov or .mil. Generally, a person is considered legally incapacitated when two doctors have tested and examined the patient and completed certificates of incompetency. Palliat. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Of these, 50% to 60% have Alzheimer's disease. Euthanasia and Assisted Dying: what Is the Current Position and what Are the Key Arguments Informing the Debate? A Systematic Review of Religious Beliefs about Major End-Of-Life Issues in the Five Major World Religions. doi:10.1016/j.jphs.2021.02.006, Dehkhoda, A., Owens, R. G., and Malpas, P. J. The author confirms being the sole contributor of this work and has approved it for publication. uuid:266dd986-b461-11b2-0a00-90521d020000 The authors argue that both contemporaneous and (most) non-contemporaneous decisions for VSED are legally permissible and do not, as many believe, constitute abuse, neglect, or assisted suicide. Public Health 8, 45504562. doi:10.1097/WAD.0000000000000238, Bravo, G., Trottier, L., and Arcand, M. (2021). 76, 864866. (2013). Living will, which establishes ones wishes concerning end-of-life care, the use of life-support systems, and the treatments one does and does not want. WebSign in. 2 As the nation, individual states, and various interest groups consider the adoption of physician-assisted suicide policies, it is essential that (2019). <>18]/P 23 0 R/Pg 44 0 R/S/Link>> First, advocacy for PAS by healthcare professionals involved in dementia care could be seen as violating the principle of beneficience, which is one of the pillars of medical ethics. endobj 3 Questions to Ask Yourself, A Day in the Life of a Hospice Social Worker, Hospice and the Medicare Beneficiary Identifier (MBI), FAQs about Hospice and Medical Conditions. It is essential to avoid a situation where patients or caregivers are made to believe that dementia is associated with a duty to die (Cholbi, 2015; Huang and Cong, 2021). For these reasons, BPSD is sometimes cited as an indication, or at least as a contributory factor, for the approval of PAS in patients with moderate or severe dementia (Dierickx et al., 2017). A Systematic Review of Non-pharmacological Interventions for BPSD in Nursing home Residents with Dementia: from a Perspective of Ergonomics. Advance Planning. 32, 6085. Advance Directives, Dementia, and Physician-Assisted Death. sharing sensitive information, make sure youre on a federal 30 0 obj JAMA Netw. Front. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Cultural factors: Scores for Hofstedes six dimensions of national culture power distance, individualism vs. collectivism, masculinity vs. femininity, uncertainty avoidance, long-term orientation, and indulgence vs. restraint, compiled in the year 2010 and updated with World Values Survey data from the year 2014. J. Alzheimers Dis. Finally, religiosity was negatively correlated with approval of euthanasia in specific cases. Moreover, even if economic burdens influence a caregivers attitudes towards PAS, this need not be interpreted as a reason to broaden access to PAS; it could equally be well seen as a reason to provide economic and logistic assistance to affected families, and to identify and treat depression in caregivers. J. Med. 53, 549553. Dementia is ruled out as a candidate for PAD, even if she is terminally ill and suffering terrible and unrelievable pain, which rules out individuals with strong and unwavering desires not to end their life in dementia. Huang, Y., and Cong, Y. Physician Aid in Dying for Dementia: The Problem with the Early vs. Late Disease Stage Distinction. First, data on attitudes towards euthanasia for twenty-eight countries, obtained from the World Values Survey, is analyzed. 19, 10571063. What Happens if I Get Better While in Hospice Care? (2021). (2021). Filling it out sends a message: I do not want anothers judgment substituted for my own. 3 0 obj 13, 10831099. Would you like email updates of new search results? We focus on a recent controversial case in which a Dutch woman with Alzheimer's disease was euthanised based on her AED. Hofstede Insights (2021). doi:10.1136/bmjopen-2016-012759, Allen, W. (2020). J. 132, 451459. Psychogeriatrics 21, 612617. Dement Geriatr. Similarly, a sample of the Dutch general public, 40% of respondents considered PAS unacceptable even in advanced dementia; disapproval was stronger in older subjects and in those with higher self-reported religiosity (Brinkman-Stoppelenburg et al., 2020). Federal government websites often end in .gov or .mil. Socioeconomic Status and Medical Assistance in Dying: A Regional Descriptive Study. endobj His conclusion is that, given that even this non-marginalized group is likely to be at risk of the abuse or inappropriate use of PAS, continued restrictions on this practice represent the most prudent course of action. WebThe tenability of maid and death and advance directives dementia physician assisted suicide, as the web site requires in this aper suggests that they are similar. endstream The SENATOR-OnTop Series. Considering that one of the arguments advanced in favour of PAS is the economic burden faced by caregivers as well as society at large, this finding is unexpected, and suggests that economic hardship or deprivation alone may not significantly influence positive attitudes towards PAS. doi:10.1016/j.jamda.2007.01.007, Finucane, T. E. (1999). Secondly, social capital was also strongly and positively correlated with approval of euthanasia. endobj 17. As with Krags (Krag, 2014) analysis of a similar situation in high-income men, such considerations suggest that, depending on social and cultural contexts, groups that are thought of as privileged may actually be paradoxically vulnerable to an indiscriminate adoption of euthanasia or PAS. J. Palliat. doi:10.1371/journal.pone.0214724, Verhofstadt, M., Audenaert, K., Van den Broeck, K., Deliens, L., Mortier, F., Titeca, K., et al. Response to: 'Dementia and advance directives: some empirical and normative concerns' by Jongsma. Dementia is the seventh leading cause of death worldwide. Non-linear curve estimation analyses for all variables possibly associated with EU-SELECT are presented in Table 4. Embedding Caregiver Support in Community-Based Services for Older Adults: A Multi-Site Randomized Trial to Test the Adult Day Service Plus Program (ADS Plus). Contemp. Niebroj, L., Bargiel-Matusiewicz, K., and Wilczynska, A. A wide range of problematic behaviours, grouped together under the umbrella term BPSD, can be observed in patients with dementia. Watson, B., Tatangelo, G., and McCabe, M. (2019). (You cannot make any directive after you become incapacitated.). Though this argument may be more ethically sound than the previous one, as it involves informed consent from patients themselves, it still entails certain difficulties. Understanding Economic and Other Burdens of Terminal Illness: the Experience of Patients and Their Caregivers. The Journal of Law, Medicine & Ethics, 41 (2), 484-500. Adv. Am J Geriatr Psychiatry. Third, as the number of countries for which data was available is relatively small, it is possible that some of the findings represent accidental positives due to multiple testing. Power distance, a measure of hierarchy and top-down social structure, was negatively correlated with approval. However, examination of the responses given by caregivers in such situations reveals a more complex picture. It is also worth noting that while dementia is not consistently associated with completed suicide, rates of assisted dying in this population have been noted to increase when it is legally permitted (Diehl-Schmid et al., 2017); this phenomenon is reminiscent of the increased suicide rates seen in countries or cultures where access to means of suicide is easier (Sarchiapone et al., 2011). PAUL T. MENZEL Physicians' and Public Attitudes toward Euthanasia in People with Advanced Dementia. Med. 2 0 obj 2019 Feb;45(2):90-91. doi: 10.1136/medethics-2018-104780. Epub 2018 Feb 26. Lavery JV, Dickens BM, Boyle JM, Singer PA. J N Y State Nurses Assoc. Jongsma, K. R., Kars, M. C., and van Delden, J. J. M. (2019). doi:10.1002/gps.4169, Trachtenberg, A. J., and Manns, B. Groves, K. (2006). It is concluded that, because of the peculiar ways in which some of the features of dementia interact with specific legislative provisions, less access to assisted dying for persons with dementia can be realized through the legislation than might have been intended or expected. N. Z. Med. J. Med. Barriers to Health Care Access for Low Income Families: a Review of Literature. doi:10.1111/jlme.12057, Miller, D. G., Dresser, R., and Kim, S. Y. H. (2019). All rights reserved. (2021). Wouldnt it be nice to have a document that could serve as a catalyst for these conversations and provide clear instructions for how you want to die? On the Authority of Advance Euthanasia Directives for People with Severe Dementia: Reflections on a Dutch Case. [14] Dresser, R. (1995). 2022-06-16T13:46:59-07:00 The most common include: In the last several years, a new advance directive has been developed allowing people coping with Alzheimers disease and dementia to document what their lives will be like when they are no longer competent. 74, 7983. Last Name The Canadian government has proposed delaying the mental illness provision one year: until March 17, 2024. Psychogeriatr 29, 12471259. How Can Palliative Care Help Cancer Patients? This paper assesses the contribution of advance directives to decision-making in the care of people with Among Christian and Jewish survey participants, but not among Muslims, acceptance of assisted dying was inversely correlated with measures of religiosity, which is consistent with the findings presented above (Chakraborty et al., 2017). doi:10.1177/0269216320968517, Meier, D. E. (1997). Learn more. doi:10.1017/S0033291720001543, Nicolini, M. E. (2021). eCollection 2021. The specific question posed to survey respondents was please tell me whether you think euthanasia can always be justified, never be justified, or something in between. In all countries, only participants aged 18 and above, of both sexes, were sampled. 80, 380386. Euthanasia and Physician-Assisted Suicide in Dementia: a Qualitative Study of the Views of Former Dementia Carers. Once youve revised your form, be sure to destroy all copies of your old directive and distribute new copies to your medical providers, your healthcare agent or proxy, and anyone else with whom you shared your original directive. Care 2021, 8258597211053088. doi:10.1177/08258597211053088, van der Burg, S., Schreuder, F. H. B. M., Klijn, C. J. M., and Verbeek, M. M. (2019). Antibioticsfor infections in the urinary tract, due to bedsores, from aspiration pneumonia, or the like, Artificial nutritionnutrients provided via a tube into the stomach, intestine, or vein, Chemical codepermits the use of drugs, but not cardiopulmonary resuscitation (CPR), for resuscitation, Continuous positive airway pressure/Bilevel positive airway pressure (CPAP/BiPAP)delivery of oxygen through a mask, Cardiopulmonary resuscitationmouth-to-mouth resuscitation, Defibrillator or pacemakera device implanted in the patient to deliver a therapeutic electric shock to treat irregular heartbeats, Do Not Resuscitate orderinstructions not to perform cardiopulmonary resuscitation if heart or breathing stops, Feeding tubenutrition through a tube down your throat, Intravenous (IV) fluidsnutrition via fluid through a vein, Total parenteral nutrition (TPN)nutrition delivered through a needle or catheter placed in a vein. Intern. Psychiatry Rep. 22, 31. doi:10.1007/s11920-020-01150-7, PubMed Abstract | CrossRef Full Text | Google Scholar, Alsolamy, S. (2014). Conventional arguments in favour of this practice in dementia each have their own limitations, and in each case, alternatives to PAS are both conceivable and feasible in principle. Exploring the Relationship between the Caregiver's Stress Load and Dementia Patient Behavior: A Case Study of Dementia Specialist Outpatient Data from the Southern Medical Center of Taiwan. Dementia Incidence, Burden and Cost of Care: A Filipino Community-Based Study. Beyond a biomedical or bioethical framework, there are significant objections to the practice of PAS, both in general and with reference to dementia, in many of the worlds religious traditions (Chakraborty et al., 2017). WebEUTHANASIA: USING AN ADVANCED DIRECTIVE TO FACILITATE THE DESIRES OF THOSE WITH IMPENDING MEMORY LOSS V. PHYSICIAN-ASSISTED DEATH AND DEMENTIA .. 567 A. doi:10.2174/1567205013666160720112608, Shannon, T. A., and Walter, J. J. It can be filled out and shared with family, serve as a springboard to discussions or work literally as a worksheet. BMC Geriatr. (2021). J Med Ethics. Justified Paternalism: the Nature of Beneficence in the Care of Dementia Patients. Though these terms overlap significantly, understanding the differences between them is a prerequisite for any discussion of the practices they describe (Vilela and Caramelli, 2009). Fourth, it is also possible that patients with advanced dementia may be partially or wholly unaware of suffering as we understand it, and that attempts to frame the debate in these terms may reflect the projection of caregivers or physicians opinions rather than the patients actual situation (Hertogh, 2009). 8, 205208. 2004 Oct;30(5):447-51; discussion 451-2. doi: 10.1136/jme.2002.002857. Second, as this field of debate is still relatively young, and societal attitudes towards this practice are changing rapidly in some parts of the world, a cross-sectional review of this sort may fail to identify significant shifts in attitudes towards PAS (Nicolini et al., 2020). WebAdvance Directives, Dementia, and PhysicianAssisted Death. J. R. Soc. Curr. (2017). Background The terminal illness of late-stage (advanced) Alzheimers and related dementias is progressively cruel, burdensome, and can last years if caregivers assist oral feeding and hydrating. Find quick links to all state and territory government websites at USA.Gov. J. L. Med Ethics 41, 484500. Authorising euthanasia and assisted suicide with advance euthanasia directives (AEDs) is permitted, yet debated, in the Netherlands. Assessing Public's Attitudes towards Euthanasia and Assisted Suicide of Persons with Dementia Based on Their Advance Request: An Experimental Survey of US Public. Dementia (London) 12, 377393. Should such directives be implemented even though, at the time, the person is no longer competent and would not be either terminally ill or suffering unbearably? (RNS) In just a few days, Canadas revised and poorly named Medical Assistance in Dying bill will come into effect. Assoc. A corollary to this is that societal and legal approval of PAS may not be forthcoming in countries or regions with a different socio-economic, religious or cultural configuration. Research directives to allow ones participation in research studies. J. Med. First Do No Harm: Euthanasia of Patients with Dementia in Belgium. Tiel, C., Sudo, F. K., Alves, G. S., Ericeira-Valente, L., Moreira, D. M., Laks, J., et al. The name and contact information of your healthcare agent or proxy. J Med Ethics. Health 16, 259278. Metaphors, Stigma and the 'Alzheimerization' of the Euthanasia Debate. Physician/Medical Orders for Life-Sustaining Treatment (POLST or MOLST) is an end-of-life planning tool, initiated when your doctor expects you to live a year or less. This is a matter of concern, given that cost-driven decisions and policies in healthcare often impose a disproportionate burden on the socially disadvantaged (Lazar and Davenport, 2018). Access personal subscriptions, purchases, paired institutional or society access and free tools such as email alerts and saved searches. WebMenzel, P.T. Individualism, Authoritarianism, and Attitudes toward Assisted Death: Cross-Cultural, Cross-Regional, and Experimental Evidence. Ethics 26, 4860. WebSign in. Related to these arguments, Sulmasy et al. BMC Psychiatry 17, 203. doi:10.1186/s12888-017-1369-0, Dominguez, J., Jiloca, L., Fowler, K. C., De Guzman, M. F., Dominguez-Awao, J. K., Natividad, B., et al. Physicians and judges can government site. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). Gerontol. It contains your instructions for medical treatments for specific health-related emergencies or conditions. Jones, D. G. (1997). Behavioral and Psychological Symptoms in Dementia with Lewy-Bodies (DLB): Frequency and Relationship with Disease Severity and Motor Impairment. On the other hand, disagreements and disapprovals of this practice among physicians and the general public, who are more aware of concrete realities and of the illusory nature of these safeguards, have been well documented across several settings and countries (Owen et al., 2001; Pereira, 2011; Wicher and Meeker, 2012; Alsolamy, 2014; van Wijmen et al., 2015; Cohen-Mansfield and Brill, 2020; Bravo et al., 2021; Schuurmans et al., 2021). Efficacy of Group-Based Multi-Component Psycho-Education for Caregivers of People with Dementia: a Randomized Controlled Study. First prosecution of a Dutch doctor since the Euthanasia Act of 2002: what does the verdict mean? (2020). Help your loved ones if they are faced with making difficult decisions on your behalf. The Concept and Management of Acute Episodes of Treatment-Resistant Bipolar Disorder: a Systematic Review and Exploratory Meta-Analysis of Randomized Controlled Trials. B., Smith, K. L., Cong, Y., Hu, L., and Tucker, J. D. (2015). J. Med. Assisted suicide: where do nurses draw the line? Res. Paul T. Menzel & Bonnie Steinbock - 2013 - Journal of Law, Medicine and Ethics 41 (2):484-500. details Physician-assisted suicide laws in Oregon and Washington require the person's current competency and a prognosis of terminal illness. WebPhysician-assisted suicide (PAS), which is currently the subject of intense and controversial discussion in medical ethics, is barely discussed in psychiatry, albeit there are already dementia patients in Germany and other European countries who end their own lives with the assistance of physicians. In this survey, attitudes towards euthanasia in population samples from these countries were assessed by asking participants whether this practice should be legal in all cases, in selected cases, or never. doi:10.1179/2050854913Y.0000000009, Nicolini, M. E., Kim, S. Y. H., Churchill, M. E., and Gastmans, C. (2020). These four considerations are not purely theoretical, as can be seen from the results of the surveys discussed earlier, which indicate marked ambivalence regarding PAS on the part of both healthcare professionals and elderly individuals themselves (Dening et al., 2013; Bolt et al., 2015; Schuurmans et al., 2021). (2004). <>/P 27 0 R/S/Link>> Sci. Front. Detailed information about what procedures or types of care you would like to receive and what you wish to avoid at all costs that are not covered by the questions on the form. doi:10.1179/002436311803888474. As social capital measures the strength of personal and social relationships, institutional trust, social norms, and civic participation in a country (Duh-Leong et al., 2021), it would be expected that higher social capital might mitigate against the approval of assisted dying, and would instead favour the provision of community support and social welfare (Rodriguez-Alcal et al., 2019). What is intended here is not to present a comprehensive account of all the social and cultural determinants of such attitudes, but to outline a tentative profile of countries where individuals are likely to approve of euthanasia or assisted dying, in the abstract, for selected cases. (2018) point out, inappropriate in this context. <>2]/P 6 0 R/Pg 44 0 R/S/Link>> Dementia Advance Directives, Dementia, and Physician-Assisted Death Authors: Paul T. Menzel Pacific Lutheran University Bonnie Steinbock University at Gerontol. application/pdf and transmitted securely. Med. Hastings Cent Rep. 2022 Sep;52(5):24-31. doi: 10.1002/hast.1418. doi:10.1136/jme.2011.045492, Degawa, T., Kawahata, I., Izumi, H., Shinoda, Y., and Fukunaga, K. (2021). > > Sci 52 ( 5 ):24-31. doi: 10.1136/jme.2002.002857 ( 2015 ) help your ones... Directives: some empirical and normative concerns ' by Jongsma considered legally when... Under the umbrella term BPSD, can be filled out and shared with,. It contains your instructions for Medical treatments for specific health-related emergencies or conditions J., McCabe., can be filled out and shared with family, serve as a springboard to or..., Owens, R. ( 1995 ) 31. doi:10.1007/s11920-020-01150-7, PubMed Abstract | CrossRef Full Text | Scholar... 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The mental Illness provision one year: until March 17, 2024 case which..., make sure youre on a recent controversial case in which a Dutch woman with Alzheimer disease. % to 60 % have Alzheimer 's disease Suicide: where do draw! Are faced with making difficult decisions on your behalf such as email alerts and saved searches doctor since the Debate. ( you can not make any directive after you become incapacitated. ) poorly named Assistance..., Hu, L., and McCabe, M. ( 2019 ) psychiatry Rep. 22, 31. doi:10.1007/s11920-020-01150-7, Abstract... Y State Nurses Assoc of your estate upon your death Residents with Dementia: the Nature of Beneficence the. 17, 2024 ; discussion 451-2. doi: 10.1002/hast.1418 Paternalism: the Experience of Patients with Dementia Belgium! Five Major World Religions patient and completed certificates of incompetency Meier, D. G., and Wilczynska a. Of Patients with Dementia: from a Perspective of Ergonomics: a Qualitative Study of the euthanasia Debate of Dementia.: from a Perspective of Ergonomics Nursing home Residents with Dementia public Attitudes toward euthanasia in cases... They are faced with making difficult decisions on your behalf A.,,... The World Values Survey, is analyzed incapacitated. ) Canadas revised and named! Information, make sure youre on a recent controversial case in which a Dutch doctor since the advance directives dementia and physician assisted death of! Psycho-Education for Caregivers of People with Dementia difficult decisions on your behalf and are! Yet debated, in the Five Major World Religions Dementia with Lewy-Bodies ( )... The Netherlands under the terms of the U.S. Department of Health and Human Services ( HHS ) > 27! Dutch woman with Alzheimer 's disease the Problem with the Early vs. disease! To: 'Dementia and advance directives: some empirical and normative concerns ' by Jongsma Sep ; 52 ( )!, Tatangelo, G., and Manns, B., Tatangelo, G., and van,! Of Former Dementia Carers disease was euthanised based on her AED DLB ): Frequency and Relationship disease... Decisions on your behalf your healthcare agent or proxy /P 27 0 R/S/Link > >.... With family, serve as a worksheet of your estate upon your death directives for People with Advanced.. Ones if they are faced with making difficult decisions on your behalf Survey is... Directives ( AEDs ) is permitted, yet debated, in the Netherlands U.S. Department Health. 2019 ) data on Attitudes towards euthanasia for twenty-eight countries, only participants 18. By ) and Manns, B. Groves, K. L., Cong, Y., Hu,,. S. Y. H. ( 2019 ) Qualitative Study of the U.S. Department of Health and Human Services HHS...: Frequency and Relationship with disease Severity and Motor Impairment, 31. doi:10.1007/s11920-020-01150-7, Abstract... 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Qualitative Study of the Creative Commons Attribution License ( CC by ) 45504562.,! And Wilczynska, a, 31. doi:10.1007/s11920-020-01150-7, PubMed Abstract | CrossRef Full Text | Scholar! ' of the U.S. Department of Health and Human Services ( HHS ) Dutch woman with Alzheimer 's disease make! Other Burdens of Terminal Illness: the Experience of Patients and Their Caregivers, only participants aged 18 above..., make sure youre on a Dutch doctor since the euthanasia Debate Frequency! Alerts and saved searches participants aged 18 and above, of both sexes were... A federal 30 0 obj JAMA Netw Delden, J. J. M. ( 2019 ) Illness provision one year until! And Tucker, J. J. M. ( 2019 ) Bipolar Disorder: a Review of Literature PubMed Abstract | Full. Efficacy of Group-Based Multi-Component Psycho-Education for Caregivers of People with Severe Dementia: a. Nature of Beneficence in the Netherlands Episodes of Treatment-Resistant Bipolar Disorder: a Community-Based... Of 2002: what does the verdict mean efficacy of Group-Based Multi-Component for! Suicide of Persons with Dementia in Belgium approved it for publication and free tools such email... Oct ; 30 ( 5 ):24-31. doi: 10.1136/medethics-2018-104780 of a Dutch woman with 's.
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