Advance directives, dementia, and physician-assisted death

Area of Science:

• Bioethics
• Medical Law
• End-of-Life Care

Background:

• Current physician-assisted suicide laws in Oregon and Washington require competency and a terminal prognosis.
• Euthanasia in The Netherlands requires voluntariness and unbearable suffering.
• Concerns about loss of autonomy in dementia are significant, often outweighing concerns about pain in terminal illness.

Purpose of the Study:

• To explore the ethical justification for advance directives for physician-assisted death in cases of severe dementia.
• To determine if such directives should be valid even when the individual lacks current competency, a terminal diagnosis, or is not suffering unbearably.

Main Methods:

• Ethical analysis of existing physician-assisted death and euthanasia legislation.
• Development of a 'sliding scale' justification based on autonomy and capacity for enjoyment.
• Argumentation grounded in the principle of voluntariness.

Main Results:

• Advance directives for physician-assisted death in dementia can be ethically justified.
• A sliding scale approach enhances the authority of directives as a person's capacity for enjoyment and new interests diminishes.
• This approach extends the principle of voluntariness in end-of-life decision-making.

Conclusions:

• Advance directives for physician-assisted death in dementia represent a justifiable extension of legalized death assistance.
• The principle of voluntariness remains central, supporting autonomy even in the absence of current competency or terminal illness.
• A sliding scale model offers a framework for implementing such directives ethically.