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

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.