Leaving Life Too Early or Leaving the Decision Too Late in Alzheimer-Type Dementias: Choices and Preferences for Medical Assistance in Dying (MAID)

Abstract

In many Western countries, especially if they have good palliative care services, dementia is now more feared than cancer and surveys consistently show that most indigenous citizens would not want to continue living once dementia had become severe or even moderately severe. If they were to develop a life-threatening condition at this stage of the illness, most would not want to be resuscitated, yet that is what commonly happens. In Britain and Canada, most would like the option of an advance request for medical assistance in dying (MAID) in the form of euthanasia when dementia reaches a certain degree of severity. That is legal in the Benelux countries but even doctors sympathetic to MAID may find the process difficult. The only alternatives, restricted to people with early dementia, are MAID by medically assisted rational suicide (MARS, available in Switzerland) voluntary euthanasia (available in Benelux countries and probably now Canada) or voluntarily stopping eating and drinking (VSED—legal in most countries) before they lose mental capacity. Surveys also show important differences between religious groups in their attitudes to MAID in all diagnostic contexts after discussing some of the ethical, philosophical, religious and diagnostic issues that MAID raises, and this chapter presents some case histories of patients who chose and received MARS in Switzerland.

Retired psychiatrist. London, UK. Formerly lecturer, department of psychiatry, University of Birmingham and director of the community alcoholism treatment service, Westminster Hospital, London. Currently board member and medical group convener, My Death, My Decision (mydeath-mydecision.org.uk).