Are Informal Caregivers of Persons With Dementia Open to Extending Medical Aid in Dying to Incompetent Patients? Findings From a Survey Conducted in Quebec, Canada

Abstract

Euthanasia is a controversial and complex issue, especially when involving incompetent patients. On December 10, 2015, Quebec became the first Canadian province to give access to medical aid in dying (MAiD) (ie, euthanasia performed by a physician) to competent patients who satisfy strictly defined criteria. Less than 2 years later, Quebec is considering extending MAiD to incompetent patients who made an advance request. With the objective of contributing scientific data to current societal debates, we conducted a survey among 471 informal caregivers of persons with dementia, reached through Alzheimer Societies. We used a series of vignettes featuring a person with Alzheimer disease to investigate respondents' attitudes towards MAiD. The response rate was 69%. Two-thirds [68%; 95% confidence interval, 63%-73%] found it acceptable to extend MAiD to an incompetent patient at an advanced stage of Alzheimer disease who had made a written request while competent, and 91% (95% confidence interval, 87%-94%) found it acceptable at the terminal stage. Self-determination was the most widely endorsed argument in favor of access to MAiD for incompetent patients. Findings suggest strong support among informal caregivers for extending MAiD to incompetent patients, provided they are terminally-ill and had made a written request before losing capacity.

Comparing the attitudes of four groups of stakeholders from Quebec, Canada, toward extending medical aid in dying to incompetent patients with dementia

“…[20][21][22] Excluding sampled individuals who identified themselves as noneligible, response rates were 69% for informal caregivers (n = 306), 59% for nurses (n = 291), and 25% for physicians (n = 136). [20][21][22] Excluding sampled individuals who identified themselves as noneligible, response rates were 69% for informal caregivers (n = 306), 59% for nurses (n = 291), and 25% for physicians (n = 136).…”

“…Characteristics of the three other groups of respondents have been reported elsewhere. [20][21][22] Excluding sampled individuals who identified themselves as noneligible, response rates were 69% for informal caregivers (n = 306), 59% for nurses (n = 291), and 25% for physicians (n = 136). The mean age (±SD) was 66 ± 11 for informal caregivers, 52 ± 9 for nurses, and 49 ± 12 for physicians; 72% of informal caregivers, 82% of nurses, and 60% of physicians were female.…”

“…14 Another expert panel was recently given a mandate to review the evidence on this issue by the Government of Canada who decriminalized medical assistance in dying 6 months after Quebec's legislation came into force. [20][21][22] Herein, we first report older adults' attitudes on the issue and second compare attitudes across the four targeted groups. 16 Research conducted in other countries shows that acceptance of death-hastening practices has increased in the last decades, 17,18 especially for terminally ill but still competent patients who suffer unbearably from an incurable disease.…”

“…Findings from the first three groups have recently been published. [20][21][22] Herein, we first report older adults' attitudes on the issue and second compare attitudes across the four targeted groups. On the basis of the findings from other countries, 16,23 we expected older adults and informal caregivers to have more permissive attitudes than nurses and physicians toward extending MAID to incompetent patients with dementia.…”

“…Data for informal caregivers, nurses, and physicians were first reported in Bravo et al[20][21][22] Data for informal caregivers, nurses, and physicians were first reported in Bravo et al[20][21][22] …”