Assisted dying in dementia: a systematic review of the international literature on the attitudes of health professionals, patients, carers and the public, and the factors associated with these

Abstract

Sociodemographic factors can influence attitudes towards assisted dying. The impact of these, however, may also differ according to the population surveyed. The findings from this review can contribute to current debates and inform clinical practice and future research in this area.

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

“…16,17 A 5-point decrease in the index of religiosity (pointing toward less religious people) nearly doubles the odds of finding it to be acceptable that MAID be extended to the incompetent patient with Alzheimer's disease (ORs from 1.5 to 1.9 across the three models). Regarding the three potential confounders (data not shown in the table), the effect of gender was never significant, and that of age was inconsistent across models.…”

“…16 Higher support in Quebec may also reflect a general trend toward greater support over time 16,31 Continuous deep sedation is an alternative to MAID for alleviating a patient's suffering. 16 Higher support in Quebec may also reflect a general trend toward greater support over time 16,31 Continuous deep sedation is an alternative to MAID for alleviating a patient's suffering.…”

“…15 Little empirical data are currently available in Canada to inform the work of these panels. 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. Euthanasia in patients with dementia who are no longer competent is more controversial and continues to be debated, even in The Netherlands where the practice is legal in some circumstances.…”

“…Eligibility for MAID is restricted to competent adults residing in Quebec, who are at the end of their lives, have made persistent explicit requests for MAID, and "suffer from a serious and incurable illness, are in an advanced state of irreversible decline in capacity, and experience constant and unbearable physical or psychological suffering, which cannot be relieved in a manner the patient deems tolera- Little empirical data are currently available in Canada to inform the work of these panels. 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. Euthanasia in patients with dementia who are no longer competent is more controversial and continues to be debated, even in The Netherlands where the practice is legal in some circumstances.…”

“…[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. We further expected support for extending MAID to such patients to be stronger for those who are at the end of life and appear to be suffering, two requirements that are part of the current Quebec legislation.…”