Euthanasia and physician-assisted suicide in dementia: A qualitative study of the views of former dementia carers

Tomlinson, Emily; Spector, Aimee; Nurock, Shirley; Stott, Joshua

doi:10.1177/0269216315582143

Cited by 35 publications

(49 citation statements)

References 36 publications

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“…Legality varies by country. The main reason that carers of people with advanced dementia consider assisted dying is the person with dementia's distress (565). This provides a strong rationale for providing maximal comfort and quality of life as death approaches.…”

Section: Key Challenges In End-of-life Care For People With Dementia mentioning

confidence: 99%

Dementia prevention, intervention, and care

et al. 2017

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People with dementia are usually older, often have co-morbidities and may need help in coping with these illnesses. A third of older people now die with dementia and all professionals working in endof-life care need to make this a central part of their planning and communication. In this commission, we have detailed evidence-based approaches to dementia and its symptoms. Services should be available, scalable and give value. As there are limited resources, professionals and services need to use what works, not use what is ineffective, and be aware of the difference. Overall, there is good potential for prevention and, once someone develops dementia, for care to be high-quality, accessible, and give value to an under-served, growing population. Effective dementia prevention and care could transform the future for society and vastly improve living and dying for individuals with dementia and their families. Acting now on what we already know can make this difference happen. Key Messages 1 There are increasing numbers of people with dementia globally although incidence in some countries has decreased. 2 Be ambitious about prevention: We recommend energetically treating hypertension in middle aged and older people without dementia to reduce dementia incidence. Interventions for other risk factors, including more childhood education, exercise, maintaining social engagement, reducing smoking, and management of hearing loss, depression, diabetes and obesity; may have the potential of delaying or preventing a third of dementias. 3 Treat cognitive symptoms: To maximise cognition, people with Alzheimer's dementia or Dementia with Lewy Bodies should be offered Cholinesterase Inhibitors (ChEIs)at all stages, or memantine for severe dementia. ChEIs are not effective in Mild Cognitive Impairment. 4 Individualise dementia care: Good dementia care spans medical, social and supportive care, should be tailored to unique individual and cultural needs, preferences, priorities, and should incorporate support for the family carers 5 Care for family carers. Family carers are at high risk of depression. Effective interventions reduce the risk and treat the symptoms, include START (Strategies for Relatives) or REACH (Resources for Enhancing Alzheimer's Caregiver Health intervention) and should be made available. 6 Plan for the future. People with dementia and their families value discussions about the future and decisions about possible attorneys to make decisions. Clinicians should consider capacity to make different types of decisions at diagnosis. 7 Protect people with dementia. People with dementia and society require protection from possible risks of the condition, including self-neglect, vulnerability including to exploitation, managing money, driving or using weapons. Risk assessment and management at all stages of the disease is essential but it should be balanced against the persons' right to autonomy. 8 Manage neuropsychiatric symptoms. Management of the neuropsychiatric symptoms of dementia including agitation, low mood or psyc...

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Section: Key Challenges In End-of-life Care For People With Dementia mentioning

confidence: 99%

Dementia prevention, intervention, and care

et al. 2017

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“…(7) Other characteristics associated with HCPs’ opinions include medical specialty(12–15) and especially religiosity. (7,12–14,16) Finally, various studies have elucidated the sentiments of particular stakeholder groups, such as Italian primary care physicians,(17) Greek intensive care unit physicians and nurses,(18) former caregivers of people with dementia,(19) and patients with advanced cancer. (20–22)…”

Section: Introductionmentioning

confidence: 99%

Health Care Professionals' Attitudes About Physician-Assisted Death: An Analysis of Their Justifications and the Roles of Terminology and Patient Competency

Braverman

Marcus

Wakim

et al. 2017

Journal of Pain and Symptom Management

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Context Healthcare professionals (HCPs) are crucial to physician-assisted death (PAD) provision. Objectives To quantitatively assess the favorability of justifications for or against PAD legalization among HCPs, the effect of the terms “suicide” and “euthanasia” on their views, and their support for three forms of PAD. Methods Our questionnaire presented three cases: physician-assisted suicide, euthanasia for a competent patient, and euthanasia for an incompetent patient with an advance directive for euthanasia. Respondents judged whether each case was ethical and should be legal, and selected their justifications from commonly cited reasons. The sample included physician clinicians, researchers, non-physician clinicians, and other non-clinical staff at a major academic medical center. Results Of 221 HCPs, the majority thought each case was ethical and should be legal. In order of declining favorability, justifications supporting PAD legalization were relief of suffering, right to die, mercy, acceptance of death, non-abandonment, and saving money for the healthcare system; opposing justifications were the slippery slope argument, unnecessary due to palliative care, killing patients is wrong, religious views, and suicide is wrong. Use of suicide and euthanasia terminology did not affect responses. Participants preferred physician-assisted suicide to euthanasia for a competent patient (p<0.0001) and euthanasia for an incompetent patient to euthanasia for a competent patient (p<0.005). Conclusions HCPs endorsed patient-centered justifications over other reasons, including role-specific duties. Suicide and euthanasia language did not bias HCPs against PAD, challenging claims that such value-laden terms hinder dialogue. More research is required to understand the significance of competency in shaping attitudes toward PAD.

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“…Suffering a terminal illness remains an important condition to granting a euthanasia request. 3,16,17 Two-thirds of all GPs would perform euthanasia in a patient with endstage dementia if that patient had a clear declaration of will and if legislation is adjusted to this condition. Arguments to support these statements include respect for the patient's autonomy, dignity, and quality of life.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…This trend was also observed in other studies. 3,9,16 A possible explanation for the openness of the oldest group of doctors towards euthanasia is that these doctors already faced concrete situations with dementia and euthanasia requests, possibly even within their own family. 10 The barrier to performing euthanasia in the case of dementia seems to be lower for GPs who have or have had a family member with dementia than it is for doctors without a family member with dementia.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Euthanasia in the case of dementia: a survey among Flemish GPs

Cleemput

Schoenmakers

2019

BJGP Open

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BackgroundIn Belgium law prohibits euthanasia at the end stage of dementia when patients are no longer able to formulate their will. The number of applications for euthanasia based on dementia is low, but patients and their relatives are searching for access to euthanasia.AimThis study assessed the opinions of GPs facing requests for euthanasia in patients with dementia.Design & settingA cross-sectional survey was performed in general practice. Flemish GPs were invited by email to participate in the study.MethodGPs were reached through the regional GP association and the online survey was open for 4 weeks. The data were then anonymised, analysed, and interpreted. The outcome of interest addresses opinions of Flemish GPs regarding euthanasia in patients with dementia.ResultsA total of 113/308 doctors participated. It was found that 69% agreed that euthanasia in patients without dementia is more acceptable than in patients with dementia. When patients with dementia had concomitant diseases, 59% stated that euthanasia was more acceptable than when patients were ‘healthy’. It was also found that 56% agreed the euthanasia law needs adjustments towards patients with dementia. Legal adjustments were supported more by GPs of a younger generation. Non-religious doctors were twice as likely to be in favour of legal adjustments than their religious colleagues; 51% believed that the ability of patients to repeat their will is essential; while 72% of GPs feared pressure from relatives to follow the declaration of will.ConclusionThe Belgian GP has an open attitude towards euthanasia for patients with dementia. There was a willingness to perform euthanasia as the stage of dementia worsened and in cases of terminal conditions. Debate, education, and experience will influence opinion and the legislation process.

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Euthanasia and physician-assisted suicide in dementia: A qualitative study of the views of former dementia carers

Abstract: Health workers should be mindful of the holistic experience of dementia at the end of life. The psychological and existential aspects of suffering should be addressed, as well as relief of physical pain. Further research is required.

Cited by 35 publications

References 36 publications

Dementia prevention, intervention, and care

Dementia prevention, intervention, and care

Health Care Professionals' Attitudes About Physician-Assisted Death: An Analysis of Their Justifications and the Roles of Terminology and Patient Competency

Euthanasia in the case of dementia: a survey among Flemish GPs

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