When People Facing Dementia Choose to Hasten Death: The Landscape of Current Ethical, Legal, Medical, and Social Considerations in the United States

Abstract

Some individuals facing dementia contemplate hastening their own death: weighing the possibility of living longer with dementia against the alternative of dying sooner but avoiding the later stages of cognitive and functional impairment. This weighing resonates with an ethical and legal consensus in the United States that individuals can voluntarily choose to forgo life‐sustaining interventions and also that medical professionals can support these choices even when they will result in an earlier death. For these reasons, whether and how a terminally ill individual can choose to control the timing of their death is a topic that cannot be avoided when considering the dementia trajectory. With a focus on the U.S. context, this landscape review considers the status of provisions that would legally permit people facing dementia to hasten death with appropriate support from medical professionals. This review can be used to plan and guide clinical and legal practitioner discussion and policy development concerning evolving questions not fully covered by existing medical decision‐making provisions.

Choice in the Context of Dementia: Emerging Issues for Health Care Practice in Aging Societies

“…The landscape review responds to these initial questions. 6 Discussions during the first meeting of the project's team and work group in late 2019 identified additional questions relevant to how a person facing dementia perceives what life with progressive dementia is potentially like and how this undeniably difficult experience could be better supported. Following these discussions, the work group expanded to include more participants with expert knowl-edge of dementia care, often based in disciplines outside of bioethics or health care.…”