Soc. Attitudes toward Euthanasia: A Longitudinal Analysis of the Role of Economic, Cultural, and Health-Related Factors. This danger may be especially acute in low- and middle-income countries, where rapid increases in the elderly population and the absence of a social welfare safety net may further contribute to such incentivization (Dominguez et al., 2021). Hospice vs. Palliative Care: What's the Difference? Ethical Issues Raised by the Introduction of Artificial Companions to Older Adults with Cognitive Impairment: A Call for Interdisciplinary Collaborations. Documenting concrete preferences for end-of-life care doesnt have to be daunting. I8Div yQJ> :'APv> w2%^QxX2(F"\=L;ui!A*{Zt@zI szTC)U]r'Q;YZ4%vd(C=$M;`qg;di{$[_i,z>6,Vb)0a (Hyn080{\*9?ZKYU.d,^${sl[KiV5=]_:f >Kdg % 3p^ %:6hxG"y}"JO[Vf_1^9470J`|7#lV\. In the former care, a further distinction can be profitably made between life-sustaining, basic forms of care, such as nutrition and hydration, and heroic forms of care, such as aggressive pharmacological treatment or repeated attempts at resuscitation. / . Mens Sana Monogr. In this model, gross national income was positively associated with approval of euthanasia in selected cases, while uncertainty avoidance was negatively associated with it. Asian J. Psychiatry 64, 102802. doi:10.1016/j.ajp.2021.102802, Nakanishi, A., Cuthbertson, L., and Chase, J. 2021 Dec 22;6:815233. doi: 10.3389/fsoc.2021.815233. Curr. Flow diagram showing the selection of articles for conceptual analysis. J. Subscribe to our E-Newsletter. JAMA Netw. official website and that any information you provide is encrypted doi:10.1016/j.legalmed.2019.07.007, Cohen-Almagor, R. (2016). (2009). 76, 864866. PLoS One 14, e0214724. In making these assessments, it is important to rely on logic, evidence, the principles of medical ethics, and the realities of diverse cultures and value systems outside the small number of countries which have endorsed this practice. J. Geriatr. 46, 101106. (2017). doi:10.3233/JAD-210078, Krag, E. (2014). J. L. Med Ethics 41, 484500. Counteracting Throwaway Culture in Daily Clinical Practice. Physician-assisted Suicide and Euthanasia in the Netherlands and Oregon: a Medical and Psychological Perspective, in Oxford Textbook of Suicidology and Suicide Prevention, Ch. Attitudes toward Physician-Assisted Death from Individuals Who Learn They Have an Alzheimer Disease Biomarker. Bolt, E. E., Snijdewind, M. C., Willems, D. L., van der Heide, A., and Onwuteaka-Philipsen, B. D. (2015). A Systematic Review of Older Adults' Request for or Attitude toward Euthanasia or Assisted-Suicide. Clipboard, Search History, and several other advanced features are temporarily unavailable. Curr. Christ Bioeth. Euthanasia in Adults with Psychiatric Conditions: A Descriptive Study of the Experiences of Belgian Psychiatrists. To learn more: read this JAMA essay about the rationale behind this project, and listen to this feature about it on NPR. 2023 Jan 8;52(1):afac310. Suicide and Assisted Dying in Dementia: what We Know and what We Need to Know. Some of these symptoms may be associated with particular causes or subtypes of dementia: for example, depression and apathy are common in vascular dementia (Tiel et al., 2015) while hallucinations are common in dementia with Lewy bodies (Borroni et al., 2008). Affect Disord. It may be appropriate to appoint a legal guardian to make decisions about property or finances, for example, yet leave other decisionsperhaps personal care, food, shelter and medical careto the person with Alzheimers disease. 41, 7489. Elaborating on these points in a further review (Sulmasy et al., 2018), the same author draws on the same argument, and further adduces arguments that have been discussed earlier in this paper, such as the limits of autonomy, the distinction between active killing and passive denial of particular treatments, the social ramifications of suicide and assisted suicide, and the possibility of a slippery slope characterized by incremental extension. Based on these, he concludes that the medical profession should continue its opposition to PAS on both prudential and ethical grounds. 21, 594599. Advance Directives, Dementia, and PhysicianAssisted Death. Understanding Economic and Other Burdens of Terminal Illness: the Experience of Patients and Their Caregivers. Int. doi:10.1111/psyg.12721, Deardorff, W. J., and Grossberg, G. T. (2019). Physician-Assisted Suicide in Dementia: Paradoxes, Pitfalls and the Need for Prudence. doi:10.1080/13607863.2019.1697201, Chakraborty, R., El-Jawahri, A. R., Litzow, M. R., Syrjala, K. L., Parnes, A. D., and Hashmi, S. K. (2017). J. doi:10.1007/s11606-018-4424-8, Sulmasy, D. P., Travaline, J. M., Mitchell, L. A., and Ely, E. W. (2016). Its called an advance directive, and completing it is one of the best ways to ensure your care preferences are honored. Being uninhibited, remiss about hygiene, inclined to mishaps or unable to keep things tidy does not indicate mental incompetence. Among Christian and Jewish survey participants, but not among Muslims, acceptance of assisted dying was inversely correlated with measures of religiosity, which is consistent with the findings presented above (Chakraborty et al., 2017). J. Med. As with Krags (Krag, 2014) analysis of a similar situation in high-income men, such considerations suggest that, depending on social and cultural contexts, groups that are thought of as privileged may actually be paradoxically vulnerable to an indiscriminate adoption of euthanasia or PAS. End-of-life Care and Psychiatry: Current Trends and Future Directions in India. However, examination of the responses given by caregivers in such situations reveals a more complex picture. Advocates of PAS in dementia could credibly respond to the three preceding sections by suggesting that the practice should be confined to patients with severe or terminal dementia, where the patients life expectancy is already low and there is little or no scope for improvement (Mondragn et al., 2020). The perceived right of an individual to make decisions about their own life and death, particularly when cognitive and neurological impairment leads to significant suffering and loss of autonomy or identity. Int. AEDs are problematic, but Mrs A is a misleading case. Money Changes Everything. doi:10.1097/YCO.0000000000000523, Fekadu, A., Wooderson, S. C., Markopoulo, K., Donaldson, C., Papadopoulos, A., and Cleare, A. J. Sci. agsdi-message-2. Names and signatures of individuals who witness you signing your advance directive, if required by your state. An argument about abortion, euthanasia and endobj In states where this directive is not legal, it can still be used to document wishes and provide a guide for families, health care providers, long-term care providers, and others. Individualism, Authoritarianism, and Attitudes toward Assisted Death: Cross-Cultural, Cross-Regional, and Experimental Evidence. After these transformations were applied, Pearsons correlation coefficient (r) was used to estimate the possible linear relationship between approval of euthanasia in selected cases and the above variables. doi:10.2174/1567205013666160720112608, Shannon, T. A., and Walter, J. J. Euthanasia and Physician-Assisted Suicide in Dementia: a Qualitative Study of the Views of Former Dementia Carers. WebPhysician-assisted suicide and advance directives concerning life support. This could lead to consent or approval being given under duress, and thus being of limited validity. 33 This option is lawful in Belgium and the Netherlands, and some scholars 34 0 obj (2003). Aging, Dementia and Care: Setting Limits on the Allocation of Health Care Resources to the Aged. Int. Dollars & Death. J. Physician-assisted death (PAD) covers both physician-assisted suicide (PAS) and euthanasia. xU[S[UB2Kr-jm::CuEH3>uB^49g^Zw6UBA0nnJr0T1Q8>!Zl-nYUKI: 9:Wx}=vR*J doi:10.1177/0141076818803452, Fornaro, M., Carvalho, A. F., Fusco, A., Anastasia, A., Solmi, M., Berk, M., et al. The number of dementia patients requesting euthanasia in the Netherlands has increased over the past five years. Epub 2014 Aug 12. (2020). Behavioural and Psychological Symptoms of Dementia in Patients with Alzheimer's Disease and Family Caregiver burden: a Path Analysis. Fifth, as these findings are based on country-level data, they cannot be extrapolated to individual residents of a given country. The National Hospice and Palliative Care Organization has a list of advance directive forms for every state, list of all advance directive/living will requirements by state, Creating Your Life File: A Checklist for End-of-Life Planning. Front. National Library of Medicine Given this, it is plausible that economic considerations may lead to the incentivization of PAS for patients with dementia, regardless of the best interests of the patient or their caregivers (Finucane, 1999; Sachs et al., 2004). Also referred to as hyperalimentation, Transfusionsoften of blood or blood products. However, in more recent times, there have been appeals to extend this practice to patients with other diagnoses, including dementia (Mondragn et al., 2019) and chronic depression or chronic pain disorders (Dees et al., 2011). Variables examined in association to national attitudes towards euthanasia in selected cases, with their data sources. Please enable it to take advantage of the complete set of features! As the focus of the current paper was on attitudes towards assisted dying in selected cases, the percentage of respondents for in selected cases (henceforth abbreviated EU-SELECT) was selected as the outcome (dependent) variable. A wide range of problematic behaviours, grouped together under the umbrella term BPSD, can be observed in patients with dementia. (2018) point out, inappropriate in this context. Efficacy and Safety of Pharmacotherapy for Alzheimer's Disease and for Behavioural and Psychological Symptoms of Dementia in Older Patients with Moderate and Severe Functional Impairments: a Systematic Review of Controlled Trials. The .gov means its official. Gerontol. J. Clin. Euthanasia and assisted suicide. These approaches could include healthcare-based approaches such as case management (Saragih et al., 2021), community-based interventions aimed at supporting patients and their families (De Luca et al., 2021), and even scientific research into the neurobiology of the most distressing manifestations of dementia (Kobayashi et al., 2021) which could lead to the development of safer and better treatment methods. doi:10.1111/j.1467-8519.2008.00708.x, Gerk, E. (2017). Biol. J. Palliat. The site is secure. endobj (2013). Dworkin on dementia: elegant theory, questionable policy. doi:10.1590/s0104-42302009000300016, von Knel, R., Mausbach, B. T., Dimsdale, J. E., Ziegler, M. G., Mills, P. J., Allison, M. A., et al. These four considerations are not purely theoretical, as can be seen from the results of the surveys discussed earlier, which indicate marked ambivalence regarding PAS on the part of both healthcare professionals and elderly individuals themselves (Dening et al., 2013; Bolt et al., 2015; Schuurmans et al., 2021). application/pdf Basing decisions regarding PAS on the least expensive or most cost-effective option subordinates the rights of both patients and caregivers to economic factors (Bilchik, 1996; Meier, 1997; Gerk, 2017) and opens the door to various forms of abuse (Kipke, 2015). 50, 12411256. The unfeasibility of requests for euthanasia in advance directives. (RNS) In just a few days, Canadas revised and poorly named Medical Assistance in Dying bill will come into effect. Socioeconomic Status and Medical Assistance in Dying: A Regional Descriptive Study. It is found that seemingly reasonable safeguards for the care and protection of terminally ill patients written into the Oregon law are being circumvented. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). These include apathy, depression, agitation, aggression, delusions, hallucinations, sleep disturbances, and behavioural disinhibition (Deardorff and Grossberg, 2019). WebGT was clearly able to consent to physician assisted death and the case does not discuss advance directives. <>7]/P 6 0 R/Pg 44 0 R/S/Link>> One limit to what an individual can ask for in an advance directive is medical assistance in dying (MAID). 800 897 (1997) The following countries were included in the final analysis: Algeria, Azerbaijan, Armenia, Brazil, China, Colombia, Ecuador, Egypt, Georgia, Haiti, Iraq, Kuwait, Lebanon, Libya, Mexico, Netherlands, New Zealand, Pakistan, Peru, the Philippines, Rwanda, Slovenia, South Africa, Sweden, Thailand, Tunisia, Uruguay and Yemen. J. Along with terminal illness, defined as prognosis of death within six months, contemporary competence is regarded as an important. Ending Treatment, VSED and other options. %PDF-1.7 % Ethics 18, 62. doi:10.1186/s12910-017-0222-9, Tomlinson, E., Spector, A., Nurock, S., and Stott, J. Second, the literature on existing attitudes towards PAS in cases of dementia, along with ethical arguments for and against the practice, is reviewed and specific hazards for patients, caregivers and healthcare professionals are identified. 22, 439451. Exploring the Relationship between the Caregiver's Stress Load and Dementia Patient Behavior: A Case Study of Dementia Specialist Outpatient Data from the Southern Medical Center of Taiwan. Ethics 41, 599606. 61 0 obj Is easily reachable by email, phone, and/or text. 2 As the nation, individual states, and various interest groups consider the adoption of physician-assisted suicide policies, it is essential that doi:10.1016/B978-0-444-64012-3.00002-2, Dees, M. K., Vernooij-Dassen, M. J., Dekkers, W. J., Vissers, K. C., and van Weel, C. (2011). Dementia is ruled out as a candidate for PAD, even if she is terminally ill and suffering terrible and unrelievable pain, which rules out individuals with strong and unwavering desires not to end their life in dementia. on the Question of Argumentative Coherence of Endorsing Assisted Suicide. What Happens to Patients with Treatment-Resistant Depression? What is needed is not advocacy of PAS as a quick fix for the complex problems encountered by patients with dementia and their caregivers, but respecting patients humanity and providing them with more care, compassion, and good doctoring. (Cohen-Almagor, 2016; Hendin et al., 2021), and an attitude of neutrality or passivity on the part of the medical profession is, as Sulmasy et al. Clipboard, Search History, and several other advanced features are temporarily unavailable. Med. In recent times, euthanasia and physician-assisted suicide for specific medical conditions have been legalized in specific countries and territories (Pereira, 2011; Tomlinson and Stott, 2015). Durable power of attorney for healthcare, which assigns decision-making authority on medical matters to a particular person if one is no longer competent. 35, 2837. First, as noted above, responses given by study subjects in surveys are crucially influenced by methodological issues, such as the manner in which a question is framed; thus, some of the lack of uniformity in results may reflect the influence of these factors. An official website of the United States government. 62 0 obj and transmitted securely. Epub 2016 Oct 21. endobj In some countries, the term medical assistance in dying is used as a synonym for assisted dying. Thus, both euthanasia and PAS require the intervention of a physician, with the only difference between the two practices being the person who administers the drugs in question. doi:10.1177/0024363920936080, Gao, C., Chapagain, N. Y., and Scullin, M. K. (2019). Each doi:10.1111/j.1525-1497.2004.30329.x, Saragih, I. D., Tonapa, S. I., Lin, C. J., and Lee, B. O. doi:10.1136/jme.2011.045492, Degawa, T., Kawahata, I., Izumi, H., Shinoda, Y., and Fukunaga, K. (2021). Geriatr. The results of a stepwise multivariate linear regression analysis, taking EU-SELECT as the dependent variable and all significantly correlated parameters from the bivariate analyses as independent variables, is presented in Table 3. The significant discrepancy between these results suggests that legalization of PAS may produce significant shifts in the attitudes of caregivers towards this practice, regardless of their earlier attitudes; moreover, such attitudes and shifts are unlikely to be uniform, and may be crucially influenced by variables such as sex and ethnicity (Owen et al., 2001; Wicher and Meeker, 2012; Stolz et al., 2015; Cohen-Mansfield and Brill, 2020) as well as by individual political and religious beliefs (Kemmelmeier et al., 2002; Richter et al., 2001; O'Dwyer et al., 2016). Webdisease. Euthanasia and Assisted Suicide of Persons With Dementia in the Netherlands. We have the right to make our own healthcare decisionseven when we have Alzheimers disease. J. Environ. After Providing End of Life Care to Relatives, what Care Options Do Family Caregivers Prefer for Themselves? 2004 Oct;30(5):447-51; discussion 451-2. doi: 10.1136/jme.2002.002857. Omega (Westport) 43, 349361. 1 0 obj WebADVANCE DIRECTIVES, DEMENTIA, AND ELIGIBILITY FOR PHYSICIAN-ASSISTED DEATH I. Would you like email updates of new search results? Advance consent, critical interests and dementia research. WebThe tenability of maid and death and advance directives dementia physician assisted suicide, as the web site requires in this aper suggests that they are similar. These are not independent of each other; for example, a survey of African-Americans found that several factors, including their cultural and spiritual values and their attitude towards the healthcare system, influenced their lower preference for euthanasia or PAS (Wicher and Meeker, 2012). WebPosted in Something Special | Tagged advance directive for dementia, Alzheimer's disease, Dementia and physician assisted death, Emily Largent, Medical aid in dying, Penn Memory Center, Gaster is a primary care physician and a professor of medicine at the University of Washington who has developed the Advance Directive for Dementia. It is essential to avoid a situation where patients or caregivers are made to believe that dementia is associated with a duty to die (Cholbi, 2015; Huang and Cong, 2021). Psychiatry 29, 384394. Alzheimer Dis. Rev Neurol (Paris). Depression and Anxiety Among Partner and Offspring Carers of People with Dementia: a Systematic Review. Voiceless and Vulnerable: Dementia Patients without Surrogates in an Era of Capitation. G KZlcL4Hs|r;t{8q3E(&[lf 0)B'[s@TPsP (PHeZL60Z\]/8~]gQ23F;Lw %Q |ymED|r.WlZeT7A#Ij^IjQ\qc*):AyS ^mu..\=9~?cEyNC1wT*=u2dW6JH#exc,)x54XvDcKw`8T_8uK?&{hB YQo]gLI{Y+vl%[i$*EPw;#6Wm_I+Nh8W{i;\Ho s<=`V-ZJo jyqpnT!{Ru$6g[C7V^ `[-qN'vp|%DH1NV&8N)xtbqI3AR93$4-<=N!De,Y8PC9hB2LIA Zj6 By issuing an advance treatment directive, an autonomous person can formally express what kinds of treatment she wishes and does not wish to receive in case she becomes ill or injured and unable to, Advances in Intelligent Systems and Computing. MAID entails a physician or nurse practitioner administering, prescribing, or providing to a patient, at the patients request, a substance that will cause the patients death. Further, it is argued that since informed consent may be impossible once this disintegration has occurred, such an option should not be restricted only to advanced cases (Cipriani and Di Fiorino, 2019), and should be included in advance directives (Menzel and Steinbock, 2013) under the principle of precedent autonomy (Groves, 2006). (2003). (2012). FOIA It is argued that, given the loss of autonomy that is entailed by cognitive decline, patients should have the right to choose PAS via advance directive prior to the onset of such decline. doi:10.1503/cmaj.160650, Tran, M., Honarmand, K., Sibbald, R., Priestap, F., Oczkowski, S., and Ball, I. M. (2021). Good news: such a document exists. doi:10.1016/j.jpainsymman.2021.01.009, Jakhar, J., Ambreen, S., and Prasad, S. (2020). doi:10.1016/s1474-4422(03)00536-2, Richter, J., Eisemann, M., and Zgonnikova, E. (2001). J. Toward the Clarification of Ideas: Medical Futility, Persistent/obstinate Therapy and Extra/ordinary Means. The authors argue that both contemporaneous and (most) non-contemporaneous decisions for VSED are legally permissible and do not, as many believe, constitute abuse, neglect, or assisted suicide. WebMenzel, P.T. Instead, other countries and cultures might benefit from alternative approaches to alleviate the suffering caused to patients and caregivers by this condition. ISSUE. The name and contact information of your healthcare agent or proxy. <> A multi-centre, quasi-experimental study was conducted to test the feasibility and acceptability of a theory - Farr Law Firm. Learn more. J. R. Soc. Considering that one of the arguments advanced in favour of PAS is the economic burden faced by caregivers as well as society at large, this finding is unexpected, and suggests that economic hardship or deprivation alone may not significantly influence positive attitudes towards PAS. Prof. Psychol. doi:10.1016/j.jagp.2020.07.013, Materstvedt, L. J., Clark, D., Ellershaw, J., Frde, R., Gravgaard, A. M., Mller-Busch, H. C., et al. The final model included only two variables gross national income and uncertainty avoidance and explained approximately 58% of the variance in attitudes towards euthanasia (R2 = 0.628; adjusted R2 = 0.581). Compassion and Love: the Antidote for Sentimentalism at the End of Life. TABLE 1. Physicians and judges can National Library of Medicine Physician Aid in Dying for Dementia: The Problem with the Early vs. Late Disease Stage Distinction. endobj WebThe movement toward physician-assisted suicide, also called assisted death (AD), is built upon a fundamental moral premise: each of us should have control over our lives and deaths. Fifth, there are certain dangers in relying on an advance directive in such cases, because an individuals wishes may vary over time: a patient with early dementia might express a wish for PAS due to psychosocial factors (such as depression or economic hardship) at one point in time, but express a different attitude if such problems are ameliorated (Dcruz, 2021). J. 'Mrs A': a controversial or extreme case? This is partly supported by the available data (Table 4). Second, they attempt to capture attitudes towards a complex ethical situation using simple nominal categories, leading to a loss of nuance. doi:10.1177/0269216312464094, Deodhar, J. K. (2016). Med. Ann. (2003). In the last several years, a new advance directive has been developed allowing people coping with Alzheimers Cost Analysis of Medical Assistance in Dying in Canada. Semantic Scholar is a free, AI-powered research tool for scientific literature, based at the Allen Institute for AI. doi:10.1177/1471301211429168. <>14]/P 22 0 R/Pg 44 0 R/S/Link>> It is suggested that the practice of PAS in dementia is not one that can be widely or safely endorsed, on both cultural and ethical grounds, and the medical field should work in collaboration with governmental, social welfare and patient advocacy services to ensure optimal physical, emotional and financial support to this group of patients and their caregivers. Second, as this field of debate is still relatively young, and societal attitudes towards this practice are changing rapidly in some parts of the world, a cross-sectional review of this sort may fail to identify significant shifts in attitudes towards PAS (Nicolini et al., 2020). 37 0 obj T-type Ca2+ Channel Enhancer SAK3 Administration Improves the BPSD-like Behaviors in AppNL-G-F/NL-G-F Knock-In Mice. National Library of Medicine Sleep Duration and Sleep Quality in Caregivers of Patients with Dementia: a Systematic Review and Meta-Analysis. Assoc. Third, as the number of countries for which data was available is relatively small, it is possible that some of the findings represent accidental positives due to multiple testing. Is Physician-Assisted Death Possible for People with Dementia? Hospice and Palliative Care Eligibility Guidelines, Medicare Hospice Benefit & Physician Billing, Hospice Puts the Patient and Family in Control. The majority of caregivers (11/21, 52.4%) denied any such ideations or behaviour (O'Dwyer et al., 2016). Geriatr. Front. The wishes of a person with dementia should be considered whenever possible and until safety becomes an issue. Dementia as a Source of Social Disadvantage and Exclusion. (2008). 36, E262E283. Stat. Refining Caregiver Vulnerability for Clinical Practice: Determinants of Self-Rated Health in Spousal Dementia Caregivers. Med. 17, 9779. You can review or change your advance directive at any time. 35, 447454. We focus on a recent controversial case in which a Dutch woman with Alzheimer's disease was euthanised based on her AED. Now It's Entering the Debate over the Right to Die-Wwith Explosive Results. There is an urgent need to develop research into the patient's perspective with regard to medical treatment and care-giving in dementia, including end-of-life care, as well as ethical and practical dilemmas created by euthanasia requests in advance directives. Ethics 45, 9294. Perimortal initiatives: issues in foregoing life-sustaining treatment, suicide, and assisted suicide. When there is no AD and family and professionals are assessing the competence of a person with Alzheimers, the Alzheimers Association urges the least restrictive alternativesin other words, choose to protect the persons right to make his/her own decisions whenever possible. Skip to main content. A Personalist Approach to Euthanasia in Persons with Severe Dementia. Dementia and advance Directives: Some Empirical and Normative Concerns. In this contribution we discuss some of the main arguments: the nature of suffering, the voluntariness of the request and the role of the physician. Advance care planning (ACP) is highly relevant for people with early-stage dementia to communicate their care preferences for serious illness conditions with their family caregivers before they become mentally incapacitated. (2021). Barriers to Health Care Access for Low Income Families: a Review of Literature. WebGale Academic OneFile includes Advance directives, dementia, and physician-assisted de by Paul T. Menzel and Bonnie Steinbock. 67, 527539. Groenewoud AS, Leijten E, van den Oever S, van Sommeren J, Boer TA. Coers DO, de Boer ME, Sizoo EM, Smalbrugge M, Leget CJW, Hertogh CMPM. Watson, B., Tatangelo, G., and McCabe, M. (2019). (2021). <> Second, dementia is generally not a condition associated with severe, intractable pain or other forms of suffering that are seen other terminal illnesses; thus, it would be fallacious to argue for PAS on the basis of suffering in these patients. <>/P 27 0 R/S/Link>> Following the Money. What is needed, instead, is the identification a middle position that recognizes the futility of aggressive or heroic treatments in advanced dementia, while avoiding the pitfalls associated with euthanasia or PAS (Jones, 1997; Hendin et al., 2021). Bethesda, MD 20894, Web Policies Bookshelf Justified Paternalism: the Nature of Beneficence in the Care of Dementia Patients. Psychol. Persons with pre-dementia have no Kantian duty to die. endobj Finally, as Johnstone (2013) has pointed out, the use of dementia in public debates over assisted dying has led to the adoption of problematic imagery and metaphors to describe dementia. Embedding Caregiver Support in Community-Based Services for Older Adults: A Multi-Site Randomized Trial to Test the Adult Day Service Plus Program (ADS Plus). The doctor is called in to help the suffering person cope with discomfort, pain, anguish and a whole array of mental and spiritual challenges that occur during these last days months The author confirms being the sole contributor of this work and has approved it for publication. In addition to impairing the quality of life of both patients and caregivers, some of these symptoms particularly agitation, aggression and hallucinations are associated with a marked elevation in the burden faced by caregivers (Kim et al., 2021). L. 60, 278286. have pointed out that the endorsement of PAS creates a fundamental conflict between a physicians role as providing care to the vulnerable, and their participation in a destructive act (Sulmasy et al., 2016).