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May 4, 2022

Physician-Assisted Death for Patients With Dementia

Author Affiliations
  • 1GGZ inGeest Mental Healthcare, Amsterdam, the Netherlands
  • 2Department of Ethics, Law and Humanities, Amsterdam University Medical Center, Amsterdam, the Netherlands
  • 3Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands
JAMA Psychiatry. 2022;79(7):637-638. doi:10.1001/jamapsychiatry.2022.0808

In an increasing number of jurisdictions, including several US states, physician-assisted death (PAD) has been made possible. In the medical ethical debate, 2 conditions are generally mentioned for PAD to be justifiable. The first condition is the presence of unbearable and irremediable suffering, which for physicians may lead to a conflict of obligations between the duty to preserve life and the duty to relieve suffering. The second condition is a competent request by the patient to end life. When a patient requests PAD owing to dementia, both justifications may be challenged.

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2 Comments for this article
UW's Dementia Advanced Directive
Ann Mayo, DNSc | University of San Diego
This specialized advanced directive may be helpful with the competency issues that health care professionals face.

Crossing a Line
eugene breen, MB, MRCPsych, MRCPI | Mater Misericordiae University Hospital Dublin
The practice of medicine is all about curing and bringing comfort to sick people. When doctors cross the line of helping to harming something fundamental has been broken in our contract with society, the individual patient and with ourselves and broader profession. End of life care is a varied scenario between quick natural death to prolonged demise. 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 or years. A doctor is not called in to terminate a life even if "rationally requested" by the patient. That is not our job. Vets are called in to "put down" animals but animals are not rational free and spiritual beings - humans are and that is why you cannot kill them. The natural law forbids it as does the history and culture of medicine to date. The impact of medically assisted deaths on the vulnerable and elderly and depressed and those with serious illnesses is to undermine their hope and think they are a burden and are under pressure to be gone. This ripple effect can be seen in questionnaires from areas where such practice occurs.