A new international survey reveals sharp divisions among clinicians on the acceptability of euthanasia for patients with dementia who request it, with nearly half in favor and almost as many opposed.<\/p>\n
\u201cNearly half of the clinicians found it acceptable for people with dementia, while almost the same percentage considered it unacceptable,\u201d Jenny T. van der Steen, MSc, PhD, who worked on the survey, told Medscape Medical News.<\/p>\n
Acceptability of euthanasia for dementia varied substantially across countries and between individual providers, said van der Steen, with the Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.<\/p>\n
Notably, training in palliative medicine, religious affiliation, and certain coping styles were linked to lower acceptance of \u2014 or willingness to perform \u2014 euthanasia at the request of a patient with dementia.<\/p>\n
The survey results were published online<\/a> on August 20 in the American Journal of Geriatric Psychiatry.<\/p>\n A Controversial Issue<\/p>\n \u201cSome people with dementia would rather die than live with the condition, and they may consult their doctor or request medical assistance in dying or euthanasia in jurisdictions where this is allowed,\u201d said van der Steen noted.<\/p>\n \u201cClinicians are responsible to evaluate and respond to such requests, and in the case of euthanasia, they may also perform it. However, euthanasia is particularly controversial in the case of dementia because of the declining cognitive capacity accompanying the disease,\u201d she noted.<\/p>\n The survey assessed clinicians\u2019 views on the acceptability of euthanasia for people with dementia, surveying 202 physicians and three nurse specialists with comparable medical responsibilities across six high-income countries \u2014 the Netherlands, Switzerland, Germany, the US, Japan, and Israel \u2014 which differ in their legislation and end-of-life options.<\/p>\n Euthanasia for dementia is not permitted in the US, Switzerland, Germany, Japan, or Israel. The Netherlands permits euthanasia, including for people with dementia, although it\u2019s primarily restricted to people with mild dementia who are still capable of sound decision-making.<\/p>\n Switzerland permits physician-assisted dying (PAD) in cases of dementia, provided the patient has the mental capacity to decide and is able to self-administer the lethal medication.<\/p>\n PAD is legal in some US states, including Oregon, Washington, California, Colorado, New Jersey, Maine, New Mexico, Vermont, Hawaii, Montana, and Washington, DC \u2014 but not for patients with dementia.<\/p>\n Varied Perspectives<\/p>\n In the survey, clinicians\u2019 perspectives on the acceptability of euthanasia for those with dementia varied across countries and individual providers.<\/p>\n Overall, more than 2 in 5 (44%) of clinicians considered euthanasia acceptable for people with dementia, ranging from 23% in Switzerland to 66% in the Netherlands.<\/p>\n Willingness to carry out euthanasia was lower: Only 38% of clinicians said they would perform the procedure at the request of a patient with dementia, with rates ranging from 18% in Germany to 58% in the Netherlands. Just 15% were willing to act on a request from a family caregiver. Yet 35% reported they would want euthanasia for themselves if they developed dementia.<\/p>\n Overall, the researchers said the findings highlight a core \u201ctension\u201d in end-of-life care for dementia \u2014 balancing respect for the autonomy of individuals with mild dementia who request euthanasia because they view advanced dementia as unbearable, against the need to protect vulnerable, incompetent patients by carefully assessing current suffering and guarding against undue influence from relatives.<\/p>\n However, they cautioned that the survey did not specify factors such as decision-making capacity or dementia stage \u2014 elements that clinicians may consider crucial when judging the acceptability of euthanasia.<\/p>\n The Clinician\u2019s Role<\/p>\n \u201cIn our opinion, doctors should inform patients when they raise questions about assisted dying, but we do not recommend doctors to actively inform all patients about the options as this wish and request should be fully theirs,\u201d said van der Steen.<\/p>\n \u201cDoctors also have a role in clarifying and attending to the underlying reasons that motivate the person\u2019s request for assisted dying in case these are modifiable,\u201d she said.<\/p>\n To support these difficult discussions, the nonprofit Compassion & Choices, in partnership with the American Society on Aging, has developed a clinician resource titled Essential Conversations: Planning for Life with Dementia.<\/a><\/p>\n \u201cSince dementia is a progressive disease that will impact a person\u2019s ability to communicate, make decisions, and participate in daily activities, it is critical healthcare providers provide clear information on what to expect, what supports are available, and begin advance care planning conversations as soon as possible,\u201d Jessica Empe\u00f1o, MSW, APHSW-C, national director, clinical engagement, Compassion & Choices, told Medscape Medical News.<\/p>\n In addition to a standard advance directive, Compassion & Choices recommends a dementia directive to incorporate specific information and instructions related to life with dementia, Empe\u00f1o said.<\/p>\n