Introduction

Webcast archive: Euthanasia for Alzheimer’s disease

This week, we discuss news stories about providing euthanasia for people with dementia.

Webcast archive: Euthanasia for Alzheimer’s disease

In this episode of Euthanasia & Disability, Amy Hasbrouck, Taylor Hyatt, & Christian Debray discuss:

  • Euthanasia for Alzheimer’s disease
  • World Medical Association reaffirms opposition to AS/E

Please note that this text is only a script and that our webcast contains additional commentary.

EUTHANASIA FOR ALZHEIMER’S DISEASE

  • We recently learned of two incidents of euthanasia where the medical condition was Alzheimer’s disease.
  • The first occurred in British Columbia in 2017 and was described in an article in the Globe and Mail last month.  Like most coverage of AS/E, the article was all in favour of the euthanasia, and evoked fear of disability, with phrases such as “the descent into dementia is harrowing under any circumstance.”
  • The article laid out the conditions under which Mary Wilson, a woman in her 70s, said she didn’t want to live. “I do not want to be placed in a home and I do not want to live past the day when I can’t recognize [my husband] or the kids or my sister and brother.”  Though these conditions had nothing to do with pain or physical symptoms, she nonetheless had the “full-throated support” of her husband and children to die, once her “beautifully-tuned mind” could no longer perform up to its usual standard.
  • The author builds dramatic tension by highlighting the difficulty in planning the euthanasia around the requirements that Ms. Wilson’s condition was in an advanced state of irreversible decline, that her death had become “reasonably foreseeable” and that she was still competent to consent when euthanasia was performed.
  • Events came to a head in the summer of 2017 when Ms. Wilson’s husband was hospitalized, and could no longer help her with daily activities like dressing. This, along with forgetting “for a fleeting moment” that she had three children (and not just the one in the room with her), is offered as fulfilling the conditions she set out for her death.
  • In a piece for the Sunday Edition on October 27, the CBC takes up the story of the euthanasia of people with dementia with an account of the death of another BC resident, Gayle Garlock in August of this year. Like the Globe and Mail journalist, the CBC reporter assumed that loss of intellectual capacity amounted to “intolerable suffering;” in Mr. Garlock’s case, being unable to read.  Also like the other article, the CBC piece portrays the doctors as heroic defenders of the person’s right to choose to die, but didn’t question whether the person had a full range of options for living. The journalists said nothing about providing the supports necessary to grieve the loss of memory and intellectual ability, adapt to the new reality and live comfortably at home until their natural death.
  • Here are some ideas to think about.
  • Both articles refer to guidelines created by the Canadian Association of MAiD Assessors and Providers (CAMAP) for evaluating MAiD requests from people with Alzheimer’s disease or other dementia.  Those guidelines state that “it is not the responsibility of the clinician who assesses eligibility for MAiD to formally diagnose dementia, but it may be necessary for that clinician to form an opinion as to the presence, duration, impact, and type of cognitive impairment or dementia.” CAMAP gives the Diagnostic and Statistical Manual (DSM-5) criteria for dementia (now called “major neurocognitive disorder”), the first of which is “evidence of significant cognitive decline.”  The guidelines list many causes of cognitive decline that can be remedied, including thyroid problems, depression, sleep apnea, vitamin B-12 deficiency, medication side effects, and environmental toxins. The recommendations then say “The clinician assessing for MAiD eligibility is not responsible for testing and excluding these possible contributing factors but should be assured that reasonable efforts have been made to exclude and/or mitigate them.” If the person who makes the life-or-death decision isn’t responsible, who is?
  • Some people might point to the timing and style of these two articles as evidence of a campaign by pro euthanasia groups like Dying with Dignity to build public tolerance for euthanasia of people with dementia.  Those same people might also consider the selection of Lise Pigeon’s question about MAiD during the second French-language debate to be part of a similar effort to ensure public support for the Attorney General’s decision not to appeal the Truchon decision. Would those people be paranoid, cynical and jaded, or merely perceptive and realistic?
  • Finally, the idea that being unable to read or “rattle off the names and ascension dates of every British monarch back to 1066” equals intolerable suffering seems elitist.  For Amy, who depends on memory, logic and deduction to make sense of very limited visual input she gets, losing mental capacity would basically mean losing some of her vision, but it’s certainly not worth dying over.  Being around disabled people and having a disability means learning to accept people as they are, to take one day at a time, that there’s more than one way to get things done, and to appreciate the important things in life.

WORLD MEDICAL ASSOCIATION REAFFIRMS OPPOSITION TO AS/E

  • In a statement released October 26, 2019, the World Medical Association has reaffirmed its long-standing policy of opposition to euthanasia and physician-assisted suicide.
  • At its annual Assembly in Tbilisi, Georgia, the WMA adopted a revised Declaration on Euthanasia and Physician-Assisted Suicide. While opposing AS/E, the declaration says a doctor who “respects the basic right of the patient to decline medical treatment does not act unethically in forgoing or withholding unwanted care.”
  • The WMA defines euthanasia as “a physician deliberately administering a lethal substance or carrying out an intervention to cause the death of a patient with decision-making capacity at the patient’s own voluntary request,” while assisted suicide involves “a physician deliberately enabl[ing] a patient to end his or her own life by prescribing or providing medical substances with the intent to bring about death.”