Citation

Mondragón JD, Salame L, Kraus A, De Deyn PP. Dement. Geriatr. Cogn. Dis. Extra 2019; 9(2): 217-226.

Copyright

(Copyright © 2019, Karger Publishers)

DOI

10.1159/000500183

PMID

unavailable

Abstract

BACKGROUND: Requests for physician-assisted death (PAD) in patients with cognitive impairment are complex and require careful consideration. Of particular difficulty is determination of whether the request is voluntary and well considered.

RESULTS: Euthanasia and physician-assisted suicide (PAS) are both legal in The Netherlands, Luxemburg, Colombia, and Canada. Euthanasia is legal in Belgium, while PAS is legal in Switzerland and Oregon, Washington, Montana, Vermont, and California (USA). Upon a PAD request, evaluation of the capacity to consent medical treatment is relevant for the decision-making process, while evaluation of testamentary capacity is appropriate before an advance euthanasia directive is written. Anosognosia assessment throughout the Alzheimer's disease continuum provides essential and relevant information regarding the voluntary and well-considered nature of the PAD request; meanwhile, early assessment of hypernosognosia or subjective cognitive decline assists in formulation of a clinical prognosis. Furthermore, the assessment of physical and psychological suffering should incorporate verbal and nonverbal cues as well as consideration of the psychosocial factors that might affect due care criteria.

CONCLUSION: The clinical approach to a PAD request should consider the legal framework and the decision-making capacity, assess memory deficit awareness and the perception of suffering, and evaluate mental competency when considered pertinent. © 2019 The Author(s) Published by S. Karger AG, Basel.

Language: en

Keywords

Montana; Canada; human; Colombia; assisted suicide; Euthanasia; California; Dementia; Netherlands; euthanasia; physician; priority journal; social psychology; Alzheimer disease; living will; clinical decision making; Suffering; Article; Vermont; clinical assessment; anosognosia; Anosognosia; Luxembourg; Alzheimer; Decision-making capacity