As Alzheimer’s disease progresses, patients gradually lose control of their cognitive and physical abilities. For some, this means an inevitable decline toward death that can be unbearable for both the individual and their loved ones. Seeking a peaceful end, more and more people are considering “medical aid in dying” as an option. However, even with recent legal changes allowing this practice in some countries, there is controversy around who should be eligible for it. In this article, we explore the opinions of doctors who suggest that medical aid in dying should be reserved for those in the advanced stages of Alzheimer’s disease.
The debate surrounding medical assistance in dying (MAiD) in Canada has taken on a new dimension, as a proposed law aims to extend the practice to patients who may not be able to give their consent at the time of the procedure. The prospect of administering MAiD to patients with dementia or cognitive impairments raises ethical questions and concerns for health professionals. The proposed law, known as Bill C-7, allows patients with advanced dementia to make an advance request for MAiD, which would be carried out at a later stage, when they are no longer able to give their consent.
The issue has sparked a heated debate among medical professionals, with some arguing that granting the right to request MAiD in advance could help alleviate the distress and suffering of patients with advanced dementia, who may be unable to communicate their wishes at the time of the procedure. Others, however, have expressed concern about the implications of administering MAiD to a patient who is no longer competent or conscious to give their consent.
Dr. Claude Rivard, an experienced palliative care physician, believes that the new context of the proposed law presents a different challenge. “We want to give care to people who are no longer able or conscious until the end, who are demented and who are no longer able to say, ‘Yes, I want it’ based on things they decided years before,” says Dr. Rivard. As a physician who has been providing MAiD since 2015, he also questions how to approach a patient with dementia who may reject the intervention.
The issue of “happy dementia” also complicates the debate. According to Dr. David Lussier, a geriatrician at the Montreal Geriatric University Institute, providing MAiD to patients with advanced dementia raises the question of whether it should be considered a end-of-life care, particularly for patients in the later stages of the disease, where the lines between what is medically necessary and what constitutes a happy life are blurred.
One of the challenges of the proposed law is to convince medical professionals to offer the intervention to increasing number of patients who request it. As of 2021-2022, more than 1,400 Quebec physicians have been trained to offer MAiD, with approximately 60% of the 3,600 interventions in this area performed by a handful of health professionals. With Quebec leading the way in terms of the number of MAiD interventions, Dr. Lussier warns that the pressure on doctors is likely to increase, as more patients and families request MAiD.
Although there is no denying the need to improve end-of-life care for people with advanced dementia, the question of whether or not they should have the right to request MAiD remains contentious. While some argue that granting patients the right to choose how they die is a fundamental right, others are concerned that extending the procedure to patients who are no longer able to give their consent could lead to abuse and coercion, with legal and ethical ramifications for healthcare practitioners. As the debate continues, it is essential to ensure that the voices of patients, families, and healthcare professionals are heard and that all stakeholders have a say in shaping future legislation on this topic.
