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Response to: ‘Dementia and advance directives: some empirical and normative concerns’ by Jongsma et al
  1. Scott Y H Kim1,
  2. David Gibbes Miller1,
  3. Rebecca Dresser2
  1. 1Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
  2. 2Washington University School of Law, St. Louis, Missouri, USA
  1. Correspondence to Dr Scott Y H Kim, Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA;{at}

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We are grateful to Jongsma et al1 for their interest in our article analysing the case of ‘Mrs A’, a Dutch woman with Alzheimer’s disease who received euthanasia based on her advance euthanasia directive (AED).2 Their commentary criticises two elements of our analysis. First, the authors believe our reasons for doubting that Mrs A had the capacity to write and revise an AED rely on ‘partial’ empirical data and rest on normative errors. Second, they use two of our statements to suggest we must endorse some implausible claims, for example, that ‘… in all situations and for all people, current well-being should always take precedence over all other values’.

Capacity to write an AED

Jongsma et al assert: ‘Miller et al argue that people with dementia are impaired to make decisions.’ This casts our probabilistic claim about Mrs A’s capacity as an absolute claim about persons with dementia in general. It also implies we are using an outdated diagnosis-based view of capacity. The accusation then becomes explicit (italics below):

… several empirical studies have shown that patients with dementia are able to actively participate in qualitative studies and can respond to open questions in a meaningful way,[2-8] as well that they are able to complete an advance directive in the early phases of dementia.[9, 10] One can therefore not simply conclude on the basis of the diagnosis of dementia …

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  • Contributors All authors meet the ICMJE 2013 criteria for authorship.

  • Funding Supported in part by the Intramural Research Program of the NIH Clinical Center.

  • Disclaimer The opinions expressed in this article are the authors’ and do not represent the views or policies of the NIH, Department of Health and Human Services, or any other part of the US Government.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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