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Is this person with dementia (currently) competent to request euthanasia? A complicated and underexplored question
  1. Scott YH Kim1,
  2. Dominic Mangino1,
  3. Marie Nicolini1,2
  1. 1Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
  2. 2Interfaculty Center for Biomedical Ethics and Law, KHLeuven, Leuven, Belgium
  1. Correspondence to Dr Scott YH Kim, Department of Bioethics, National Institutes of Health, Bethesda, MD 20892, USA; scott.kim{at}nih.gov

Abstract

In euthanasia and/or assisted suicide (EAS) of persons with dementia, the controversy has mostly focused on decisionally incapable persons with very advanced dementia for whom the procedure must be based on a written advance euthanasia directive. This focus on advance euthanasia directive-based EAS has been accompanied by scant attention to the issue of decision-making capacity assessment of persons with dementia who are being evaluated for concurrent request EAS. We build on a previous analysis of concurrent request EAS cases from the Netherlands, which showed that many such cases involve persons with significant cognitive impairment. We use illustrative cases to describe the difficulty of determining decisional capacity in persons whose stage of dementia falls between severely impaired and mildly impaired. We show that the Dutch practice of capacity assessment in such dementia cases is difficult to reconcile with the widely accepted functional model of capacity—a model explicitly endorsed by the Dutch euthanasia review committees. We discuss why such deviations from the standard functional model might be occurring, as well as their ethical implications for dementia EAS policy and practice.

  • euthanasia
  • dementia
  • competence/incompetence
  • living wills/advance directives
  • capacity
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Footnotes

  • Twitter @scottbioethics

  • Funding Funded in part by the Intramural Research Program of the NIH (ZIA CL010539-04 CC).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository.

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