Euthanasia for Alzheimer’s Patients?

The medically vulnerable have rarely been in greater jeopardy. Alzheimer’s disease patients are at particular risk. In a recent poll from Quebec—where lethal-injection euthanasia is legal—a chilling 72 percent of caregivers favor permitting Alzheimer’s patients to be euthanized, even if the afflicted person never requested euthanasia. If the patient requested euthanasia in writing upon becoming incompetent, the percentage of caregivers approving is a horrific 91 percent.

Both scenarios are against the law, though perhaps not for long. With lethal-injection euthanasia now legal throughout Canada, predictable efforts are under way to permit patients to create binding written orders to have themselves killed if they lose mental capacity.

This approach is already legal in the Netherlands and Belgium, two countries that seem to be competing with each other to craft the most radical euthanasia policies. What if the Alzheimer’s patient, having lost the ability to make his own decisions, is not suffering terribly after all? Tough. His former desire is deemed controlling over his current state of happiness. Indeed, in an awful case from the Netherlands, a struggling elderly Alzheimer’s patient was held down by her family as she fought against being lethally injected. Dutch authorities determined that the homicide was permissible, since “the doctor acted in good faith.”

If only euthanasia advocates could be sued for false advocacy. For years, they have soothingly assured wary societies that only those with the capacity to choose to be killed would have access to facilitated death. That promise was always highly questionable. “Choice” has never been the point of euthanasia—otherwise euthanasia should be available to anyone, sick or well, who wants to die. Rather, the goal is to normalize killing as an acceptable remedy to suffering, even—as we are seeing with the Alzheimer’s policy—when the patient is incapable of making a rational decision.

Where assisted suicide is legal in the United States, it is still not allowed for people who lack decision-making capacities. This restriction may be a matter of political tactics, rather than of bedrock principle. A few years ago, Barbara Coombs Lee, head of the assisted suicide advocacy organization Compassion and Choices, said that assisted suicide for Alzheimer’s patients was “an issue for another day, but no less compelling” than legalization for the competent terminally ill—strongly implying that allowing life-terminations of people with dementia would follow once the country accepted the Compassion and Choices agenda.

Indeed, Compassion and Choices already targets the elderly with instruction in suicide by self-starvation, known in euthanasia movement parlance as “voluntary stop eating and drinking” (VSED). From its how-to guide:

Many people struggle with the unrelieved suffering of a chronic or incurable and progressive disorder. Others may decide that they are simply “done” after eight or nine decades of a fully lived life.

Alarmingly, the American Nursing Association adopted a policy in support of the right to commit VSED without intervention, stating, “A patient’s decision regarding VSED is binding, even if the patient subsequently loses capacity.”

VSED is, presumably, legal. But what if an incompetent dementia patient who willingly takes food and water had instructed in an advance directive that he wanted to be denied sustenance when incompetent? Increasingly, prominent bioethicists contend that caregivers should be forced to withhold spoon-feeding, which is to say, should be required to starve patients to death. For example, in the May-June 2014 Hastings Center Report, Paul T. Menzel and M. Colette Chandler-Cramer argue:

The principle behind [advance medical directives] is that people do not lose their rights when they become incompetent; someone else just has to exercise those rights for them. The driving element behind VSED is that forcing people to ingest food is as objectionable an intrusion on bodily integrity, privacy, and liberty as imposing unwanted medical treatment. Thus, if incompetent people do not lose their rights to refuse life-saving treatment, then people do not lose their right to VSED when incompetent either.

This is rank bootstrapping. Advance directives govern the provision or refusal of medical treatments. A patient may refuse a feeding tube in advance, because “artificial nutrition and hydration” is considered a medical treatment in law. But spoon-feeding isn’t a treatment, it is humane care—no different ethically from turning a patient in order to prevent bed sores, or providing proper hygiene. Just as an advance directive instructing that a patient should not be kept clean must be disregarded, so too should a directive instructing that a patient should be starved to death.

There’s one more point to which we must attend. Suffering due to Alzheimer’s disease sometimes falls heavier on caregivers than on patients. True, many say at the end of the difficult road that it was an honor to care for their incapacitated loved ones. But we shouldn’t sugarcoat it: Caregiving can be exhausting and heartbreaking, and in some cases perilous to caregivers’ health. I know this up-close and personal. My wife and I cared for my aged mother in our home—whose Alzheimer’s was then biting deep—for the last five months of her life. Believe me, memory loss is the least of it.

Caregivers are properly allowed to refuse intensive life-extending medical treatment. Then, when death comes, it as a matter of nature taking its course. But allowing caregivers to order doctors (or nurses) to end the patient’s life is a bridge too far. At least in some cases, such a license would allow caregivers to put a patient out of their misery. Add potential conflict-of-interest issues, such as inheritance and the costs of treatment, and we see the potential for elder abuse.

As bad as Alzheimer’s can be, the severely afflicted often experience moments of clarity and joy. Even when that becomes impossible, these helpless people remain full and equal members of the moral community, entitled to the best care we can offer. If a society is judged by the way it treats its most vulnerable members, we will reject the let’s-kill-Alzheimer’s-patients agenda out of hand and focus on improving our capacities to care.