What do you do about someone with, say, Alzheimer's, who may want to end their life precisely because they are beginning to drift in and out of lucidity? Maybe Switzerland has it all figured out but it is not that easy.
One potential solution is ahead-of-time decision making.
When young and lucid, make the decision of what criteria would cause you to prefer physician-assisted suicide. Write that down in a document. Allow that document to have legal force.
In the US, we already have the notion of Advanced Health Care Directives, which allow for things like power of attorney, nominating a proxy decision-maker, and criteria were a caretaker is allowed, or even required, to stop providing life-extending treatment. Health care providers generally follow these directives if made aware of them.
Thinking about this sort of thing ahead of time is not something that people want to do. But, for people who do complete one (with sufficiently-rigorous criteria), it solves some of the ethical issues around consent and incapacity.
By the way, I strongly recommend more people complete an AHCD. I had to care for a close relative at the end of her life, and the fact that her wishes were written down on paper was an incomparable gift to me. This should really become more routine.
Go through the process and let death take you. It's better to help some people than to help no one at all. I don't have the perfect protocol of such a process, I am just writing an example to prove that my original point is valid.
I think people that have Alzheimer's and want to die should be able to be assisted.
OK, but you are sidestepping the issue here. As you've said, if you accept active euthanasia you'd probably consider the deterioration of Alzheimer's an acceptable reason. And most people take informed and uncoerced consent as important to the process. And yet how do you ensure that consent with someone who is losing their mental faculties?
As someone with experience of a relative with Alzheimer's, it's completely clear in every possible way that informed consent is no longer an option.
Alzheimer's creates a mental handicap that makes normal adult functioning impossible. You can literally ask the same question twice in two minutes and get two conflicting answers - with no memory of the previous answer, or even that the question was asked before.
In mid-stage Alzheimer's memory is so impaired that it's literally shorter than a spoken sentence. In late Alzheimer's even that disappears.
The solution in the UK is to hand over care decisions by Power of Attorney. If no relative is available for that, decisions are handed over to care and medical staff.
If assisted death is ever an option in the UK, it would have to be written into a living will while informed consent was still possible.
Obviously there are huge legal issues with that, especially if there's an inheritance involved.
That aside, people really do get to the point where they just want to die.
I've seen it twice now. In one case it was very clear indeed, and had been clear for at least a couple of years. In another it was less clear, but it was something my relative talked about openly.
Personally, having seen cancer and Alzheimer's close up, I'm really not convinced I'd want to wait around for a natural death from either.
I think most people would have a hard time accepting active euthanasia one the basis of documents prepared in the past, particularly when you consider the significant possibility of duress, forgery, etc.
Forgery - require a notarized document, a video, etc. Tons of documentation, why not.
Duress - could apply equally to euthanasia today too, couldn't it? If not, then take whatever magical anti-duress method we use now and apply it to this.
No. Alzheimer's is a form of dementia. Here is the description of "moderate" symptoms from Wikipedia:
> Behavioural and neuropsychiatric changes become more prevalent. Common manifestations are wandering, irritability and labile affect, leading to crying, outbursts of unpremeditated aggression, or resistance to caregiving.[26] Sundowning can also appear.[31] Approximately 30% of people with AD develop illusionary misidentifications and other delusional symptoms.[26] Subjects also lose insight of their disease process and limitations (anosognosia).[26] Urinary incontinence can develop.[26] These symptoms create stress for relatives and carers, which can be reduced by moving the person from home care to other long-term care facilities.[26][32]
