May 31, 2017

Dementia and Assisted Dying Laws

Later this year, Victorian parliament will have a vote on whether to legalise assisted suicide for those with terminal illnesses.

One of the more vexing issues with such voluntary euthanasia laws is the question on who qualifies, and how this is determined.

When most people think of assisted suicide, the most common condition that most think of is cancer. This may be because of highly publicised cases such as Kylie Monaghan, and South Australian advocate who was battling cancer, or Brittany Maynard, an American who had terminal brain cancer and was able to die under Oregon’s Death with Dignity Act.

But what about people with dementia and Alzheimer’s disease – should they also be included as potential candidates for physician-assisted death?

What the new laws would allow is for those who have life-ending illnesses the right to a physician-assisted death, however, there are other conditions that are in place.

Under the strict condition that they are over 18 years of age, a Victorian resident and an Australian citizen, only those with decision-making capacity who suffer from a “serious and incurable” condition, and are at the end stages of their life are qualified for assisted death.

As per those conditions, that leaves people with dementia ineligible for voluntary euthanasia – essentially because of the span of time between “decision-making capacity” and “end stages of life”. On average, a person with dementia survives for three to ten years from the point of diagnosis.

People with dementia who have the capacity to make such decision are unlikely to die within the 12 month time frame that is being considered by the government. Conversely, when they are closer to death, they will not have the decision-making capacity to request for assisted suicide.

The difficulty with dementia is that this kind of decision would have to be made earlier than for someone with cancer or other life-threatening conditions.

Many people with dementia have to make serious decisions regarding their future far in advance, such as financial decisions, Centrelink benefits and power of attorney. End-of-life decisions could potentially be a part of that. 

Health Minister Jill Hennessy has emphasised that strict safeguards are vital in introducing voluntary euthanasia, and that there will be those who won’t be satisfied with the scope of legislation.

“Many will be very disappointed that there’s a model that doesn’t include dementia or Alzheimer’s but critical to the security and protections in this model is that a person does have competence and capability,” she says.

That being said, there are advocates who are still urging the government to reconsider and allow dementia patients to have the same end-of-life choices as other terminally ill patients.

Ann Reilly, the acting general manager of client services at Alzheimer’s Australia Vic has proposed that advance care plans could be created in the earlier stages of dementia, while the person still had decision making capacity, to set end-of-life wishes in a legally binding document.

“We want people with dementia to have the same provisions that others have access to,” Reilly says. “We recognise that it’s complicated, but we think that given the amount of people we’ve got living with dementia in Victoria, it’s a complexity that needs to be dealt with.”

In order to introduce the new laws, an advisory panel submitted an interim report to the government, which is to be followed by a full report with recommendations in the middle of the year. From there, the bill will be formed and voted on later in the year.

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