Euthanasia is homicide either way.

But more importantly, what if prior to the supposed dementia she said "No matter what I say, euthanise me"?

Euthanasia is homicide either way.

But more importantly, what if prior to the supposed dementia she said "No matter what I say, euthanise me"?

I think she even signed a letter that, yes, she wanted to be euthanized. But in the end, her protests and unwillingness to give consent proved differently.

I personally don't have enough context to make a judgement that wouldn't be rash.

You either trust the parents' ability to evaluate her personality change, or you don't.

Either way, hope she's in a better place.

I guess the question is: should we euthanize someone even if they are not of sound mind to consent to it?

Consent being binding for a later version of yourself that is then unable to form a legally binding will is not unusual. You can make binding preparations for your care while you are still of sound mind, and these will stay in effect.

The question is then whether or not active euthanasia warrants special consideration. It's already common practice for patients to make arrangements for passive euthanasia, like turning off life-saving machinery. So what really ends up making the difference can only be the active part. But, if we allow active euthanasia in general, why does it matter whether the patient is unconscious, conscious but compliant, or conscious and not compliant?

Presumably, the person wishing for euthanasia did so precisely to avoid becoming the demented self that was ultimately killed.

Maybe.

You have to ask: Qui bono?

The demented patient could've peacefully lived out the rest of her life in a ward. It might not have gotten anywhere near as bad as presumed.

And if it did - it's mainly the parents who would benefit from not having to take care of her. She would be a weight off their shoulders and maybe prior to dementia she thought about it and would rather be euthanised than become a burden.

@Wayfarer care to weigh in the karmic effects?

Very good points. People, including myself, would rather be euthanized than exist as a vegetable.

In this case, even though she was without a sound mind, she no less refused to be killed. So something, whether it was instinct or habit, led her to expressly refuse consent.

The article is light in details of what exactly the women wanted. Did she want to avoid the dementia, or some sort of other state? Did she address the possibility of changing her mind in a demented state?
Minus that information, I think all involved made the best of an unfortunate situation. No law was broken, the patients wishes were respected. The people best to judge in that situation would be the family, with doctor consultation.

Very fair.

We know that she signed the letter of consent. We know that she since changed her mind, though she may have been completely delirious when doing so. That withdrawal of consent seems to me to trump all previous consent no matter what she once wanted.

But then you are discarding the consent of the non-demented version. Its a dichotomy. You have to choose to violate one instance of consent (and thereby the person) over the other. I think the fully aware and if faculty person takes priority.

A curious case from the Netherland’s raises questions about euthanasia. — NOS4A2

Interesting case. It reminds me of the days of Dr. Kevorkian. He became the face of assisted suicide. But he operated in a very gray area. Some of his patience changed their mind but he killed them anyway.

Very often the actual real-life examples of general principles are far messier than the principles. That's why abstract political ideas must be tempered by reality.

Personally I hope I get hit from behind by a meteor that I never knew was coming. Fast and painless. All you can ask for.

I think she even signed a letter that, yes, she wanted to be euthanized. But in the end, her protests and unwillingness to give consent proved differently. — NOS4A2

The problem is, by this time she was in the grips of dementia, so much so that she had forgotten what euthanasia even was. — NOS4A2

How could she be unwilling to give consent to something which she didn't even know was a possibility?

Will you consent to a shpruckening?

How could she be unwilling to give consent to something which she didn't even know was a possibility?

I assume they asked her.

Shprucked if I know.

I assume they asked her. — NOS4A2

But she didn't understand the question, so how could she counted as giving, or failing to give, consent?

If you know what?
My point is that you can be unwilling to consent to something you dont know of, to answer your question. Likely not to, in fact.

Ugh, edited to add: nvmd, i get what you meant by “if I know”. I was being dumb there lol

Some people with dementia are fed, washed and put to bed when they do not consent. If they don't understand what's going on they will likely object to anything and everything. If the person understood the idea of consent and would be able to answer something lucid like "I won't consent to that because I don't understand what you are proposing", that might be a different matter. But surely if they could understand the idea of consent they could understand the idea of euthanasia, no?

If a patient with dementia can be surreptitiously sedated, how would s/he know the difference if s/he were being euthanazed?

Ah, ok. I understand. I misunderstood.

Euthanasia is homicide either way. — Shamshir

Euthanasia (eu + thanatos = good or easy death) is a nice euphemism, (an auspicious word) ORWELL ALERT: Be suspicious when politicians use a lot of Latinate words...

What euthanasia is about, to put it in blunt Anglo-Saxon language, is killing the sick and/or old.

I'm not in the pro-life camp where every body must be kept "alive". In my book, the brain dead are dead, whether their heart is beating or not. There are real hopeless cases which no medical intervention can mend, but can assist (palliative care). But actively killing patients is not a policy we should allow (or worse, actively pursue).

People will suffer? Sorry, but yes. Lots of people in this world have suffered, are suffering, and will suffer in the future. We can and ought to relieve suffering. We can and ought to allow people to opt for a limitation on life-preserving procedures, when a) they are in sound mind and b) the patients condition fits their stated preferences and c) a short period of time lies between the patients declaration and the crisis.

What patients can reasonably opt for in the event of severe damage are things like, "do not intubate"; do not force feed; do not sustain with IV water, and such.

But "limitation of life-sustaining procedures" (barring force feeding, intubation and respirator use, resuscitation, etc.) are a far cry from a doctor, judge, nurse, or anyone else deciding to get the patient "out of their and our misery.

Assisted suicide (like a doctor writing an Rx for enough sedative to cause death if taken all at once) isn't euthanasia, either.

Gee, I never do that! :wink:

This is a timely topic, because diseases like Alzheimers and other forms of terminal dementia are increasing with an aging population, and will continue to increase unless we find an effective treatment. So far no luck on that front. A lot of people die from other causes, and reach a point where the benefit of further treatment gives no return, not merely diminished returns.

Rather than resorting to killing Alzheimer (or other terminal) patients, we can provide hospice care under the same terms that (religious hospices, for instance) provide care to the dying cancer patient, the dying infection patient, the dying... whatever patient: No curative measures will be taken in hospice; comfort care is the core. Patients are fed, given drink, kept clean and warm, and supported as long as they can participate (are conscious). When they can no longer swallow, no further food or water is given. Pain relief is continued (injection). They continue to be kept warm and clean. Usually death follows within a week or two. This is "the old fashioned way of dying". No heroics, no crash team, no beeping monitors, no drips, no drugs, no respirators, no cardiac assistance.

The most important element of this story vis-a-vis euthanasia is that the poor woman resisted. This is the reason why you've posted this story as resistance to euthanasia suggests unwillingness to die.

However, it behooves us to understand the disease she was suffering from = Alzheimer's which is characterized by progressive loss of memory and deterioration of personal identity. The consent to euthanasia was given when she was capable of making careful informed decisions and she probably gave to consent to medically-assisted suicide when her Alzheimer's reached a certain stage. The doctor and family simply carried out her instructions.

Her resistance and "objections" are equivalent to the severe intractable pain of last-stage cancer. We carry out euthanasia exactly when the pain becomes intolerable and so the concerned doctor did exactly that - the woman had reached the last-stage of Alzheimer's. I guess I'm saying that the patient resisting and objecting are an indication of the last stage of Alzheimer's and don't have legal import as far as the doctor's and the family's decision to euthanize the poor woman is concerned.

Our concern for the poor woman isn't misplaced after all resisting and objecting to her own wishes seems to suggest that she wants to withdraw her consent. But, this type of behavior is exactly what one would expect at the last stages of Alzheimer's.

That said, the story of this poor woman is extremely important for the medical community that have to deal with euthanasia requests for mental illnesses because there is always that off chance that the person could regain their faculties and we would have no way of differentiating actual restoration of mental faculties from the last stages of a mental illness because both will show the "symptom" of resistance and objection to euthanasia.

I think, the doctor and family made the right decision given the extent of their knowledge of Alzheimer's but this story should be an impetus to the medical community to ascertain how we deal with situations that are ambiguous (is it that the mental faculties have been restored or is it that the disease has reached its last stage) so that mistakes are minimized.

But she didn't understand the question, so how could she counted as giving, or failing to give, consent?

She vocally and physically resisted the killing. Her last moments were watching in horror as her family held her down while someone else gave her a lethal injection. That is not assisted suicide.

Whether in a poor state of mind, irrational, or completely delusional, she nonetheless refused to go through with her suicide. It wasn’t her choice to die that day. She was forced to die. I just cannot see it as a suicide, assisted or otherwise.

Whether in a poor state of mind, irrational, or completely delusional, she nonetheless refused to go through with her suicide. It wasn’t her choice to die that day. She was forced to die. I just cannot see it as a suicide, assisted or otherwise. — NOS4A2

I'm having difficulty expressing myself well. Anyway...

You have seen similar situations in horror movies. A soon-to-become werewolf makes his friends promise to kill him when he turns. The woman, in her senses, makes the express wish to die when Alzheimer's reaches a specified point in its history. When that happened, just like the werewolf is killed as promised, the doctor and family euthanized the woman despite "her" refusal. You could say that the woman is the werewolf - resisting, fighting, refusing but exactly at the stage she, when compos mentis, wanted to end her life.

Having said that I think the woman's story brings to light the status of euthanasia as it applies to mental illness. You say "I just cannot see it as a suicide, assisted or otherwise" because you assumed that she was in her senses when she refused to accept euthanasia. However, unfortunately for the woman, these are expected behavior for advanced Alzheimer's (memory loss, change in personality) and so the doctor and family made another false assumption - that she was ready to be euthanized. In fact, in this case, the difficulty is making the distinction between restoration of mental faculties and advanced stage of mental illness, in this case Alzheimer's. The medical community has to work out an accurate method of determining this difference before they carry out euthanasia on mental patients.

Well put.

I think that if a patient is brain dead, they aren't necessarily dead - but if a brain transplant or some other form of brain vivification isn't applied within 24hrs you may as well pull the plug and let the patient go in peace.

For me, it should be obvious, death is about resting in peace. And obviously with this particular case, at first glance, the patient didn't go out peacefully.
But as aforementioned, there could be context through which the procedure would offer internal peace, despite contrary appearances.

And as you pointed out:

But "limitation of life-sustaining procedures" (barring force feeding, intubation and respirator use, resuscitation, etc.) are a far cry from a doctor, judge, nurse, or anyone else deciding to get the patient "out of their and our misery. — Bitter Crank

So we're kind of left with trusting or not, the deciding authorities, whether they're family or not.
And while sometimes such things are obviously rushed, other times they at least appear to be for the better.

May you answer the following:
Do you find the comatose to differ from the brain dead and by how much?
If you had to compare euthanasia vs suicide, outside of the obvious shift in responsibility, how do they differ?

Often I've heard of regret from suicide survivors, but none such from euthanasia survivors, if there are any.

If she didn't understand she was being euthanazed how would she have distinguished the experience from being, for example sedated. or given flu shots or whatever?

Without the consent and against the protests of the patient herself, the doctor sedated the woman then administered a lethal injection while the family held her down. — NOS4A2

I am not against euthanasia, but this gives me a very uneasy feeling in my stomach.

Moreover, it seems like a slippery slope to me.

Firstly, who decides a person is 'too far gone' to renounce their intention of wanting to be euthanized? When is it too late for a change of heart? Who is to say the change of heart isn't genuine? Especially around a matter like death, I don't find it unthinkable that people would not want to go through with it.

Secondly, the power that a person's relatives have in this situation is also uncanny. They can claim to know a person better than the doctor. They can even claim to know a person better than the person themselves, since they are suffering from dementia. Very scary to think what happens when the relatives have an agenda that differs from the person's best interests.

Do you find the comatose to differ from the brain dead and by how much?
If you had to compare euthanasia vs suicide, outside of the obvious shift in responsibility, how do they differ? — Shamshir

There is a huge difference between being in a coma and being brain dead. "Brain dead" means that the brain does not, can not, and will not function again. Both higher brain and brain stem functions have ceased. Once ceased they do not resume. A dead brain is kaput. Coma and vegetative states apply to brains that are still working (even if not very well) and are not always permanent. People often recover consciousness after being in coma, and sometimes after being in vegetative states, even after a long duration. People in persistent vegetative states [PVS] are not brain dead. Some people who have recovered from PVS report that they were aware, but could not execute any communication.

An effort to test whether PVS subjects could be aware was conducted. fMRI scans on normal subjects had shown that certain kinds of thoughts were detectable; for instance, if the subject was asked to imagine they were playing tennis, a certain pattern of brain activity occurred. When PVS patients were examined in the same way, some, at least, showed exactly the same pattern. They were aware of the test and being told to imagine playing tennis. From these questions yes/no questions were asked of the patient, with 'yes' being imagining tennis, 'no' being thinking of something else.

From this research it was determined that at least some PVS patients are aware.

Suicide and euthanasia are quite different. Turning over the responsibility for one's voluntary death to an agent requires a diagnosis, planning, and various legal rigmarole, as I understand it. On the spur of the moment euthanasia is not legally possible (yet).

Suicide can occur very much on the spur of the moment, or on the spike of despair. If one has a loaded gun handy, it takes just a minute to pick it up, aim, and fire, then sic transit gloria. That's why guns are so often the means of suicide. Pills take time to accumulate and are not all that reliable. Hanging works quite well, but it requires preparation. Gas, carbon monoxide, bridges, high roofs, water, bleeding, alcohol poisoning, plastic bag on one's head... diverse methods.

So we're kind of left with trusting or not, the deciding authorities — Shamshir

One of the problems of 'advance directives on final care' is that they are not legally binding. Another problem is that they are not always available to the hospital involved in care of patients who are in very bad shape. The attending physicians would not be aware of the advance directive in that situation.

My father was 102 when his heart and lungs began their failure. The doctors at Mayo were interested in pursuing exotic tests and procedures. (His pacemaker battery was about empty, too.). Fortunately, Dad was still quite competent, and the family was present to advocate. On questioning, the doctor admitted that the invasive tests wouldn't lead to survivable procedures. So hospice was decided upon. He spent a reasonably comfortable month in hospice and then died.

I consider this a best-possible outcome. Lots of people can cite both very good and just awful outcomes in care at the end of life.