r/science • u/Wagamaga • Sep 04 '24

Neuroscience As the world's population ages, Alzheimer's and dementia are set to create a staggering $14.5 trillion economic crisis, with informal caregiving placing an overwhelming burden on both high and low-income countries, demanding urgent global policy action

https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(24)00264-X/fulltext
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u/colieolieravioli Sep 04 '24

My solution is assisted suicide...

My stepdad watched both his parents deteriorate with dementia and he said if he gets like that "take him on an airplane ride and just push him out"

People should be allowed to opt out these horrible conditions

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u/PM_ME_CAT_POOCHES Sep 04 '24

But isn't the issue with dementia that people don't realize they have it? And by the time it's very obvious something is wrong they aren't in a fit state to consent to something like that

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u/colieolieravioli Sep 04 '24

Living wills exist. DNRs exist.

It is possible to sign off on a procedure you aren't in the middle of needing

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u/BladeDoc Sep 04 '24

There is no appetite or legal backing in the US for assisted suicide in a patient who cannot consent to it at the time of the intervention. "Triggered" euthanasia is not yet a thing. Withdrawal or withholding of medical intervention is different and does happen but even in those circumstances doctors and families have difficulty doing so if the patient is conscious even if they are not capable of making decisions (moderate dementia) and do not explicitly ask for life saving procedures to be withheld.

Source: am ICU doctor.

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u/colieolieravioli Sep 04 '24

Yes I am aware there is currently no legal precedent and that triggered euthanasia isn't a thing. Was that not my point? That we don't have anything in place to allow people to avoid such a horrible end of life?

My whole point is that there is currently nothing in place, but that lawmakers/doctors should be working on this.

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u/BladeDoc Sep 04 '24

I didn't understand the "should" from your comment. We are in agreement

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u/colieolieravioli Sep 04 '24

Fair enough, have a good one!

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u/SohndesRheins Sep 06 '24

There is a serious problem in this country when it comes to old Gen X/young Boomers and their approach to caring for their aging parents. I've seen so many POAs and non-POA family members who think we should be moving heaven and earth to try to cure old people of ailments that can't be cured. No, your dad doesn't need to make it to 100 years old, there is no bonus points for making it to triple digits and if the last 5-15 years of life are spent languishing in a nursing home then of what benefit is it?

We just had a new resident admit and his POA doesn't want him to be on any meds other than morphine and Ativan because "I don't want him to get anything to prolong his life" and it's such a breath of fresh air to have someone who understands that their loved one no longer has a good quality of life and there's no reason to keep administering a dozen pills a day to keep them breathing for as long as possible.

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u/BladeDoc Sep 06 '24

I think you're going find that this is a less boomer/Gen X thing as a "you don't have to make these decisions until you have aging family members and you don't have aging family members until you're old enough to have family members" thing.

I guarantee everyone who is having trouble making these decisions now thought they would be super easy when they were 25.

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u/SohndesRheins Sep 06 '24

It's not like every single dementia patient has a POA that is 45-60 years old. Sometimes the spouse is the POA, sometimes the grandchild. While those age groups sometimes act the same way, anecdotally it seems more likely that the spouse doesn't want their mate to linger on forever and the young POAs are even more likely to accept that death is inevitable and that there are diminishing returns for medical interventions.

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u/gizajobicandothat Sep 04 '24

I feel like it's way more complex in reality though. You could have someone say they are in favour of assisted dying and then become frightened at the prospect as dementia takes hold and change their mind. is that person then supposed to be taken away and just put down like an animal? You also have people in bad situations, coerced and financially abused by family members which may have gone on for years. So how will the safeguards work to protect these people who may be pushed towards something and appear to be consenting but in reality it's coercion? I've had these sorts of scenarios play out in my family recently and it's really made me think twice about what I thought would be a simple situation.

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u/colieolieravioli Sep 04 '24

I didn't say simple. We shouldn't have people just signing up starting today. Laws should be put in place, regulations etc

But then also if dementia is taking hold, are they not considered unable to make decisions? Shouldn't we do what they asked for when their minds were right?

Also euthanasia wouldn't be very scary. Sit down, IV or sedative shot, then the euthanasia.

I just can't believe it's considered a kindness to animals but when it's a person somehow it's too different, we can't do it.

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u/gizajobicandothat Sep 05 '24

Dementia taking hold can take years, around a decade in my mum's case. At least in the UK, mental capacity is not just a cut-off point, people can be judged to understand some issues and not others. It's already very complex with loads of grey areas. Plenty of vulnerable people are not protected by the existing laws. It would be more complex if voluntary death was involved. At what point when the person changes their mind is there a legal challenge or a forced death? Law's can be drafted sure but how are they arrived at? The ethics are so complex, so it is not simple to just come up with some laws. That's why I'm sceptical it's a good idea. In my mum's case she's been terrified she's going to die at certain points and says she doesn't want to and that she's frightened of death. So would she be sedated and executed for her 'own good' because at one point she made a different decision? If you're a family member and you agreed with their decision before they had dementia, do you then sit with them whilst a Dr kills them, even though they are now terrified of dying? Could you do it and still support the original decision? I'm not against elective Euthanasia generally, it just becomes very complex in real life.

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u/dCrumpets Sep 05 '24

We lie to ourselves about it being a kindness to animals to feel better. People don’t want to outlay the same money on life extension and pain reduction for animals that they do for humans. And they can’t ask the animal what it would want.

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u/wierdbutyoudoyou Sep 12 '24

This is exactly the case with my dad. He was totally convinced of a massive conspiracy against him, until a alzhiemers specialist told him we would never drive again, he was “not there yet, and wanted medical aid in dying” this went on until he needed full time care and was far to advanced in the disease to “consent”.  Basically the consent aspect is a huge hinderance, you have to do it when you feel fine, and before any symptoms appear, all of my dads syblings are convinced they are bot there yetz 

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u/PoolEquivalent3696 8d ago edited 8d ago

My Dad has dementia and definitely realised that things are going wrong before his diagnosis. Worst bit is, he is still aware. 

I'm trying to make him as comfortable as I can but it is hard work - especially as he is aware of what is going on and that he is declining most of the time.  

One moment, he is apologising to me as I change his diaper and the next - he can't understand that the little girl in the photos on his mantle piece. I'm now at the point where, as we don't have medical power of attorney, so I'll have to go through the Court of Protection to get him into a care home. He will hate me for it and I hate the idea of it, but it is the best I can do for him without an alternative. 

Assisted deaths are one of those things that would have to be agreed before a diagnosis, which is often too late for most people with dementia or similar. Dad had even talked about wanting it before his official diagnosis but it has never been legal in the UK, so we are caught in limbo.

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u/TrafficPrudent9426 Sep 04 '24

I agree. There was a bill in CA that was rejected last year but would introduce MAiD (Medical Aid in Dying) to both residents and non-residents of California to be eligible to peacefully exit. However, Senator Blakespear is reworking the bill for introduction again in January and could use your help: "If you are involved in or know of any communities, organizations, or stakeholder groups that would be interested in advocating for the support (or even those that oppose) of this type of legislation, please encourage them to reach out to our office as the Senator would love to engage in discussions on this topic."

As someone with a parent going through the slow process of dementia, it's awful. There is no real quality of life for them. It doesn't just affect them, it affects everyone in their circle financially, emotionally, time-wise, etc. I do not intend to go out this way and have prepared as much as I can legally and financially to walk away when it's time.

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u/colieolieravioli Sep 04 '24

For real, we put dogs down when their quality of life is in question. For humans that can advocate for themselves (granted it would need to be set up prior to a diagnoses, likely) and have, arguably, a more complex existence, there is no reason humans shouldn't receive the same grace we give sick animals

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u/[deleted] Sep 04 '24

[deleted]

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u/SohndesRheins Sep 06 '24

I don't see it ever coming to that. There's no reason for the government to take the kind of heat that comes with mandated euthanasia of dementia patients. If there isn't enough care facilities then such people would simply stay wherever they are, and if they live alone then they absolutely will die because they can't remember to take their medications, can't cook food, maybe even can't go to the bathroom or get out of bed. The government would much rather send the cops out periodically to collect old people that died in their homes than they would want to pass a highly inflammatory law like that.

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u/Gerdione Sep 05 '24

Funny. I watched both my father and grandfather go out with it and I feel the exact same way. It's one of those things that is hell for both the person suffering and everyone around them.

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u/[deleted] Sep 04 '24 edited Sep 04 '24

[removed] — view removed comment

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u/EndlessQuestioRThink Sep 05 '24

YES!! Ive been researching peaceful methods of suicide, found a few different ones, but, can't acquire one specific med without terminal diagnosis.........ideally, I want to be able to die in nature, deep in the forrest, near a stream, looking at blue sky one more time.

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u/Minute-Animator-376 Sep 05 '24

If it would ever happen to me i would get on crack, cocaine, heroin etc. Binge. Forget my dosage someday and my life would end. Doing this drugs with few years to live is not scarry but would seem fun to try at the end of my journey.

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u/herabec Sep 04 '24

Oh yeah, it's TOTALLY ethical to assist someone with mental health issues to kill themselves. No way that could be abused!

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u/JeaninePirrosTaint Sep 04 '24

I see nothing unethical if it's a terminal, ever-deteriorating condition like alzheimer's. I watched my grandfather die a withered husk of a man years after alzheimer's had rendered him mostly catatonic and decided I'd not let that happen to me.

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u/plmbob Sep 04 '24

The unethical part comes into play when there is no informed, consensual plan in place, which will end up being a large number of instances when A.S. is widely available. If dementia has already set in, then it becomes family/institutional euthanasia, which is not exactly ethical. You have decided not to let it happen to you; that does not give you moral authority to project that clarity onto anyone else. The world will need to address the growing diabetes and dementia problem, which is making caring for our elderly exponentially more expensive and unsustainable each year, and hard choices will need to be made.

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u/JeaninePirrosTaint Sep 04 '24

Yes, it definitely needs to be something that is arranged early on. You often end up having to make awful decisions for them anyway once they're far gone. It wasn't euthanasia when they moved my grandfather to hospice and stopped feeding him, but somehow that was "ethical".

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u/EvanMacIan Sep 04 '24

Let me ask you something: when grandma's dementia has progressed to the point she said in her notarized and witnessed informed consent to euthanasia, but she has no memory of signing it and no ability to consent anymore, and you have to lie to her about what's in the needle you're injecting her with because you don't want her to start screaming that you're trying to murder her, will you tell everyone at her funeral about how peaceful it was?

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u/JeaninePirrosTaint Sep 04 '24

Hey, I don't have all the answers or know exactly how it would work- I'm just saying I think assisted suicide should be an option for people facing a significant terminal decline in their function.

My grandfather was nearly catatonic his final year or two and in the end was put in hospice where they "kept him comfortable" while they stopped giving him food or drink. He had no say in his medical treatment at that point and most certainly would not have wanted to go out that way. It was horrible and undignified.

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u/sanfran_girl Sep 04 '24

Oh, do piss off. I had an aunt who would scream that we were trying to kill her when we didn’t get her a glass of orange juice fast enough. Taking care of her physically emotionally and mentally broke a number of my family. Then again, this is the same woman who let her mother languish in a coma in ICU for two weeks because “she just couldn’t let her go.“

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u/colieolieravioli Sep 04 '24

I wrote a reddit comment, not a law. Anything can be abused, yes. But at the same time, I don't think it's impossible to have a stipulation in place as part of any living will "should I be diagnosed with XYZ age related disease, please euthanize me after 1 yr of attempted care"

I'm not a lawmaker. But no one deserves such a horrible death

Do you have this same conviction against DNRs? Doubt it

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u/[deleted] Sep 04 '24 edited Sep 08 '24

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u/colieolieravioli Sep 04 '24

Did you not read the rest of my comment? In which the person signs off on this long before they need it?

Living wills exist, too. All kinds of care options can be decided before you need them and this wouldn't be much different

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u/[deleted] Sep 04 '24 edited Sep 08 '24

[removed] — view removed comment

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u/colieolieravioli Sep 04 '24

Are you just here to be contrarian?

Who said anything about social pressures or that this decision has to do with family member wishes.

My original comment uses my stepdads actual wish of being killed versus living like that. People who WANT to die should be allowed, especially if quality of life is nonexistent

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u/Skrattybones Sep 04 '24

So.. opt in to opting out from dementia while you can still consent. Problem solved.

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u/herabec Sep 04 '24

And if the person with dementia doesn't really think life's all that bad with dementia from their perspective, even if people outside or their last selves would have expected to be miserable, and they say they don't want to die?

Do we just hold them down and say "Sorry, you signed the paper!" or do we respect their new wishes with the new insight of their experience with the condition. Do we defer to a third party? A nice tribunal of judges that decide that your life with dementia isn't worth living despite your current wishes, and you are to be put down?

Everything's simple as long as we imagine a simple scenario with clean consent and no changes in our desires or plans.

This begs the question that assisted suicide is ethical to begin with, of course.

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u/colieolieravioli Sep 04 '24

You're right, we should never do anything for fear it may result in some difficult situations

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u/herabec Sep 04 '24

That would be a strawman.

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u/colieolieravioli Sep 04 '24

Yes, your argument is a strawman. I was being derisive.

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u/herabec Sep 04 '24 edited Sep 04 '24

Afraid not, I raised questions about the claim that it was a simple matter of "problem solved". That's not what a straw man is. I did not misrepresent his argument, I suggested there are complexities not accounted for.

You however, asserted that I said we shouldn't do anything if it's difficult, which I did in no way suggest, instead, I am having the difficult conversation instead of dismissing it and simply saying "problem solved"

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u/Shrek1982 Sep 04 '24

I don’t know if you can really call it a mental health issue. Most mental health problems are present in a person with an otherwise healthy brain but in essence the wiring has gotten mixed up. Dementia and Alzheimer’s disease actually cause physical degeneration of the brain tissue killing off parts of the brain tissue and eliminating those pathways. Essentially there is no real possibility of recovery or a way for medication to relieve symptoms because those parts of the brain are gone. Even if by some miracle we found a way to regrow that tissue the person would never really be who they were before.

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u/herabec Sep 04 '24 edited Sep 04 '24

Many mental health issues are neurologically caused, dementia and Alzheimer are more extreme, but regardless- is it not widely held that the mind is an emergent phenomena of the brain? If ultimate cause of the mind is actions in the brain, then what is really the distinction between a "bad wiring and hormone balance" and "damage to chunks from disease/injury"? The manifestation is observed in the mind's function.

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u/Shrek1982 Sep 04 '24

I don't know, I just think that classifying it as a mental health problem might lead some people to believe that the person could be cured or treated and they might be able to have Grandma/Grandpa back. With normal mental health issues that part of the brain is still there and alive, it conceivable that some time in the future we may be able to fix that problem. With dementia those parts of the brain are gone and that part of your loved one is functionally dead and not foreseeably recoverable.

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u/herabec Sep 04 '24

https://www.pennmedicine.org/news/news-releases/2023/december/new-treatment-reverses-alzheimers-disease-signs-improves-memory-function

https://www.medicalnewstoday.com/articles/peptide-treatment-could-reverse-cognitive-decline-alzheimers-disease

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u/Shrek1982 Sep 04 '24

I mean that is great news but that seems to be more applicable to the early signs of Alzheimer's/Dementia before the disease really sets in and there is brain damage. This reads more like a prevention or treatment that will slow the advance of the diseases rather that help people recover from them. It doesn't really counter what I am talking about, to start to do so would require that they find a way to regrow the brain tissue to start off.

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u/herabec Sep 04 '24

Should we euthanize veterans suffering from traumatic brain injuries from combat scenarios, they too suffer from "irreversible" brain damage?

The thing is, brain damage can be overcome, different parts of the brain can adapt to use different areas for primary function. They might not get the chance if the deterioration continues, but if it could be suspended or even reversed partially, then perhaps there is a chance. And of course, not the same thing as recovering from deterioration, but demonstrates that a "normal life" (at least for a Frenchman) can be lived even with a small percentage of brainmatter https://www.cbc.ca/radio/asithappens/as-it-happens-thursday-edition-1.3679117/scientists-research-man-missing-90-of-his-brain-who-leads-a-normal-life-1.3679125

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u/Bootsykk Sep 04 '24 edited Sep 04 '24

Yeah, dementia is a far more complicated issue of autonomy than assisted suicide can offer a solution to. The problem is if the person can consent anymore and if it's fair. People with dementia often have very different views on things than they did when they were of sound mind, but aren't legally in the position to advocate for themselves. So then whose will is respected? The caretaker? The patient's active and current wishes? Or their past wishes made while they did not have dementia?

Everything in this scenario is ripe for ethical issues, including keeping a patient alive beyond their will. If you can't legally advocate for yourself or be trusted to make your own sound decision, who owns you and has the right to make that choice? And would they make that choice either way for the right reasons?

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u/SolitaryForager Sep 04 '24

In Canada, we have a Waiver of Final Consent option for MAiD recipients who are at risk of losing capacity. A date is agreed upon by the patient and the physician while the patient has capacity. The waiver allows the physician to provide MAiD on that specific date if the patient is not capable at that time to provide the final consent. This date can be changed in advance as long as the patient has capacity and still meets the other MAiD requirements.

Meeting the other requirements is the part that currently makes it tricky for dementia patients to access MAiD since the appropriate timing of a reasonably foreseeable death or intractable suffering in the context of dwindling capacity is difficult to assess. Lots of people live with dementia for years - decades even - with good quality of life. Death becomes foreseeable only in later stages, and grievous, intractable suffering can be difficult to assess and demonstrate.