April 21, 2024

Is a dementia patient two different people?

If so, how can the present person bind the future person through an advance directive?

from 'Reflections of the Past', a photo series by Tom Hussey 

Canada’s new euthanasia legislation does not permit binding advance directives. However, there is pressure to incorporate them into legislation. Supporters argue that some people choose euthanasia too soon because they fear lingering on in a demented state.

In an acute analysis of the situation in the blog Impact Ethics, Valentina Romano points out that the “legalizing dementia-related advance directives … is problematic because the justification rests on the assumption that dementia patients are simpler, faded versions of the healthy persons they once were. In reality dementia patients are not abridged versions of their past selves; they are different persons facing new challenges with a different set of interests.”

It is impossible to predict what the wishes of a person with dementia will be, as the disease is “enigmatic and unpredictable”. Romano argues that dementia patients slowly become two different persons as their disease progresses. Therefore “a prospective end-of-life decision made through an advance directive affords too much power to the present person and none at all to the future one.” She concludes:

For a person facing dementia to make a life-ending decision for a future self is more equivalent to that patient making such a decision for a complete stranger. This is, in my mind, the most problematic aspect of advance directives for dementia-related MAiD. By the time they are effective, advance directives for MAiD are to implement wishes that may be utterly irrelevant and completely forgotten by the late-stage demented patient.

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