Yes, say German and Dutch bioethicists; they don’t know their own mind

One problem sector in regimes which have legalised euthanasia is demented people who have made advance directives asking for euthanasia. They have drifted away from terra firma, but they often are sailing quite happily along and no longer request life-ending treatment. They seem to have an adequate quality of life. In technical terms, they have undergone a “response shift”. Should they be denied a choice they made when their feet were firmly on the ground?

A recent article in the Journal of Medical Ethics argues that their choice should probably be honoured. Three authors from the Netherlands and Germany contend that demented people do not really undergo a response shift because their disease makes them unable to change their values.

Dementia patients do not choose what they forget, therefore what they still remember and the values they still express are not to be considered the ones with the highest priority. Which values and preferences remain is not the result of a conscious choice but is dictated by the disease. It is therefore a false conclusion to say that the dementia patient no longer ‘cares’ about the things that mattered when he did not have dementia.

This implies that the current wishes of a person with dementia should not necessarily be respected if they have made an advance directive requesting euthanasia: “It is unwarranted to argue that one’s current well-being should always take precedence over all other values once a person is incapacitated.” The authors stress that advance directives should not followed blindly, but neither should carers refrain from euthanasing demented people simply because they look happy as Larry in their present condition. 

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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