This post begins a multi-part series about dementia directives, analyzing their provisions and their purposes.
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Ezekiel J. Emanuel, distinguished oncologist and bioethicist, a vice provost at the University of Pennsylvania, chair of the Department of Medical Ethics and Health Policy, an author and editor in the health care field, wants to die at age 75. Why would he make such a decision in what many would see as the prime of his life?
One of the most organized efforts to defeat right-to-die (RTD) legislation wherever it is proposed is spear-headed by Not Dead Yet (NDY) under its current President, Diane Coleman. NDY claims to represent, or be representative of, at least 12 disability rights groups who oppose RTD legislation. Coleman’s failed appeal to Maine Governor Janet Mills to veto the RTD law, passed narrowly by Maine’s legislature, presents an outline of the arguments used to oppose such RTD laws.
Thanks to everyone who made suggestions to deal with Jane’s presumptive problems (see previous post). If Jane had an independent social worker–one not in her healthcare system–that person might respond to Jane’s difficulties with something like the following:
If we use “existential suffering” as a stand-in for all of the related terms we use, it will help us discuss what we may mean by them. Certainly, distress, dread, angst, anxiety, anguish, or crisis all suggest suffering at least in a mental or psychological sense, a kind of suffering that all people encounter at one point or another in their lives, or even daily. Some existential suffering can be mitigated through changes in circumstances or with the help of others, but when one is dying, whether slowly or rapidly, one may wish to forego the suffering whether or not there may be temporary relief for it.
In Part 1 of this series, I addressed ten criticisms of MAID laws, particularly those in Oregon and Washington, though most such laws are modeled largely on Oregon’s law. In Part 2, I look at criticisms of MAID laws concerning economic pressures, coercion, depression, inadequate resources for MAID clients, doctor shopping, inadequate Medicaid rules, ableism, and the failure of the drugs prescribed to MAID clients. My hope is that we can learn from opponents of MAID laws how to make the laws better.
Larissa MacFarquhar discusses treatment approaches for people in the late stages of dementia in the October 8, 2018, issue of The New Yorker–The Comforting Fictions of Dementia Care. It is not unusual for late-stage dementia patients to have delusions (the belief in something that is not real) or hallucinations (false sensory perceptions of objects or events). How caregivers might respond to these and related dementia problems is the subject of MacFarquhar’s article.
In Part 2 of this post about dementia, disability, and advance directives, Lamar Hankins challenges Dresser’s assertion that an advance directive that calls for allowing a person to die in the later stages of dementia should be ignored in favor of her view of what care is appropriate.
Rebecca Dresser is a law professor and recognized expert in biomedical ethics. She argues that “people usually live for many years after a dementia diagnosis, years in which meaningful and satisfying life can continue. People can’t be sure how they will fare as dementia patients . . .” She suggests that because dementia patients can adapt to their new circumstances, they must, therefore, be allowed to accept this new life.. Lamar Hankins analyses her ideas in a two-part post.
Jim Waun, a retired anesthesiologist, shares some of his personal experiences that led him to support the Death With Dignity movement and the Final Exit Network (FEN), and he explains how FEN’s Exit Guide program works.
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