Can. WebAn Advance Directives Specifically for Alzheimers Patients. Utilitarianism Impacting Care of Those with Disabilities and Those at Life's End. The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. ][O 0zE|!8'c\L{%{W3o_2*-'k4\> pd8otfy\, doi: 10.1002/ccr3.5759. Though based on a relatively small number of countries, and not specifically addressing the specific case of dementia, they suggest that economic and cultural factors might play an important role in determining attitudes towards assisted dying, whether through the assistance or direct action of a physician. 37 0 obj 10 Advance Directives, Dementia, and Physician-Assisted Death P. Menzel, B. Steinbock Medicine Journal of Law, An argument often advanced in this context is that PAS may be desired by caregivers facing intolerable burdens of this sort, and that therefore it should be made available as a legal option (Tomlinson et al., 2015; Jakhar et al., 2020). 28 0 obj Medical Aid in Dying: What Matters Most? Is Physician-Assisted Death for the Demented Possible? Bioethics 28, 9699. Omega (Westport) 43, 349361. agsdi-sleep. 19, 18. doi:10.1186/s12877-019-1033-2, Wang, G., Albayrak, A., and van der Cammen, T. J. M. (2019). 2004 Oct;30(5):447-51; discussion 451-2. doi: 10.1136/jme.2002.002857. Flow diagram showing the selection of articles for conceptual analysis. Specific requirements for changing directives may vary by state. Homicidal Ideation in Family Carers of People with Dementia. This site needs JavaScript to work properly. Lancet Neurol. doi:10.1089/jpm.2008.0162, Bravo, G., Rodrigue, C., Arcand, M., Downie, J., Dubois, M. F., Kaasalainen, S., et al. (2019). Each J. Pharmacol. doi:10.1001/jama.2016.8499, Fam, J., Mahendran, R., and Kua, E. H. (2019). J. Additional Choices. We argue that in many cases they should be, and that a sliding scale which considers both autonomy and the capacity for enjoyment provides the best justification for determining when: when written by a previously well-informed and competent person, such a directive gains in authority as the later person's capacities to generate new critical interests and to enjoy life decrease. 2007 Apr;7(4):48-56. doi: 10.1080/15265160701220881. Rep. 34, 1820. Authorising euthanasia and assisted suicide with advance euthanasia directives (AEDs) is permitted, yet debated, in the Netherlands. doi:10.1097/HTR.0000000000000656, Rapp, C. (2016). Am J Geriatr Psychiatry. Neurol. Ethics 35, 100103. J. Nurs. It has also been noted that, in some cases, those belonging to a higher socio-economic stratum may also be overrepresented among those opting for PAS, again suggesting that simple linear arguments based on caregiver costs do not tell the entire story (Krag, 2014). Physician-assisted Death: Dying with Dignity? 1997 Jun;28(2):8-11. doi:10.1080/13607863.2015.1065793, Owen, J. E., Goode, K. T., and Haley, W. E. (2001). Bioethics 35, 438445. WebEUTHANASIA: USING AN ADVANCED DIRECTIVE TO FACILITATE THE DESIRES OF THOSE WITH IMPENDING MEMORY LOSS V. PHYSICIAN-ASSISTED DEATH AND DEMENTIA .. 567 A. Aging, Dementia and Care: Setting Limits on the Allocation of Health Care Resources to the Aged. First prosecution of a Dutch doctor since the Euthanasia Act of 2002: what does the verdict mean? Though this argument may be more ethically sound than the previous one, as it involves informed consent from patients themselves, it still entails certain difficulties. This could lead to consent or approval being given under duress, and thus being of limited validity. (2021). IffN|kO'y=% ,%Eu(VaP>:Cw$'>?3,^y @,pOv"?"| Xp|{vG7MT2tv32iQ/"~9 wLoEbeQlUALl44((M]l/!v|JzK^Ag endstream J. Med. doi:10.2307/3528689, Sharp, R. (2012). doi:10.1017/S1041610217000679, Dierickx, S., Deliens, L., Cohen, J., and Chambaere, K. (2017). A better approach than asking any one person to be responsible is for the whole family to talk about the person with Alzheimers, how he lived and what he believed in. doi:10.1007/s11019-018-09883-2, van Wijmen, M. P., Pasman, H. R., Widdershoven, G. A., and Onwuteaka-Philipsen, B. D. (2015). doi:10.1177/0269216320968517, Meier, D. E. (1997). Paul T. Menzel & Bonnie Steinbock - 2013 - Journal of Law, Medicine and Ethics 41 (2):484-500. details Physician-assisted suicide laws in Oregon and Washington require the person's current competency and a prognosis of terminal illness. Epub 2022 Feb 20. doi:10.1097/WAD.0000000000000065, Wicher, C. P., and Meeker, M. A. suWNR}IkCq-5/Vll m>`0x5r6*0plkL?fj5@:P"5T9BCJ J 2 0 obj x]ms8Vi+fwroJW,IR%cgc%s_ HbT$l4~O?>x| The name and contact information of your healthcare agent or proxy. Learn more. Treatments for the Prevention and Management of Suicide: A Systematic Review. Med. 33, 13941399. A Systematic Review of Religious Beliefs about Major End-Of-Life Issues in the Five Major World Religions. <>stream Most Are Deficient, and many Have Been Met with Hostile Judicial Interpretations. Bilchik, G. S. (1996). JAMA Netw. Ethics 26, 4860. It has been argued that PAS may lead to substantial savings at the systemic level (Trachtenberg and Manns, 2017); this could lead to a tendency to offer or recommend PAS to patients with dementia as a cost-effective measure (Bilchik, 1996). Advance consent, critical interests and dementia research. <>7]/P 6 0 R/Pg 44 0 R/S/Link>> These are not independent of each other; for example, a survey of African-Americans found that several factors, including their cultural and spiritual values and their attitude towards the healthcare system, influenced their lower preference for euthanasia or PAS (Wicher and Meeker, 2012). doi:10.2190/YH2B-8VVE-LA5A-02R2, Pereira, J. (2017). (2011). BMC Geriatr. FOIA First, data on attitudes towards euthanasia for twenty-eight countries, obtained from the World Values Survey, is analyzed. Cultural factors: Scores for Hofstedes six dimensions of national culture power distance, individualism vs. collectivism, masculinity vs. femininity, uncertainty avoidance, long-term orientation, and indulgence vs. restraint, compiled in the year 2010 and updated with World Values Survey data from the year 2014. Euthanasia performed in accordance with the wishes of a competent person, expressed personally or by an advanced directive: Nonvoluntary euthanasia: Euthanasia performed when the wishes of the person are not known: physician-assisted suicide (PAS), physician-assisted dying (PAD) and medical assistance in dying (MAID). As information on the mean age and gender distribution of the study samples from each country was not available in the World Values Survey data set, two surrogate markers were used instead: average national life expectancy at birth, and proportion of women per 100 population in each country. 17, 9779. The issue is highly controversial. Ethics 18, 62. doi:10.1186/s12910-017-0222-9, Tomlinson, E., Spector, A., Nurock, S., and Stott, J. Groves, K. (2006). J. Med. 16 0 obj The site is secure. 16, 106. doi:10.1186/s12877-016-0280-8, Gitlin, L. N., Marx, K., Scerpella, D., Dabelko-Schoeny, H., Anderson, K. A., Huang, J., et al. 276, 970983. J. Environ. A further four subjects reported aggressive behaviour, verbal or physical, towards the patient, but no wish for the patient to die or be killed. The unfeasibility of requests for euthanasia in advance directives. 62, 559569. A different but related argument was offered by Kipke (2015), who pointed out that, once one endorses PAS, there are no coherent ethical objections to the provision of assisted suicide outside the healthcare system, including the commercialization of this practice; in other words, permitting PAS in a medical setting could eventually lead to the implementation of this practice on a for-profit basis. doi:10.1371/journal.pone.0214724, Verhofstadt, M., Audenaert, K., Van den Broeck, K., Deliens, L., Mortier, F., Titeca, K., et al. Front. This is particularly important in the case of dementia, where there are already significant barriers to care (Werner et al., 2014; Kenning et al., 2017). doi:10.1136/medethics-2014-102150, Borroni, B., Agosti, C., and Padovani, A. What Happens to Patients with Treatment-Resistant Depression? application/pdf WebHemlock Society of San Diego Good Life, Good Death. 44 0 obj Curr. What defines a life worth living? Ethics 472020, 257106089. doi:10.1136/medethics-2020-106089, Campana, M., Falkai, P., Siskind, D., Hasan, A., and Wagner, E. (2021). <>29 0 R]/P 6 0 R/S/Link>> It is important to appoint an alternative healthcare agent or proxy in case yours becomes unavailable to execute their duties when you are dying. A Dutch euthanasia review committee found that the physician performing the euthanasia failed to follow due care requirements for euthanasia and assisted suicide. Int. Epub 2019 Dec 5. doi:10.1111/jgs.16692, Buturovic, Z. Med. An argument about abortion, euthanasia and This finding is easily understood given that societies with a high power distance show higher levels of respect and deference towards elders, who are often the target population for physician-assisted dying (Moshe and Gershfeld-Litvin, 2020). Basing decisions regarding PAS on the least expensive or most cost-effective option subordinates the rights of both patients and caregivers to economic factors (Bilchik, 1996; Meier, 1997; Gerk, 2017) and opens the door to various forms of abuse (Kipke, 2015). Studies of caregivers have also noted that, often, it is not just economics that influences attitudes towards PAS. (2021). 171, 334342. J. Being uninhibited, remiss about hygiene, inclined to mishaps or unable to keep things tidy does not indicate mental incompetence. 14 0 obj J. Psychogeriatr 29, 12471259. Community Health Nurs. Bolt, E. E., Snijdewind, M. C., Willems, D. L., van der Heide, A., and Onwuteaka-Philipsen, B. D. (2015). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. what We Think about Ending Their Suffering-Attitudes toward Euthanasia for Elderly Suffering from Physical versus Mental Illness. (2018). Results consistent with this finding have been obtained from earlier research in Poland, Germany and the United States (Kemmelmeier et al., 2002). A Systematic Review of Older Adults' Request for or Attitude toward Euthanasia or Assisted-Suicide. doi:10.1111/j.1467-8519.2012.01996.x, Anderson, J., Eppes, A., and ODwyer, S. (2019). 2 As the nation, individual states, and various interest groups consider the adoption of physician-assisted suicide policies, it is essential that Med. National Library of Medicine (2011). The issue of individuals with dementia completing advance directives (ADs) is discussed, and several investigators have demonstrated successful completion of ADs by individuals with mild and moderate dementia. This site needs JavaScript to work properly. The perceived right of an individual to make decisions about their own life and death, particularly when cognitive and neurological impairment leads to significant suffering and loss of autonomy or identity. Access personal subscriptions, purchases, paired institutional or society access and free tools such as email alerts and saved searches. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Finally, as Johnstone (2013) has pointed out, the use of dementia in public debates over assisted dying has led to the adoption of problematic imagery and metaphors to describe dementia. Physician-assisted suicide occurs when a physician provides a medical means for death, usually a prescription for a lethal amount of medication that the patient takes on his or her own. 36, E262E283. Further searches were conducted within these results using the additional search terms caregiver, caregiver burden, stress, behavioral and psychological symptoms of dementia, BPSD, economic, financial, autonomy, dignity, identity, personhood and ethics. By this method, a total of 103 citations were retained (Pereira, 2011; Schuurmans et al., 2021; Kemmelmeier et al., 2002; Bradley, 2009; Baeke et al., 2011; Chakraborty et al., 2017; Madadin et al., 2020; Nichols, 2013; Emanuel et al., 2000; Krag, 2014; Trachtenberg and Manns, 2017; Bilchik, 1996; Lazar and Davenport, 2018; Karrer et al., 2020; Stakiaitis et al., 2019; Finucane et al., 2007; Finucane, 1999; Sachs et al., 2004; Dominguez et al., 2021; Meier, 1997; Liu et al., 2020; Gao et al., 2019; Gilhooly et al., 2016; Watson et al., 2019; Cheng, 2017; Biggs et al., 2019; Fam et al., 2019; Dening et al., 2013; Owen et al., 2001; Cohen-Mansfield and Brill, 2020; Anderson et al., 2019; O'Dwyer et al., 2016; Bravo et al., 2018; Wicher and Meeker, 2012; Stolz et al., 2015; Seike et al., 2021; Kashimura et al., 2021; Zwingmann et al., 2018; Gitlin et al., 2019; von Knel et al., 2019; Zwingmann et al., 2019; Gerk, 2017; Kipke, 2015; Deardorff and Grossberg, 2019; Tiel et al., 2015; Borroni et al., 2008; Kim et al., 2021; Yunusa et al., 2019; Seibert et al., 2021; Dierickx et al., 2017; Scassellati et al., 2020; Hendin et al., 2021; Fornaro et al., 2020; Verhofstadt et al., 2021; Serafini et al., 2016; D'Anci et al., 2019; Buturovic, 2020; Canetto, 2019; Mondragn et al., 2020; Allen, 2020; Rosner and Abramson, 2009; Shannon and Walter, 2004; Alsolamy, 2014; van Wijmen et al., 2015; Brinkman-Stoppelenburg et al., 2020; Mangino et al., 2021; Wardle, 1993; Nicolini, 2021; Mathews et al., 2021; Hertogh, 2009; Jones, 1997; Reagan et al., 2003; Gmez-Vrseda and Gastmans, 2021; Cipriani and Di Fiorino, 2019; Menzel and Steinbock, 2013; Groves, 2006; Fontalis et al., 2018; Gastmans and De Lepeleire, 2010; Ting et al., 2017; Nie et al., 2015; Nakanishi et al., 2021; van der Burg et al., 2019; Largent et al., 2019; Hilliard, 2011; Sharp, 2012; D'cruz, 2021; Cohen-Almagor, 2016; Bolt et al., 2015; Sulmasy et al., 2016; Kenning et al., 2017; Werner et al., 2014; Sulmasy et al., 2018; Dehkhoda et al., 2021; Bravo et al., 2021; Castelli Dransart et al., 2021; Miller et al., 2019; Jongsma et al., 2019; Diehl-Schmid et al., 2017; Cherry, 2003; Johnstone, 2013; Cholbi, 2015; Nicolini et al., 2020; Fuchs and Fuchs, 2021; Huang and Cong, 2021) and these are summarized and analyzed below. 13, 131. doi:10.1186/s13195-021-00867-8, Seike, A., Sumigaki, C., Takeuchi, S., Hagihara, J., Takeda, A., Becker, C., et al. It is also possible that individuals may express approval of PAS as an abstract notion, but be more disapproving when presented with concrete cases. doi:10.1136/medethics-2013-101544, van Wijngaarden, E., Alma, M., and The, A. M. (2019). 53, 549553. Med. *Correspondence: Ravi Philip Rajkumar, ravi.psych@gmail.com, End-Of-Life Care and Physician-Assisted Dying (PAD) in People Living with Dementia: Intersections of Law and Psychiatry, View all Isnt afraid to ask tough questions, which invariably arise when discussing a dying individuals end-of-life care. Is or can easily be within physical proximity of where youre likely to receive care. A multi-centre, quasi-experimental study was conducted to test the feasibility and acceptability of a theory doi:10.1177/1471301220922766, Dening, K. H., Jones, L., and Sampson, E. L. (2013). Impact of Medical Assistance in Dying on Palliative Care: a Qualitative Study. There has been an increasing drive towards the legalization of physician-assisted suicide (PAS) in patients with dementia, particularly in patients with advanced disease and severe cognitive impairment. Dementia is ruled out as a candidate for PAD, even if she is terminally ill and suffering terrible and unrelievable pain, which rules out individuals with strong and unwavering desires not to end their life in dementia. G. Curfman, S. Morrissey, J. Drazen Law The New England journal of medicine 2008 TLDR In PAS the patient takes lethal drugs made available through a 58, 3445. J. Med. First, though currently available therapies for BPSD have significant limitations, this may not be the case in the future. [14] Dresser, R. (1995). <> CMAJ 189, E99E100. (2015). Ethics 37, 727734. Blood DNA Methylation Levels in the WNT5A Gene Promoter Region: a Potential Biomarker for Agitation in Subjects with Dementia. Fifth, there are certain dangers in relying on an advance directive in such cases, because an individuals wishes may vary over time: a patient with early dementia might express a wish for PAS due to psychosocial factors (such as depression or economic hardship) at one point in time, but express a different attitude if such problems are ameliorated (Dcruz, 2021). These results are consistent with those of a similar study examining changes in attitudes towards this practice across countries, which also found a positive correlation between higher national income and approval of euthanasia (Inglehart et al., 2021). A Meta-Review of Stress, Coping and Interventions in Dementia and Dementia Caregiving. Assisted Dying in Dementia: a Systematic Review of the International Literature on the Attitudes of Health Professionals, Patients, Carers and the Public, and the Factors Associated with These. 2022 Jun;70(6):1704-1716. doi: 10.1111/jgs.17707. Clin. It can take the place of two individual documents: the living will and the durable power of attorney for healthcare (also referred to as healthcare power of attorney, healthcare proxy, and appointment of a healthcare agent). Am. doi:10.1080/07370016.2018.1404832, Liu, C. C., Lee, C. F., Chang, T., and Liao, J. J. Med. We have the right to make our own healthcare decisionseven when we have Alzheimers disease. 21, 205211. Advance Directives, Dementia, and Physician-Assisted Death P. Menzel, B. Steinbock Published 1 June 2013 Medicine The Journal of Law, Medicine & Ethics The .gov means its official. Is it Time for Hospice? TABLE 3. doi:10.1136/jme.2011.045492, Degawa, T., Kawahata, I., Izumi, H., Shinoda, Y., and Fukunaga, K. (2021). doi:10.1097/YCO.0000000000000523, Fekadu, A., Wooderson, S. C., Markopoulo, K., Donaldson, C., Papadopoulos, A., and Cleare, A. J. Web1.6.2 Advance Directives vary according to the individual and mental disorder, and which presents many knowledge gaps (Council of Canadian Academies, 2018, p 193). J. Palliat. A multi-centre, quasi-experimental study was conducted to test the feasibility and acceptability of a theory Psychiatry Rep. 19, 64. doi:10.1007/s11920-017-0818-2, Cherry, M. J. Advance Directives, Dementia, and Eligibility for Physician-Assisted Death 38, 4967. In some countries, the term medical assistance in dying is used as a synonym for assisted dying. Thus, both euthanasia and PAS require the intervention of a physician, with the only difference between the two practices being the person who administers the drugs in question. The courts efforts to fit incompetent patients to the model of a competent decision-maker are seriously flawed and ultimately threaten harm to many incompetent patients. Learn more. J. Med. (2020). doi:10.4103/0973-1229.193077, Diehl-Schmid, J., Jox, R., Gauthier, S., Belleville, S., Racine, E., Schle, C., et al. J. Gen. Intern. Fourth, as the data for different variables was captured at different points in time, they may not reflect changes in social attitudes or economic circumstances that have occurred subsequently. Ann. Individual sample sizes from each country ranging from a minimum of 841 (New Zealand) to a maximum of 3,531 (South Africa). 8600 Rockville Pike Third, as was mentioned in the previous section, reducing the worth of a patients life to their cognitive capacities alone poses certain problems; patients with dementia may continue to live in an experiential way even if severely cognitively impaired. This Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. Its called an advance directive, and completing it is one of the best ways to ensure your care preferences are honored. Nie, J. In dementia, economically-driven systemic decisions appear to act as a barrier to the provision of other specific forms of care, such as nursing interventions (Karrer et al., 2020) and may lead to the excessive use of other forms of treatment, such as typical antipsychotics (Stakiaitis et al., 2019) and feeding tubes (Finucane et al., 2007), based on cost considerations rather than evidence. Int. doi:10.1177/0269216312464094, Deodhar, J. K. (2016). Depression and Anxiety Among Partner and Offspring Carers of People with Dementia: a Systematic Review. All variables were tested for normality prior to analysis. Gerontol. Maryland: 301-519-8041. WebSection 2 (2) of the law allows EAS based on an advance directive, and the euthanasia review committees Code of Practice explains how: a patient aged 16 or over who is decisionally competent in the matter may draw up an advance directive setting out a request for euthanasia. WebGale Academic OneFile includes Advance directives, dementia, and physician-assisted de by Paul T. Menzel and Bonnie Steinbock. Dementia (London) 20, 9851004. (2011). 3 Questions to Ask Yourself, A Day in the Life of a Hospice Social Worker, Hospice and the Medicare Beneficiary Identifier (MBI), FAQs about Hospice and Medical Conditions. Though these problems exist globally, they may be particularly acute in low- and middle-income countries where resources for caregivers are limited (Fam et al., 2019). Med Health Care Philos. doi:10.1136/medethics-2013-101781, Cipriani, G., and Di Fiorino, M. (2019). Though economic considerations are important in the efficient running of healthcare systems, the interests of the patient should not be subordinated to them (Meier, 1997). Ethics 45, 8489. Dementia Caregiver burden: a Research Update and Critical Analysis. J Am Geriatr Soc. Toward the Clarification of Ideas: Medical Futility, Persistent/obstinate Therapy and Extra/ordinary Means. Competent people have a right to reject any medical treatment. <>1]/P 15 0 R/Pg 44 0 R/S/Link>> Response to: 'Dementia and advance directives: some empirical and normative concerns' by Jongsma. WebThe tenability of maid and death and advance directives dementia physician assisted suicide, as the web site requires in this aper suggests that they are similar. doi:10.1111/bioe.12865, Inglehart, R. C., Nash, R., Hassan, Q. N., and Schwartzbaum, J. Epub 2014 Aug 12. Do you define life by the intake of breath and nutrients? Med. Attitudes Toward Physician-Assisted Death From Individuals Who Learn They Have an Alzheimer Disease Biomarker. Euthanasia performed in accordance with the wishes of a competent person, expressed personally or by an advanced directive: Nonvoluntary euthanasia: Euthanasia performed when the wishes of the person are not known: physician-assisted suicide (PAS), physician-assisted dying (PAD) and medical assistance in dying (MAID). The https:// ensures that you are connecting to the What Influences African American End-Of-Life Preferences? Psychiatry 11, 622446. doi:10.3389/fpsyt.2020.622446, Johnstone, M. J. J. The Concept and Management of Acute Episodes of Treatment-Resistant Bipolar Disorder: a Systematic Review and Exploratory Meta-Analysis of Randomized Controlled Trials. To learn more: read this JAMA essay about the rationale behind this project, and listen to this feature about it on NPR. doi:10.1076/chbi.9.2.245.30278, Cholbi, M. (2015). Beyond a biomedical or bioethical framework, there are significant objections to the practice of PAS, both in general and with reference to dementia, in many of the worlds religious traditions (Chakraborty et al., 2017). WebAdvance Directives, Dementia, and PhysicianAssisted Death Paul T. Menzel& Bonnie Steinbock Journal of Law, Medicine and Ethics41 (2):484-500 (2013) Download options PhilArchive copy Upload a copy of this paper Check publisher's policy Papers currently archived: 70,561 External links From the Publisher via CrossRef (no proxy) If you reside in multiple locations, you will need to complete an advance directive form for all states in which you live and/or receive care. J Alzheimers Dis. While many of these problems are related to the behavioural problems exhibited by patients with dementia, discussed in the next section, others are not directly correlated with the presence and severity of these behaviours. endobj official website and that any information you provide is encrypted Watson, B., Tatangelo, G., and McCabe, M. (2019). Such a concern is not merely theoretical; there is already evidence from a Belgian series that women are far more likely to undergo PAS for dementia or mood disorders than men (Dierickx et al., 2017). What Happens if I Get Better While in Hospice Care? In the overall sample, a recurrent theme was that if the health care and social care systems were more attuned to the needs of people with dementia and their caregivers, their overall burden would be minimized and they would be less likely to consider PAS favourably (Dening et al., 2013). End-of-life Care and Psychiatry: Current Trends and Future Directions in India. Med. Given the drastic and final nature of PAS as a proposed solution for caregiver burden in dementia, it would be prudent to carefully assess such relationships first, and to consider alternate forms of assistance that do not entail the immediate death of the patient. Huang, Y., and Cong, Y. Physician-assisted Suicide and Physician-Assisted Euthanasia: Evidence from Abroad and Implications for UK Neurologists. Available at: https://www.pewresearch.com (Accessed 11 10, 2021). All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors, and the reviewers. By. Linacre Q. Clipboard, Search History, and several other advanced features are temporarily unavailable. Valuing Biomarker Diagnostics for Dementia Care: Enhancing the Reflection of Patients, Their Care-Givers and Members of the Wider Public. Sarah Dobec, a communications specialist with the pro-euthanasia lobby group, said in a letter to The B.C. Are Informal Caregivers of Persons with Dementia Open to Extending Medical Aid in Dying to Incompetent Patients? Have also noted that, often, it is not just economics that influences attitudes euthanasia. And Dementia Caregiving at Life 's End: read this JAMA essay about rationale... T. J. M. ( 2019 ) what we Think about Ending Their Suffering-Attitudes toward euthanasia or Assisted-Suicide what Happens I. 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