Dementia and Euthanasia

The living will is a document in which a person states his or her choice to die rather than to be kept artificially alive in the event of becoming disabled beyond any reasonable expectation of recovery. Euthanasia, on the other hand, is the assisted death to a person with a terminal illness who expresses his or her desire to die. In the first case, any artificial devices sustaining the life of the dying patient are removed; in the second, the patient is painlessly killed.

The substantial and permanent increase in life expectancy over the recent decades–if I do not die today, my life expectancy will be three hours longer tomorrow–leads to a higher percentage of elderly people and consequentially, a higher occurrence of senile ailments such as Alzheimer’s disease and dementia with Lewy bodies. Their victims present pathetic mental states but, because of their bearable physical health, they may last many years, years that cannot be properly called ‘life’. Living wills do not apply in such cases and those so affected do not have any initiative to request their euthanasia. Sad situation indeed! Holland is laying corrective guidelines in this controversial territory.

In order to provide anticipated options to those people who are already unable to express their determination, the Dutch authorities for health and justice have recently updated their guidelines for the application of euthanasia in cases of severe dementia. The new rules involve patients’ statements, signed while they were still lucid, that document their desire to undergo assisted suicide, if any of the cruel forms of dementia deteriorate their initiative and will. This approach combines the conventional living will, which you can subscribe several years in advance, with the request for euthanasia, the action of which is rather immediate.

Little is yet known about the causes of the Alzheimer’s disease and even less of its treatment. One of the first genetic codes that was completed a few years ago, when the cost of the procedure exceeded half a million dollars, was the DNA of biologist James Watson, co-discoverer of the DNA structure. Since his grandmother had suffered from this disease, the scientist expressly requested not to include in his report the presence or absence of a specific gene associated with such evil. “I do not want to know such result,” he said in an interview. “If positive, I would seriously consider suicide” Fortunately, Doctor Watson is still active, six decades after having shared the Nobel Prize in medicine with other researchers.

Another situation, this one with a tragic outcome, was that of Robin Williams, who committed suicide two years ago. The famous actor and producer developed the dementia of bodies of Lewy, a disease even more painful than Alzheimer’s. Susan Schneider, the comedian’s wife, said that “however you look at it, the presence of Lewy bodies took Robin’s life”. Had the actor postponed his fatal decision if the option of a subsequent euthanasia, several months or years later, had existed? The answer to this question went away with the brilliant humorist’s life.

Sages commonly recommend detachment as the path to inner harmony. “Wish nothing and ​you will be the richest man on Earth,” Cervantes wrote. But, can we even think of detaching ourselves from our consciousness? Of course not: The consciousness of ‘our self’ is our own sense of identity, the total sum of what characterizes us, including all our preferences and addictions (as well as all our aversions and phobias). We could let go off attachments, but we could never give up our consciousness.

Unfortunately, when dementia takes control of us, our consciousness takes a step to the side and the sense of identity disappears. Thus it becomes imperative for our ‘I’ to make decisions about future eventual disabling diseases, when our consciousness is still present and active.

There is no doubt, therefore, that the steps taken by the Dutch in this territory will be followed soon by other cultures, and more and more people will make decisions for the future of their mental health while their consciousness, and thus their sense of identity, are still lucid and intact. Welcome this new pattern!

Atlanta, December 16, 2016


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