Physician-Assisted Suicide and Dementia: The Impossibility of a Workable Regulatory Regime

John B. Mitchell


Currently, four-and-a-half million Americans are afflicted with Alzheimer’s Disease, accounting for roughly half the cases of adult dementia, and fourteen million cases are projected by mid-century. With the coalescence of the baby boomers, managed health care, and increasingly scarce health care resources, our society must brace to face a social and legal policy challenge of enormous importance and complexity. In this circumstance, the inevitable call for access to physician-assisted suicide, likely triggered through some form of living will, will need to be considered within a context far different than the current focus of the assisted-suicide debate on terminal illness. Asserting the position that it is not possible to create a workable regulatory regime to legally control physician-assisted suicide (PAS) for the demented, the author posits that the false cultural myth characterizing the demented as “empty shells” diverts us from carefully examining the insurmountable difficulties with allowing PAS for dementia. The author proceeds to debunk this myth, first considering experiences of caregivers, and then demonstrating how these anecdotal stories are in line with both philosophical constructions of personhood, and current psychological theories of the self. Finally, the author explains why meaningful consent to PAS by dementia sufferers is not possible, and he cautions against attempting PAS through advance directives for dementia. Far from protecting the interests of the demented individual, such directives will give what the author terms “total interpretive discretion” over the life or death of the demented person to caregivers who will often have societal misconceptions about dementia or who will ascribe troublesome behavior to manifestations of the disease rather than to clumsy attempts to communicate needs. The author instead urges positive investment in education and research as a bulwark against increased demand and sanction of PAS for dementia as the elder population expands in coming decades.