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Old 09-29-2008, 09:34 AM   #1
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People With Alzheimer's Have A "Duty To Die"

abcnews.com

Do Alzheimer's Patients Have a 'Duty to Die?'
Ethicists, Alzheimer's Advocates Decry Baroness Mary Warnock's Comments
By DAN CHILDS
ABC News Medical Unit

Sept. 25, 2008—

When Dr. Jonathan Groner, a surgeon and ethicist at Ohio State University, heard of a suggestion by a well-known British philosopher that those with dementia have a "duty to die" in order to minimize the burden they place on society and their families, he was troubled.

First, there were the moral implications of the comments that 84-year-old Baroness Mary Helen Warnock shared with the Church of Scotland's Life and Work magazine last week, in which she stated, "If you're demented, you're wasting people's lives -- your family's lives -- and you're wasting the resources of the National Health Service."

Such a policy could put society on a slippery slope, he said. And he noted many of the potential moral pitfalls accompanying the suggestion that those suffering from dementia should make a decision to end their own lives.

But Groner said losing his own father to Alzheimer's in January has perhaps given him the most insight into the issue -- and why the lives of dementia sufferers must not be devalued.

"I think that people with dementia are not worthless," Groner said. "Dementia is a huge problem, and it will be a growing one as more people get dementia. But trying to kill them off is probably not the best solution."

Groner is not alone in his opinion. Ethicists and Alzheimer's advocacy groups alike are expressing outrage over Warnock's comments last week, which echoed the opinion she put forth in an article she authored for a Norwegian periodical, titled "A Duty to Die?"

"The suggestion made by Baroness Mary Warnock is ignorant, insensitive and cruel, and denies the humanity of people with Alzheimer's and dementia," the Alzheimer's Association said in a statement issued Wednesday.

"We dispute the fact that if you have dementia or some part of Alzheimer's that you cannot have a quality lifestyle," noted Paul Williams, director of public policy for the Assisted Living Federation of America. "We've seen in the last 10 years that these residents have been able to have the most independence and the quality of life that can be expected of them. ... Just because you have a memory disease [doesn't mean] that we let you die and we can kill you."

And Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, said he was "shocked" by the comments when he read them.

"No one has a duty to die," he said. "The notion that society should 'expect' someone to end their lives because they fear being a burden upon others is simply ethically repugnant."

Sacrificing Dementia Patients: The Legal Question

Not the least of the ethical concerns associated with Warnock's suggestion is the concept of obtaining informed consent from someone with dementia.

"The demented person cannot undertake a 'duty to die,'" said Dr. Sam Gandy, chair emeritus of the National Medical and Scientific Advisory Council for the Alzheimer's Association. "Insight is lost early in many demented people, so that at the moment that Baroness Warnock thinks that they should die pro-actively -- at their own hand, I presume? -- all those people will have lost the capacity to make informed consent and many will have lost insight as well: The demented don't realize that they are demented. They often think that everything is fine."

Gandy said that this situation would subsequently put family members in the position of choosing whether to assist a relative who has dementia with their suicide -- or enlist a doctor to bring about death.

"That still amounts to murder in this country, which is why I say that [Americans] must first debate and draw the boundaries of euthanasia before the Warnock proposal can be entertained here," he said.

Indeed, current laws would prohibit anything approaching a mandate to artificially hasten the death of those with dementia.

"As we search for ways to bring mounting health care costs under control, it is tempting to want to give preferences in access to expensive care to people who are highly functional, at least mentally," said Maxwell Mehlman, director of the Law-Medicine Center at Case Western Reserve University School of Law. "Oregon tried to do this when it adopted its Medicaid rationing program in the early 1990s, and was blocked by both the Bush and Clinton administrations, which interpreted the Americans with Disabilities Act to prohibit discriminating against persons with disabilities in allocating access to health care services."

Since this law is still on the books, Mehlman said, any government attempt to put Warnock's ideas into practice would be illegal.

An Old Idea

Mehlman added that Warnock is not the first to put forward the idea of limiting health care for the elderly. In 1987, American bioethicist Daniel Callahan expressed a somewhat similar idea in a book titled "Setting Limits."

"Callahan advocated that Medicare stop paying for the elderly after they reached a certain age," Mehlman said. "Although Callahan was not absolutely clear on this, it appeared that the cut-off age was to be around 82. ... Callahan was roundly criticized for his view, including by me."

And in at least one instance in recent history, Groner said, such Machiavellian principles have been put into practice.

"In the beginning of the era leading up to World War Two, Hitler decided that he would need more hospital beds," he said. "If you were an individual with dementia or a child with a deformity, you didn't stand a chance."

But Groner said he felt there are better ways to control health care spending.

"In terms of costs to society, I think smokers cost more," he said. "Alcohol abuse I think is pretty expensive, too. So why pick on elderly people with dementia?"
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Old 09-29-2008, 11:00 AM   #2
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Electing to end ones life rather than burden family seems like a harsh, but plausibly humane, option. I really dislike the fashion the "pro-life" movement undercuts an individuals control over their own mortality, the freedom to choose treatment, refuse treatment or pursue euthanasia strikes me as fundamental (with obvious stipulations about ones capacity to make the decision).
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Old 09-29-2008, 11:27 AM   #3
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Being pro-life means defending life and yes, sometimes defending suffering.
Becaue if we allow ourselves to prescribe death as a relief from suffering than we play God. And there is no greater sin than that.
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Old 09-29-2008, 11:50 AM   #4
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That's only if you believe in the concept of sin in the first place.
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Old 09-29-2008, 11:59 AM   #5
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Being pro-life means defending life and yes, sometimes defending suffering.
Becaue if we allow ourselves to prescribe death as a relief from suffering than we play God. And there is no greater sin than that.
But then how do all the pro-death penalty folks justify their stance then?
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Old 09-29-2008, 12:48 PM   #6
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Is this going to turn into another abortion thread?

I think we have to ask ourselves what OUR duty is to our loved ones, and what the govt's duty is to seniors. My uncle has Alzheimer's and I have seen what it has done to my mother, to watch her being so upset every time she has been to see him. The last time was so bad. But I don't think in a million years that she'd ever say he has a duty to die. She has already watched one brother die. If his family could afford a better facility that would also make a difference.

Many people are "burdensome" in life in many ways, but we can't make the decision to eliminate them in such a way. If we do what does that make us? Like the article says, what about people with other diseases? Do they have a duty to die too? I would never personally want to live with dementia and be trapped in that hell or be a burden to anyone, but I would also never make that choice for anyone but myself.
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Old 09-29-2008, 01:59 PM   #7
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I think we have to ask ourselves what OUR duty is to our loved ones
i think our duty should be to carry out their last known wishes made of sound mind, whatever they may be.
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Old 09-29-2008, 02:24 PM   #8
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Well isn't the Baroness fortunate that she hasn't suffered the same fate as others and that includes my grandmother.
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Old 09-29-2008, 03:57 PM   #9
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I just want to say that what the Baroness said was pretty heartless. I've had relatives with dementia, so I know no one in my family thought they were better off dead. My mother never went around saying "Oh, I wish my brother was dead so he would take the burden off of me." If she did, I would think she only cared for herself and not for her brother.
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Old 09-29-2008, 04:13 PM   #10
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My mother had Alzheimer's early onset. Me and my Dad took care of her for 15 years at home with the help of a home care nurse. The average life expectancy after diagnosis was 8 years. The nurse cost less than having my mom in an institution. By having her at home she experienced less abuse and as her brain gave way so did her body. She couldn't feed until she had intravenus feeding. Evenutally she couldn't absorb that so the final stages are palliative care.

Taking care of her was the best thing I ever did. It means I have no problems with guilt or conscience. There is a happiness that comes from caring for other people. Humans like to have a purpose and sometimes our lifestyles seem shallow and materialistic and having a purpose that matters helps develop character, morality, and an inward contentment.

How would I feel if I had dementia and was abused in an institution? Most likely not good, even if I couldn't tell anyone. My mom could enjoy music and eating for many years so it wasn't totally useless. She was such a good mom that I have too much pity inside of me to think of her that way.

I also learned of the times when she needed to go to the hospital and how little care she got. Family members have more motivation to do the extra things to keep patients from bedsores or from wandering into dangerous situations.

If anyone has this situation just know you aren't alone and that it's always best to have family involved as much as possible. You will never regret it.
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Old 09-29-2008, 04:17 PM   #11
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But then how do all the pro-death penalty folks justify their stance then?
Murder and disease are different. An eye for an eye and making the punishment fit the crime is what pro-death penalty believe needs to happen or else all we will care about is the criminal (because they're still alive) and forget the victim that is already dead.
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Old 09-29-2008, 04:17 PM   #12
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I just want to say that what the Baroness said was pretty heartless. I've had relatives with dementia, so I know no one in my family thought they were better off dead. My mother never went around saying "Oh, I wish my brother was dead so he would take the burden off of me."
My grandmother with dementia who died last year suffered immensely in the last 6 months of her life. It was a horror story of epic proportions including a fall off the bed that broke her hip, MRSA infection and complete septic shock. I won't lie - my Mom and everybody I knew "prayed for God to take her" because watching her suffering was just incredible. She had no quality of life left, she could not speak, she was just in pain and nothing more.

That doesn't mean anybody wanted her dead to ease their own burden - but to ease hers.
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Old 09-29-2008, 04:41 PM   #13
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My grandmother with dementia who died last year suffered immensely in the last 6 months of her life. It was a horror story of epic proportions including a fall off the bed that broke her hip, MRSA infection and complete septic shock. I won't lie - my Mom and everybody I knew "prayed for God to take her" because watching her suffering was just incredible. She had no quality of life left, she could not speak, she was just in pain and nothing more.

That doesn't mean anybody wanted her dead to ease their own burden - but to ease hers.


wow, this is incredibly close to my own experience with my grandmother who died this past June. i *adored* her, and one of the worst things i have gone through was watching her suffer, to be spoon fed pureed food and to see her blank, confused look whenever we'd visit. and she was in a great nursing home.

i am certain that if she had known what the final 5 years of her life were going to be like, she would have done something about it.
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Old 09-29-2008, 04:52 PM   #14
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Murder and disease are different. An eye for an eye and making the punishment fit the crime is what pro-death penalty believe needs to happen or else all we will care about is the criminal (because they're still alive) and forget the victim that is already dead.
Look at the comment that I was responding to... this addresses not one piece of the context I was responding to.

This is off topic, there are plenty of death penalty threads to which you can try and make that argument.
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Old 09-29-2008, 04:53 PM   #15
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Murder and disease are different. An eye for an eye and making the punishment fit the crime is what pro-death penalty believe needs to happen or else all we will care about is the criminal (because they're still alive) and forget the victim that is already dead.
Is that you, Justin?
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