The Ethicist: Navigating the Ethics of Assisted Suicide in the Face of Cognitive Decline
In this thought-provoking article, the Ethicist addresses a difficult and sensitive topic – the ethical implications of assisted suicide in the face of cognitive decline. The author shares the story of a couple in their 70s and 60s, where the husband is experiencing significant cognitive decline resembling his late father’s battle with Alzheimer’s. The husband is grappling with feelings of shame, fear, and the desire to have control over his own death.
The neurologist’s diagnosis of mild cognitive impairment instead of dementia complicates the situation, as it limits options like medical aid in dying. The husband has expressed thoughts of suicide and has asked his wife to assist him in researching the best method. The wife is torn between respecting his wishes and fearing the legal consequences of being involved in a crime.
The Ethicist acknowledges that individuals who have lost the cognitive functions necessary for autonomous living might feel that this deprives them of a dignified existence. They argue that such individuals should have the right to plan their own death. However, it is crucial to consider the husband’s current state of distress and the potential for rash actions. The Ethicist suggests that while it may not be morally wrong for the wife to provide assistance and advice, it is wise to approach the situation with caution.
The article emphasizes that countless individuals with cognitive decline can still live valuable lives and experience love and joy. It encourages the wife to consider advance care planning while her husband is still mentally competent, giving them some control over his medical future. Ultimately, the Ethicist reminds readers that even though an action may not be morally wrong, it does not necessarily mean it is wise or should be hastily undertaken.
In the readers’ responses section of the article, various perspectives are shared. One reader agrees with the Ethicist, stating that the government of the country being visited does not necessarily represent the entire population. They argue against allowing political outcomes to deter individuals from fulfilling their travel desires. Another reader cautions against ignoring travel warnings and making reckless decisions that may endanger others and undermine ethical responsibility. Additionally, the environmental impact of long-distance travel is highlighted, urging individuals concerned about global warming to reconsider pleasure trips.
To engage readers further on the topic, an additional piece delves into the concept of individual autonomy, exploring the right to die with dignity and the potential conflicts with legal and ethical frameworks. The article examines different perspectives and legal considerations surrounding assisted suicide, providing in-depth analysis supported by statistics and real-life examples. The piece delves into the importance of palliative care, advance directives, and conversations about end-of-life choices. It also explores the role of healthcare professionals and the need for compassionate support during challenging times.
Overall, this article tackles a complex ethical issue surrounding assisted suicide and cognitive decline. It prompts readers to consider the delicate balance between personal autonomy and ethical responsibility, highlighting the importance of thoughtful decision-making in challenging circumstances.
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I am in my early 70s and married to a man in his 60s. My husband’s father battled Alzheimer’s for nearly a dozen years before he died. He was incredibly tough on everyone involved. And now my husband is in the middle of his own health crisis. He has had significant cognitive decline over the past two years, which affects his ability to function satisfactorily. He constantly looks for his phone or iPad. He gets lost while he is driving. He sometimes asks me to help him send a text message or email because he doesn’t remember how to do it. This causes him a lot of shame. He says that he no longer belongs to this world. His dysfunction reminds him of his father’s decline, and he doesn’t want him or others to go through that pain.
The neurologist is of little help. My husband does quite well on 10-minute cognitive tests, so he receives a diagnosis of mild cognitive impairment instead of dementia. He has started talking about suicide and is afraid I will stop him. He has asked me to commit to letting him choose the moment of his death. Frankly, I respect his choice and believe he has the right to decide for himself. He has also asked for help in researching the best way to commit suicide. I have considered trying to help him with that, but I fear he is committing or being an accessory to a crime.
What is the ethical thing to do? (And yes, I understand that what is ethical and what is legal may differ.) — Name withheld, North Carolina
From the ethicist:
I’m so sorry for the situation you’re both in and I wish it were weirder than it is. I agree that we have the right to decide that losing the cognitive functions necessary for autonomous living deprives us of the possibility of a dignified existence. So, in my opinion, we have the right to make plans to end our lives when that happens. Unfortunately, once this happens, we may not be able to recognize our situation or execute our plans. Even states that (unlike yours) have “medical aid in dying” statutes do not allow such aid to patients with diminished decision-making capacity; cannot be guaranteed by an advance directive.
How do these broad principles and circumstances apply to your case? I am not going to rule on the legality of helping her husband end her life, neither now, when she is still mentally competent, nor at some later time when, as she fears, she is no longer so. (A lawyer can tell you how her legal exposure will be affected by the details of her attendance given the laws of her state.) I will say that since it is not morally wrong for her husband to end her own life, it is not wrong for you to give him the advice he requests.
But denying that an action is wrong does not mean that it is necessarily wise or, in any case, that you should undertake it hastily. At this moment, her husband, distraught, embarrassed, distressed by the prospect of sharing her father’s fate, might be prone to act rashly. Older men are much more likely to commit suicide than older women, and one reason may be related to gender norms; Men can feel especially humiliated when they become more dependent on others. The fact is that countless people live valuable lives while experiencing some notable degree of cognitive decline. They are capable of giving and receiving love, even joy. And it is impossible to predict when deficits will turn into outright dementia, if that is what awaits us; there may be prolonged periods of stability. Advance care planning, prepared while her husband is legally competent, can give you at least some control over her medical future. In the meantime, she urges you to consider that his current disability does not mean that his existence offers nothing of value, either to him or to those who care about him.
Readers respond
Last week’s question was from a reader concerned about vacationing in a country that has a poor human rights record. She wrote: “My husband and I are now retired and looking forward to some long-postponed once-in-a-lifetime trips. Unfortunately, the country at the top of our wish list has an authoritarian government and a poor human rights record. …Our tourism dollars would directly support the local tourism industry and the people who depend on it for their livelihoods. But we are concerned that it also indirectly supports the regime in power. How do we evaluate the ethical implications?”
In its response, the Ethicist noted: “The argument against visits is not so much that it will actually prolong a bad regime (any effect would be microscopic); rather, it is that there is something inherently regrettable about contributing to the well-being of wrongdoers. …suppose that a boycott currently existed that had the support of credible representatives of the people of that country and was having, or was likely to have, positive effects in improving conditions there. If that were the case, you should respect the boycott. “It can be good to participate in a political process even when, as with voting, your personal contribution has a minuscule effect on the outcome.” (Re-read the full question and answer here.)
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I agree with the ethicist.. The government does not necessarily represent the entire population. I wouldn’t want a political outcome in the United States to make people reconsider their visit. — There is a
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Leaving the boycott For the gods to decide whether to go or not is to nullify personal moral responsibility. — Larry
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A separate topic is whether it is safe for Americans to travel to the country in question. Check the State Department’s list to make sure there are no travel warnings for this country, and if there are, don’t ignore them. Making reckless decisions that may require others to take risks to rescue you from the consequences is not in itself ethical. — Ana
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An additional factor What needs to be taken into account is the fact that long-distance air travel is very destructive to the environment. Anyone seriously concerned about global warming should reconsider any trip that is purely for pleasure. — Ray
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My husband and I He is retired and lives in his home nation, whose democratic government was replaced by a military dictatorship a decade ago. Of course, he visits the destination on his bucket list and, as much as possible, dedicates all his business to small hotels, markets, local shops and people on the street. Avoid luxury hotels, chain restaurants, large tour operators and other businesses that you expect to be owned by autocrats and their rich cronies. You will be rewarded by lovely people who will greatly appreciate your business and attention. — Douglas
If you are having suicidal thoughts, call or text 988 to reach the 988 Suicide and Crisis Lifeline or visit SpeakingOfSuicide.com/resources for a list of additional resources. Go here to obtain resources outside the United States.
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