Fear, incompetence and death. Empirical observations and ethical concerns about dying with advanced dementia | Amsterdam University Press Journals Online
2004
Volume 45, Issue 1
  • ISSN: 0167-2444
  • E-ISSN: 2949-8651

Abstract

Abstract

In Den Hartogh’s (2023) a thorough philosophical analysis of the ethical considerations on suicide and other means of determining one’s own death is based on the empirical evidence published on the topic. In this contribution I want to emphasise the importance of concerns arising from the practice, and attempt to add to the analysis in his book by posing a number of questions arising from that practice. In order to so, I first elucidate a few empirical observations, some of which are well-known, others are just emerging. First, the fear of review and the possibility of legal sanctions physicians experience when contemplating active ending of life, particularly in ‘difficult cases’, including cases in which the patient is incompetent and thus unable to ask for active ending of life himself. Second, the on-going increase of continuous palliative sedation from 8% of all deaths in 2005 to 23% in 2021. (Van der Heide et al 2023, p.17) Taken together, these observations raise the question whether they might be related. It is clear that active ending of life for patients with advanced dementia is very difficult to obtain in the Netherlands, and it is equally clear that some of these patients are suffering. It is important to consider and research the practice and decision-making for continuous palliative sedation in these patients and how this practice should be evaluated ethically. The two questions I would like to highlight here are, first: how should we understand relatively early continuous palliative sedation in patients with advanced dementia and, second: what risks may arise from such a practice?

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