Softening the resistance to “assisting” the suicide of people with an “elevated” risk of Alzheimer’s

By Dave Andrusko

Excluding children, who are utterly powerless, no vulnerable group is more exposed to “assisted suicide” than patients with Alzheimer’s, especially advanced Alzheimer’s.

That is why you are seeing more and more trials balloons—for example, “Should Alzheimer’s Disease Qualify for Assisted Suicide” —probing for grounds to justify assisting the suicide of a woman (more often it’s a woman) with Alzheimer’s. But it’s actually worse than that, as we’ll see in a minute.

For example, MedPage Today is running an online survey that began May 3.

They prime the pump by introducing the survey with this: “A recent survey found that about 20% of older adults with heavy amyloid plaque burdens said they would consider physician-assisted suicide at dementia onset.” {As you eventually learn, this is drawn from a Research Letter that appeared in JAMA Neurology.}

But notice the difference in how the survey question is phrased: “Would assisted death be ethical for patients facing irreversible dementia?”

“Dementia onset” (the question actually of those who took part in the survey) versus “irreversible dementia.”

To see how this works, you have to appreciate that MedPage Today had already tilled the ground, softening the intuitive resistance. On April 29, Judy George, Senior Staff Writer, wrote a post headlined, “Assisted Death and Dementia— Contemplating suicide when Alzheimer’s risk is high.”

Notice before you read the first sentence, she’s not talking about patients with Alzheimer’s but people whose risk for Alzheimer’s is high.

This ought to make you very, very nervous because (for starters) we will be talking about “markers” when the “cause” of Alzheimer’s is fiercely debated. Here’s how Ms. George sets the table:

About one in five cognitively normal older adults who had elevated beta-amyloid — a biomarker that increases risk of Alzheimer’s disease — said they would consider physician-assisted death if they experienced cognitive decline, a survey of A4 (Anti-Amyloid Treatment in Asymptomatic Alzheimer’s) trial participants showed.

Learning about amyloid status did not change personal beliefs about the acceptability of physician-assisted death, but individuals who were open to the idea at baseline said elevated amyloid and dementia risk would be relevant to their decision, reported Emily Largent, JD, PhD, RN, of the University of Pennsylvania in Philadelphia, and colleagues in JAMA Neurology.

[You learn later that the “cognitively normal older adults” were enrolled in a Alzheimer’s prevention trial. Investigators are testing whether what they describe as an investigative drug [solanezumab] “could delay cognitive decline in people with amyloid accumulation.”]

Watch the trial of qualifiers. “One in five”; “consider”; doesn’t change beliefs about physician-assisted suicide; but of the one in five who are “open to the idea” these elevated levels “would be relevant” to their decision. Whew!

[By the way, I jumped back and forth between several linked articles and I never found out what “elevated” meant, or even “high.”]

Again, before going one sentence further, remember the question: “Would assisted death be ethical for patients facing irreversible dementia?” Okay, back to George’s story (that, as noted, ran April 29) which gets worse.

Recall her first sentence. “About one in five cognitively normal older adults who had elevated beta-amyloid — a biomarker that increases risk of Alzheimer’s disease — said they would consider physician-assisted suicide if they experienced cognitive decline…”

If you read further into the story, you find this sentence/clarification.

Approximately 20% of A4 respondents [the people in the clinical trial with elevated beta-amyloid] said they would pursue physician-assisted death if they became cognitively impaired, were suffering, or were burdening others. [Underlining added.]

So, the researchers asked not just about the prospect of becoming “cognitive impaired” (which can mean a whole range of capacities) but added “suffering” or “burdening others,” language guaranteed to bump up the numbers.

This is results-driven “research.” Why am I not surprised?

Early returns in the survey are heavily in favor, close to 80%.