By Wesley J. Smith
Bioethicists are looking for ways to eliminate people diagnosed with dementia when they become incapacitated. Belgium and the Netherlands permit advance orders to be euthanized. Another proposal gaining traction in bioethics would force caregivers to starve patients to death.
And here’s a new idea: Writing in the Hastings Center Report — the world’s most prominent bioethics journal — two prominent bioethicists propose the implantation of a time-release suicide device that will cause future death at the time of the patient’s choosing. They call the hypothetical device an “advance directive implant, or ADI” (bioethicists sure love their acronyms).
The ADI would require extensive engineering and may not be feasible with current technologies. Still, we suspect it could become feasible in the near future. We imagine the ADI as something like a computerized subdermal implant containing a lethal dose of a medication or combination of medications. Release of these medications would occur rapidly after a predetermined interval or after some specific event had occurred. The ADI would likely require a long-lasting battery, computerized control, and a pump or microfluidic mechanism. . . .
It is crucial that the ADI be easily and immediately removable. After all, even those certain of their wish to obtain it would still like the option of changing their minds, at least prior to the onset of dementia, whether for personal reasons or because an effective treatment for their condition has been developed.
Yeah, good luck with that, guys.
And, of course, the usual sop of safeguards to protect against abuse:
The permissibility of ADIs would, first, depend on reasonable standards of care and preimplantation assessment criteria. One would not want healthy adults with minimal risk of dementia to receive them; one would not want them to be implanted under external pressure, forcibly, or surreptitiously; one would not want them to be implanted in persons whose decision-making capacities are impaired by depression. One possible set of criteria would be those used for physician aid-in-dying in Oregon: that the requestor be an adult; able to make and communicate health care decisions; seen by at least two physicians who concur in the diagnosis, prognosis, and assessment of decision-making capacity; not suffering impaired judgment due to a psychiatric or psychological disorder, not coerced, and informed of alternatives.
I don’t have space to get deeply into it here, but the Oregon safeguards are a joke. If one doctor says no, the suicidal patient can just go doctor shopping. There is no state oversight prior to death, the system relies on doctors’ self-reporting, and there are rarely any referrals to psychologists.
Why engage this supposed “thought experiment” — which is actually much more than that? Here’s a good hint (my emphasis):
Perhaps the greatest advantage of ADIs is that they would reduce the distress that living and dying with dementia imposes on others. This is true in two senses. First, there is the obvious sense that ADIs would tend to shorten the period in which the person living with dementia represents a burden for others. . . . ADIs would also reduce the distress that dementia imposes on others because the device, relatively free of any external input or activity, mostly immune to the judgments, misgivings, and second-guessings of family members, physicians, and friends, would absolve people of many of the burdens of judgment once the patient developed advanced dementia.
In other words, we should let the patient put him- or herself out of our misery.
The authors [Margaret Pabst Battin and Brent M. Kious] describe the ADI as a means of “getting the better of Alzheimer’s.” No, it is softening the ground for authorizing direct killing of such patients. And no, this proposal isn’t satirical or a form of “what if” musing to start a philosophical salon conversation:
As we said at the outset, whether this consideration of the ADI is understood as a conjecture, as a hypothetical exploration, as a real-life thought experiment, or as a proto-proposal, we think it important to take this seemingly radical idea seriously. We may not currently have the technology to realize it, and perhaps not the social conditions that would allow it to be used without abuse.
It may even be hard to conceive of this idea: “Horrible,” said one friend, “even if I agree with the conclusion.” But we think it is an important idea nevertheless: it makes us see what is so problematic about how we respond to dementia in our current world, forcing some to suffer a future they dread and burdening others with acting for them. No one, really, wants to live with dementia: for most of us, it is bad to lose the memories and cognitive capacities that contribute to who we are and that enable us to do many of the things we care about.
There it is! “No one [they left out the implied “should”] wants to live with dementia.” That’s the dehumanizing message people facing this difficult circumstance constantly hear, stripping them of their intrinsic human equality.
Articles like this — particularly when published in influential journals — are insidious because they normalize the noxious idea that dementia patients’ lives are not worth protecting or living. Instead, we should continually assure those who face this crucible that we love them, want them, and will care for them — no matter what.
And don’t any reader tell me that I don’t know how difficult Alzheimer’s can become. My mother died of the disease, spending the last five months of her life living in my wife’s and my home, with quality hospice care. Was it easy? No! But so damn what? Part of the essence of true humanity is caring and loving each other — no matter how taxing and emotionally devastating — especially when a person is so ill or injured they can’t take care of themselves. That’s the best part of who we should be.
The movement to eliminate suffering by eliminating the sufferer is becoming a cult.
Editor’s note. Wesley’s great articles appear at National Review Online and are reposted with permission.