An article published by the Hastings Center Report, a peer-reviewed medical journal examining issues of bioethics, advocated for an “advance directive implant” (ADI) for elderly people with dementia or Alzheimer’s disease. The report, authored by Margaret Battin, an 80-year-old philosopher and medical ethicist, professor at the University of Utah and Brent Kious, an assistant professor at the University of Utah, described the ADI as a timer-based implant that would kill the patient automatically without any subsequent intervention required from a medical professional.
The device developed in the Netherlands: a built-in time-bomb
“Some of us, at least when in command of our faculties, think we would not want to live with dementia,” the report stated.
“Suppose there is a simple medical device, based on the triple technology of the timed-release capsule, the subdermal contraceptive implant, and a painless, quick-acting euthanasia drug developed in the Netherlands, where euthanasia is legal,” the report read.
In the Netherlands, doctor-assisted euthanasia was legalized in 2001 and currently, a quarter of all deaths are now carried out by assisted suicide. In a disturbing case last year, the Dutch Supreme Court ruled that a doctor who euthanized an elderly patient with dementia against her expressed wishes and while her family forcibly restrained her was innocent of any wrongdoing.
Euthanasia and socialized medicine
The Netherlands has a universal healthcare system managed by the government and supplemented by private insurers. There is a definite connection between national healthcare and euthanasia. There are several levels of euthanasia. The first form is passive, withholding treatment at the patient’s request and allowing the patient to die. Passive voluntary euthanasia is legal throughout the US per Cruzan v. Director, Missouri Department of Health.
Euthanasia can also be carried out actively in this scenario by lethal injection. When the patient actively brings about his or her own death with the assistance of a physician, the term assisted suicide is often used instead. Assisted suicide is legal in Switzerland and the U.S. states of California, Oregon, Washington, Montana, and Vermont.
Non-voluntary euthanasia is when the patient is unable to give his consent or against his will. This is technically illegal in all countries but there have been cases in which the state and legal system have usurped the position of the parents and decided to euthanize a child.
Though not all countries with universal health care have legalized euthanasia, all of the countries that have legalized euthanasia (Netherlands, Belgium, Columbia, Luxembourg, Canada, Switzerland, and Germany) have universal health care. There are currently six states in the U.S. with legalized euthanasia.
Dementia: inconvenient and uncomfortable but worthy of death?
“[I]t’s a delayed-onset, rapid-acting, painless euthanasic implant,” the report read. “Anybody newly diagnosed with Alzheimer’s or other irreversible progressive dementia, while still lucid and competent, can request one. Positioned painlessly and invisibly in the body, the implant is designed to release its lethal drug instantaneously after a designated delay — say, two or three years, or ﬁve years, or ten, whatever the patient requesting the implant stipulates.
“The implant can be easily removed, and there are full legal guarantees, rigorously observed in practice, that a patient can have it removed at any time, for any reason, with no test or cost or delay. Or it can be self-removed. If it is removed, there are no aftereffects. But if the implant is not removed, it will release the euthanasic drug after the designated delay — without further warning, without pain or discomfort, and without requiring activation of any sort. It will just go off, and, as with an instantly fatal but pain-free heart attack, that will be the end.”
The authors acknowledged that many reacted to their concept with fear and disgust.
“Should ‘yuck factor’ responses out-weigh sober reﬂection on the way the end stages of dementia may go?” the authors asked. “After all, the last third of the Alzheimer’s trajectory can be a period of quiet withdrawal, or it can be marked by paranoia, hostility, confused wandering, aggression, and bedboundness. These different courses may be viewed variously with resignation or with dread. The end stages of Alzheimer’s can be benign, or they can be awful, but what counts as benign or awful is open to interpretation.”
The authors also assumed that the patients would prefer death, though there is no possible way to know this.
“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,” they wrote, adding, “For some, a life that ends in profound dementia is perhaps the worst fate one can realistically foresee.”
The largest benefit of the ADI according to the authors would be to the family of the patient, saving them from the difficulty and discomfort of caring for a loved one with dementia.
“Perhaps the greatest advantage of ADIs is that they would reduce the distress that living and dying with dementia imposes on others,” they wrote. “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. Although there are difﬁcult questions about how we should think about being a burden, such as whether the desires of others to provide care for the person during dementia should override that person’s wish to refuse such care, it is plausible that the person facing dementia can reasonably desire to limit the burdens she will impose upon others.”
The authors further compared a person with dementia committing suicide to “[t]he soldier who sacriﬁces himself to save his comrades, the martyr who dies to avoid recanting their faith, and the emergency rescuer who accepts mortal risk to herself to save others are all doing something permissible, even praiseworthy. Then too, obtaining an ADI is relevantly similar to other ways of shortening one’s life in the face of dementia that are permissible.”
Abortions and assisted suicides are both prohibited by the Noahide Law which prohibits the spilling of blood. This is based on a verse in Genesis.
Whoever sheds the blood of man, By man shall his blood be shed; For in His image Did Hashem make man. Genesis 9:6
In an interview last year on the subject, Rabbi Pinchas Winston, a prominent end-of-days author, noted a particularly disturbing aspect of euthanasia.
“It is unthinkable but many of these cases require a child giving permission to kill their parent,” Rabbi Winston said. “Society seems to be moving in this direction as the connection between parent and child falls by the wayside. Abortion is a mother rejecting her child and euthanasia may be a child rejecting their parent.”
Rabbi Winston pointed out that respecting a parent is one of the Ten Commandments and explicitly related to lengthening life.
Honor your father and your mother, that you may long endure on the land that Hashem your God is assigning to you. Exodus 20:12
“Suffering is an important part of life,” Rabbi Winston said. “It may be difficult to accept but even suffering is from God. True humanity, true mercy and love, is long-term and may take years to work out. To cut that short is man’s desire for comfort, not a desire to be humane. The Torah fights against that. If you take away man’s divinity then all you are left with is a pursuit of comfort.”