End-Of-Life Care and Physician-Assisted Dying (PAD) in People Living with Dementia: Intersections of Law and Psychiatry

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About this Research Topic

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Background

Neurocognitive disorders encompass a wide range of conditions with progressive loss of intellectual capacities, as well as varying severity of physical and behavioral symptoms. While symptomatic treatment works for some patients, the progression of dementias often leads to loss of ‘perceived identity’, autonomy, a lower quality of life and increased comorbidity with psychiatric disorders. At advanced stages of dementia, some individuals could feel their dependance from others as humiliating and disrespectful. This raises issues such as whether euthanasia and physician-assisted dying (PAD) should be considered as part of the professional medical practice.

PAD has formed one of the most controversial areas in the field of mental health. While proponents of PAD emphasize rights of autonomy and dignity of individuals with terminal conditions to reduce their suffering, opponents are concerned about the ‘right to live’ and the risk of abuse of the practice. Even though legislation of PAD has been popularized in various nations, the discourse of PAD in dementia has been fraught with ethical, psychological, legal and moral dilemmas.

The goal of this Research Topic is to encourage empirical interdisciplinary research on the ethical, legal and psychological aspects of Physician-Assisted Dying (PAD) in neurocognitive disorders. Focus will be on understanding the perspectives of physicians, patients, caregivers and healthy older adults as well as existing research and legislation in this area and controversial aspects (i.e. lack of advanced directives). The intersections between law and psychiatry with relevance to PAD, end-of-life care for advanced dementia and advance directives facilitating PAD will be explored through this Research Topic.
We will aim at analyzing the suitability, feasibility and medical justifiability of PAD in dementia through interdisciplinary research.

Original quantitative and qualitative research, reviews, opinion articles, conceptual/theoretical perspectives and novel case-discussions are welcome in the following areas:

• Medical-ethical analysis of physician-assisted deaths in dementia;
• Global legislations and nation-based perspectives on implementation of PAD in dementia;
• Role & challenges faced by the psychiatrists in deciding for/against PAD in dementia;
• Service-user’s perspectives and real-life experiences;
• Psychosocial and legal support for advanced dementia and their caregivers: enabling decision-making for ‘end of life’;
• ‘End of life’ scenarios in dementia: role of psychiatrists in reducing suffering and providing palliative care;
• Advanced directives for PAD.

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Keywords: PAS, dementia, end of life, psychiatry, neurocognition, PAD

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