Using VSED as a bridge to MAiD for people with dementia?

In a new article in Journal of the American Geriatrics Society, “Medical aid in dying to avoid late-stage dementia,” authors Thaddeus Mason Pope, JD, PhD, and Lisa Brodoff, JD, discuss the plight of patients with dementia who wish to use medical aid-in-dying (MAiD) but are unable to qualify due to an inability to satisfy the following eligibility requirements: (1) decisional capacity, (2) self-administration of MAiD medication, and (3) a terminal condition with 6 months or less to live.

But what if dementia patients could use VSED as a bridge to MAiD?

In their paper, Pope and Brodoff discuss the case of Cody Sontag, a woman in Oregon in the early stages of Alzheimer’s disease, who recently did just that. Cody ceased eating and drinking on February 8, 2023. Five days later, Cody’s physician qualified her for MAiD on the grounds that she was dying from dehydration and had considerably less than 6 months to live. Cody was then able to self-administer the MAiD medication on day 8, thereby avoiding the final stages of VSED.

If this is indeed possible in states with MAiD laws, then there would be another path to a dignified death for those suffering what they feel to be the untenable losses of dementia.

The full text of the article is behind a paywall, but you can read the abstract below:

Many patients with dementia want the option of using medical aid in dying (MAID) to end their lives before losing decision-making capacity and other abilities that impact their desired quality of life. But, for over two decades, it has been widely understood that these patients cannot (solely because of their dementia diagnosis) satisfy three statutory eligibility requirements in all U.S. MAID laws: (1) decisional capacity, (2) the ability to self-administer the life-ending medications, and (3) a terminal condition with 6 months or less to live. Now, because of recent statutory amendments together with the use of voluntarily stopping eating and drinking (VSED) to quickly advance to a terminal condition, this dementia exclusion from MAID might no longer apply. If combining VSED and MAID is now a possibility for patients with dementia, then clinicians need more guidance on whether and when to support patients seeking to take this path. In this article, we begin to provide this guidance. First, we describe the recent case of an Oregon patient with early-stage Alzheimer’s dementia who successfully used VSED to qualify for and use MAID. Second, we discuss prior barriers to using VSED as a bridge to MAID for people with dementia. Third, we describe recent legal changes that might make this path now possible.

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