It is a matter of resources. Young children or adults with severe behavioural problems are managed without antipsychotics and sedatives, but it takes a dedicated and skilled care team and a highly functional family. Even then, the drugs still often get used.
Behavioural problems in dementia are very hard. Male patients in particular can be quite strong and mobile. They can easily hurt staff or other residents. They are also a risk to themselves. The coroner in my state published two cases of patients with dementia that highlight this: one swallowed the napkin on his dinner tray and choked, another got put of the facility and died trying to climb a fence.
The reality is that there are few viable alternatives.
I hope when I get that degraded I will live in a society kind enough to euthanize me, rather than slowly torture, drug and humiliate me, while extending my demented, horror-show 'life' to the maximal possible extent in order milk my children, savings, and/or the state. Soylent green is a utopia compared to what we have now.
"And now every time I hear that phrase I want to scream. 21st century American hospitals do not need to “cultivate a culture of life”. We have enough life. We have life up the wazoo. We have more life than we know what to do with. We have life far beyond the point where it becomes a sick caricature of itself. We prolong life until it becomes a sickness, an abomination, a miserable and pathetic flight from death that saps out and mocks everything that made life desirable in the first place. 21st century American hospitals need to cultivate a culture of life the same way that Newcastle needs to cultivate a culture of coal, the same way a man who is burning to death needs to cultivate a culture of fire."
I have to say it is unlikely there will be sanctioned euthanasia for age related decline or dementia. The practicalities of implementing such a system are probably prohibitive, the primary problem being ending the life of someone without the capacity to tell you that is what they want. This is in some ways insurmountable, because although your 50 year old fit and happy self would definitely want to be euthanised if they had severe dementia, how do we 'know' that this same person who now has severe dementia also wants to die?
It is similarly unlikely there will be a test which can predict imminent dementia well enough that you would be happy to euthanise yourself while you still have decision making capacity.
As others have said, what you can do is have some legal document which explains your wishes if you lose capacity to make decisions, where you specify the avoidance of life prolonging therapies, intensive care, resuscitation etc. The other thing which is important is having someone that will take over medical decision making whom you trust will act according to your wishes, in the event you lose decision making capacity. Another aspect of this is making sure friends and family are aware of your wishes. This is a kindness to them as much as anything, so that when the time comes to withhold or withdraw medical treatment, they don't have to ruminate on whether it is the right thing to do.
There are a lot of people with their intellectual capacities intact that express a wish to die. They don't get to die either.
For the most part society doesn't care about your wishes.
I think what it really comes down to incentives. As a society we don't want bullying people into a suicide to be a viable strategy for getting the inheritance money early. Or for getting rid of people in general.
The inheritance money argument would be a good one if it weren't for the fact that care homes and hospitals get the inheritance money instead.
There's still some sentience in middle stage dementia, but by the late stage there's literally no one home any more. It's really not obvious what - never mind who - is being kept alive.
It's certainly not a simple problem. But there are existing systems for legal oversight of care, and of power of attorney over family wealth. It doesn't seem an impossible stretch to extend those to allow early termination in cases of extreme suffering or total and irreversible loss of cognitive function.
We have a neighbour in the very late stages of terminal cancer. He's completely lucid. He wants to go, his family want him to go - this has dragged on for over a year now - and it's hard to see a good moral reason for extending everyone's suffering even further.
There is that, but I still think even in a system where everyone acts in good faith, it is by no means trivial to implement euthanasia for 'diminished states of existence'.
Agreed on incentives. There is no resolvable solution for those incentives. Especially since suicide is easy to plan and not necessarily painful. For example iirc, Robin Williams did it.
Well living is the default, so the burden of proof lies with changing that state.
Alternatively you could argue that they still get out of bed and eat and engage, and perhaps these are signs enough of some desire to live. Anyway, I think there are some philosophical complications which require exploration.
Honestly that is no defense at all for over medication. I’d rather be properly medicated and risk dying on a fence than be over medicated. If I reach that point I’ve already lived enough years and I’d prefer to maintain what abilities I can have. The worse that can happen to me then is death and death at that age isn’t so bad. — This will likely rub someone the wrong way so consider the other posters are asking for euthanasia as if self euthanasia weren’t already an option and as if we weren’t already “euthanizing” people with morphine as soon as they hit hospice.
I'm not trying to defend it. Chemical restraint is terrible, as is the lack of viable alternatives.
The worst that can happen isn't death, you can fall off the fence and break 6 vertebrae and spend the next 3 months screaming in pain on top of everything else.
People don't get euthanised in hospice. Palliative care as a profession is fairly obsessed with not shortening the lives of patients they care for. There are studies for example comparing different analgesic regimens to see if there is a difference in survival.
Palliative cate the profession may be. Palliative care as practiced by hospices is more hit than miss but they do miss. You will find comments by nurses reassuring the right to die fans that end of life care covers their concerns. Hospices have hastened death before.
Maybe America needs to reinvent generational housing. It makes no sense to put everyone's family in nursing homes. Instead reserve those for people with high needs that cannot be accommodated by traveling nurses. Give tax breaks for retirement aged parents, even if they're working. It won't work for everyone but it's a better solution than massive jail like senior centres for the destitute.
This usually happens. From everything I've seen nursing homes are almost always a last resort when family literally can't provide the care the patient needs.
> Young children or adults with severe behavioural problems are managed without antipsychotics and sedatives...
Indeed! In practice, they're often managed with dangerous restraint techniques, or mentally abusive solitary confinement practices! Consider, for instance, this wonderful coverage of Illinois:
Behavioural problems in dementia are very hard. Male patients in particular can be quite strong and mobile. They can easily hurt staff or other residents. They are also a risk to themselves. The coroner in my state published two cases of patients with dementia that highlight this: one swallowed the napkin on his dinner tray and choked, another got put of the facility and died trying to climb a fence.
The reality is that there are few viable alternatives.