Bioethics Discussion Blog: Should Early Prediction of a Personal and Family Quality of Life Disaster Lead One to Consider Suicide?

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Tuesday, June 28, 2011

Should Early Prediction of a Personal and Family Quality of Life Disaster Lead One to Consider Suicide?

If scientific research can lead to tests which can predict that years ahead an individual will develop symptoms of quality of life destructive disease and one that is currently unpreventable and untreatable, should that individual plan now how to cope with the prediction? For example, should the individual seriously consider ending his or her life prematurely through suicide at some point rather than awaiting suffering and loss of any acceptable quality of one’s life?

One example is predictive testing for Alzheimer’s disease. Parens and Johnson writing in TIME set a social duty now to consider the pros and cons of suicide or assisted suicide decisions made by individuals prior to becoming severely symptomatic with diseases such as Alzheimer’s. They write:

“It is time to listen to and take seriously those people who, upon seeing their own parents spend years, even decades, suffering with Alzheimer's, say that they refuse to expose their partner or children to the same. We cannot ignore competent people who say they would rather die than no longer recognize their children or the partner with whom they built a life. Nor should we dismiss those who say that they can't themselves afford to pay for years of nursing home care, don't want their children saddled with that expense, or would rather that the money be used for their grandchildren's education.

When it becomes possible to detect Alzheimer's disease before it has progressed, these arguments will no longer be academic. The question for our society, including our legal system, medical practitioners, religious institutions and patient support groups, is whether we will dismiss those who make these arguments as depressed and misguided or whether we will engage with them on their terms.”


Well, what do you think? Can you begin a societal discussion about the rational planning of suicide in the face of early prediction of a disease such as Alzheimer’s? ..Maurice.




12 Comments:

At Wednesday, June 29, 2011 8:17:00 AM, Anonymous Anonymous said...

I would certainly rather be dead than be in that condition. Yes, I think society should give me that choice.
But - would I want to live my life, knowing that was in my future? As time went on, wonder... will today be the day I start to lose my mind? No, that I would not.
So how to reconcile those two? I'm not sure. Maybe, if I started to get forgetful, I might want to be tested.
So again, yes, I would want the choice. How to pick the time however? That would be amazingly difficult.
TAM

 
At Monday, July 04, 2011 7:56:00 AM, Blogger Dmitri Pisartchik said...

Something of an academic interest of mine, suicide.

So far as I can see there seems to be very little personal reasons for committing suicide as a response to developing severe dementia or Alzheimer's. That is to say, I think that once it actually comes about that there is no longer a person there to have self-regarding interests, I don't see any good self-regarding reasons for ending one's life. I'm not a fan of self-regarding reasons surviving the death of the person.

That leaves other-regarding reasons, which I do think are capable of surviving the death of the person and that find very cogent and persuasive. Not wanting to subject others to the suffering of witnessing another human being ceasing to be a person is a powerful reason, in my mind, in support of a decision to commit suicide before that happens.

Of course, the interesting case is when those others express their interest in keeping me going after I have ceased to be a person. Interestingly, I find that I intuitively find myself objecting to this. But I think my objection is consistent in that I object on the grounds of a concern for others nonetheless - their energies and efforts could be put to better use in caring for someone other than me that still have the capacity to fully appreciate that care.

 
At Monday, July 04, 2011 10:53:00 PM, Blogger Maurice Bernstein, M.D. said...

Dmitri, "quality of life": why not allow a person who is anticipating a change in his or her quality of life which would be fully unacceptable to end their life at some point prior to the change if they desire to do so?

Termination of life support is ethically and legally acceptable for those who do not want further medical support because of a terminal illness or because of persistent severe debility with that support. If that is considered a rational act, why not allow the rational suicide of an individual who faces a certain unacceptable change in quality of life such as in the example of predicted Alzheimer's disease? ..Maurice.

 
At Tuesday, July 05, 2011 5:37:00 AM, Anonymous Anonymous said...

Dementia and Alzheimers are not an all or nothing disease either. You're not fine one day, and "gone" mentally the next. I have watched this with a family member, and was a point when they realized they were slipping, and a long phase of confusion and unhappiness. I wouldn't want to go through that. And also, I wouldn't want to put loved ones through the whole process.
TAM

 
At Tuesday, July 05, 2011 7:50:00 AM, Blogger Maurice Bernstein, M.D. said...

The suffering in Alzheimer's by the patient is transient but may be prolonged until the patient loses awareness. The suffering by the family both in watching the progression of the deterioration and attending to the care of the patient is unending until the death.

Shouldn't there be as much widespread and significant societal discussion regarding the ending of life after birth as there has been about ending of life before birth?

..Maurice.

 
At Thursday, July 07, 2011 11:11:00 AM, Anonymous Anonymous said...

It seems to be somewhat of an "untouchable" topic.
One of the biggest issues I suspect is, the possibility of people being pressured to end their lives, so as not to burden their families. "You don't really want to go on in this state, and use up all the money now, do you? If you cared about us, you'd put and end to this" etc.
TAM

 
At Friday, July 15, 2011 10:17:00 AM, Anonymous Anonymous said...

I feel about this subject the same as I feel when discussing death penalty issues; which is that massive suppositions must first be made before even getting to the philosophical nature of the question. For instance, before I can take a moral position on death penalty, I must first presuppose that it is applied correctly and fairly, which evidence clearly shows is not true. So, the moral issue of the very concept is somewhat irrelevant until those issues are resolved.

Similarly, I believe we are at least a century from these predictors being accurate enough for people to make this sort of decision. So, do I feel it's reasonable now to contemplate end of life based on some genetic marker? No. Will I have the same answer 100 years from now? I would probably re-think it given the most up to date evidence. But pre-supposing 99% accuracy of the predictor, yes, I think we have to let people control their own persons once we can be reasonably sure the decision is being made with some soundness of mind.

- Onion

 
At Friday, July 15, 2011 12:37:00 PM, Blogger Maurice Bernstein, M.D. said...

Onion, OK.. with regard to Alzheimer's, let's say that the untouchable predictive test for the asymptomatic human is way, way off in the future. Fair enough. But what if the physicians and psychiatrists are now dealing with a patient who demonstrates early signs of the disease but also clinically correlate with changes on MRI brain scans and which confirm that Alzheimer's Disease is present. Let's say that the early signs of this disease is not associated yet with any loss of capacity for the patient to make their own medical decisions. The disease is diagnosed as present. The probable future course is known based on the studies of patients with Alzheimer's. Shouldn't the patient at this point have the opportunity and right to make a personal decision about the quality of future life and decide about suicide before he or she becomes incapacitated? If so, then shouldn't society now reconsider its views about rational suicide? ..Maurice.

 
At Monday, July 18, 2011 12:53:00 PM, Anonymous Anonymous said...

Maurice.

I think I absolutely agree that, should a prediction be accurate enough, we have to let people control their own bodies. If that means choosing to end life, yes I agree. And as such, we need to remove the tether from physicians who looking to carry out the medical needs and choices of their patients.

 
At Monday, July 18, 2011 2:54:00 PM, Blogger Maurice Bernstein, M.D. said...

Pertinent to this discussion is a commentary by Kenneth Covinsky on 7/15/2011 in the Hastings Center "Bioethics Forum" titled "Caution on Diagnosing Preclinical Alzheimer's Disease".

Here is an excerpt:

It may never be appropriate to recommend widespread use of the preclinical Alzheimer’s disease label.

The central problem with this diagnosis is that it labels people who have completely normal cognitive function as having an illness. A key question is whether using this label will make patients better off.

The challenge here is in distinguishing risk for disease with disease itself. There is considerable evidence that many, if not most, people with these biomarkers will never get Alzheimer’s disease. For example, autopsy finding suggestive of Alzheimer’s disease are commonly found in people who never had symptoms."


..Maurice.

 
At Tuesday, August 02, 2011 11:41:00 AM, Anonymous Anonymous said...

This discussion in my opinion can be extended to the broader topic of suicide in general. If somebody who supposedly has no friends nor family wants to end his or life, should be allowed to make decisions for his own sake. It may sound immature but should'nt the person be allowed to end his or her life. Ofcourse its not an easy decision, meaning once you are gone there is no coming back for you.
OJ

 
At Tuesday, August 02, 2011 5:55:00 PM, Blogger Maurice Bernstein, M.D. said...

When one looks at the question " should'nt the person be allowed to end his or her life" the answer should include the fact that patients can decide to reject or terminate life-supportive treatment and end their life and this decision is legally and ethically acceptable. And in the U.S. states of Washington and Oregon, physician-assisted suicide is allowed after meeting legal requirements. Beyond that: "allowing" might be related to whether or not any other person or persons are involved or aware of the intended act and what are the legal implications, if any, to the estate of the deceased by suicide.
With regard to the patient who is suicidal based on a mental illness which can be diagnosed and treated successfully, then I guess suicide should not be an option unless there is no rehabilitation to a quality of life acceptable to the patient. ..Maurice.

 

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