Euthanasia at the Request of Patients With Dementia? Opinions Differ

What Is Allowed Where

The study results were published this August in the American Journal of Geriatric Psychiatry. The data, collected between July 2020 and January 2024, concerned six countries differing in legislation and end-of-life options.

Researchers sought input from more than 200 physicians, primarily specialists who may care for people with dementia at the end of life. Several advanced healthcare professionals with physician-level responsibilities were also included. Respondents came from the Netherlands, Switzerland, Germany, the USA, Japan, and Israel.

Euthanasia in dementia is not permitted in the USA, Switzerland, Germany, Japan, or Israel. The Netherlands allows euthanasia even for patients with dementia, although it is primarily intended for people with mild disease who still have sound judgment and decision-making capacity.

Switzerland allows physician-assisted dying (PAD) for dementia cases provided the patient has the mental capacity to decide and is physically able to self-administer the lethal medication.

PAD is legal in several U.S. states —⁠ including Oregon, Washington, California, Colorado, New Jersey, Maine, New Mexico, Vermont, Hawaii, Montana, and Washington, DC —⁠ but not for patients with dementia.

A Fifty–Fifty Split

The study found that, overall, 44% of physicians considered euthanasia for people with dementia acceptable, with rates ranging from 23% in Switzerland to 66% in the Netherlands.

Only 38% of physicians said they would personally perform euthanasia at the request of a patient with dementia, with willingness ranging from 18% in Germany to 58% in the Netherlands. Dutch physicians were more likely to view the procedure as acceptable than those in Switzerland and Japan. They were also more willing to carry it out than physicians in Switzerland, Germany, the USA, and Japan. Additionally, 35% of respondents said that if they themselves developed dementia, they would want euthanasia for their own end-of-life care.

A Difficult Decision

Study co-author Professor Jenny T. van der Steen of Leiden University Medical Center in the Netherlands commented on the findings for Medscape Medical News. According to her, people with dementia should have the option to consult a physician or request medical assistance in dying or euthanasia in jurisdictions where this is permitted.

Physicians are responsible for evaluating such requests and responding to them, including potentially performing euthanasia. However, euthanasia in dementia is particularly controversial due to the declining cognitive abilities that accompany the disease. In her view, physicians should inform patients about assisted-dying options only if patients themselves ask.

Neurologist and researcher Dr. Shaheen Lakhan explained that a patient with early-stage dementia may clearly articulate their wishes concerning the end of life, but years later —⁠ when they no longer recognize their surroundings —⁠ they cannot reaffirm or withdraw that choice. Physicians then face a dilemma: Should they honor the “former self,” which had full mental capacity and foresight, or protect the “current self,” which may appear content in its unawareness but can no longer express clear preferences?

To support clinicians in difficult conversations with dementia patients, the nonprofit organization Compassion & Choices, in partnership with the American Society on Aging, created a resource titled Essential Conversations: Planning for Life with Dementia.

Editorial Team, Medscope.pro

Sources:

1. Xu J., Smaling H. J. A., Nakanishi M. et al. Acceptability of Euthanasia for People With Dementia: Perspectives of Clinicians From Six Countries. Am J Geriatr Psychiatry. 2025 Aug 20: S1064-7481(25)00447-6, doi: 10.1016/j.jagp.2025.08.003.

2. Clinicians Split on Ethics of Euthanasia for Dementia. Medscape, Sept 9, 2025. Available at: www.medscape.com/viewarticle/clinicians-split-ethics-euthanasia-dementia-2025a1000nt4?form=fpf