Americans Want Option To Hasten Death If Faced With Dementia

The Press Release

Tallahassee, Florida – Final Exit Network (FEN) conducted a nationwide poll1 with YouGov in January exploring how concerned Americans are about dementia and how they feel about having options for hastening their death rather than endure the loss of selfhood caused by dementia.

Dementia, such as Alzheimer’s dementia, is an abnormal, progressive loss of brain function that can destroy a person’s ability to remember, solve problems, pay attention, recognize loved ones, and even speak. About 1-in-7 Americans age 71 and older suffer from some form of dementia, and almost a third of individuals 85 and older suffer from Alzheimer’s dementia alone.2

“The vast majority of Americans, 86%, think dementia is a serious problem,” said Brian Ruder, president of FEN, “and getting that many Americans to agree on something should get the attention of legislators considering current and future death with dignity laws.” While the idea of giving still-competent adults with early-stage dementia options for hastening their death rather than endure dementia’s fate might be new to many people—31% were neutral or unsure about the idea—many more supported the idea than opposed it for the two options presented in the FEN/YouGov poll.

Over half of respondents, 53%, supported the idea that competent individuals with early-stage dementia should be able to legally stipulate, for their future incompetent selves, that they want food and drink withdrawn and for doctors to keep them comfortable so they can die peacefully. Only 15% opposed the idea. Among those who have watched a family member struggle with dementia, support rises to 59%.

“Respondents were more hesitant about the idea of giving competent individuals diagnosed with early-stage dementia the option to end their life before losing their capacity,” noted Mary Ewert, FEN’s executive director, “but even so, supporters outnumbered opponents by almost 2-to-1,” with 44% supporting the idea and 24% opposing it. Support rises to 50% for those who have had a family member with dementia.

Ewert emphasized that, “safeguards to ensure that an individual’s choice is their own, free of coercion, and is repeatedly stated over time are essential components of any such option.”

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  1. Except where noted, figures are from YouGov. Sample size was 1148 adults. Fieldwork took place 11-12 January 2021. The survey was carried out online. The figures are weighted and representative of all US adults (aged 18+).
  2. Figures in this paragraph are from the Alzheimer’s Association’s report, 2020 Alzheimer’s Disease Facts and Figures.

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Poll Questions and Overall Results

The Importance of Safeguards

In an effort to keep the question wording short and uncomplicated, the questions did not mention safeguards to ensure that an individual’s choice is their own, uncoerced, and repeatedly stated over time. Though it goes without saying, such safeguards are an essential part of any option for hastening death.

Understanding the Option in Question 4

There is an important understanding that is not conveyed by Question 4, which asks about the option to allow competent individuals to request, for their future incompetent self, that food and fluid be removed and that they be kept comfortable and allowed to die peacefully (Voluntarily Stopping Eating and Drinking, VSED). This is not an option that would allow one to completely avoid living while incompetent, but it would allow one to shorten the time spent in end-stage dementia.

Once a person has lost capacity and deteriorated from early-stage or mild dementia into moderate dementia, the individual no longer has the mental focus or ability to remember to refuse food and fluid. As a practical matter, a loved one, healthcare representative, or caregiver is not going to withhold food and fluid from someone who is asking for it.

Therefore, the option to hasten death after competence has been lost would only come into play once an individual’s dementia had progressed to the point when the individual no longer expresses any interest in eating or drinking. Typically, this only happens in late-stage or severe dementia, so the individual would have to progress through the moderate and moderately severe stages of dementia, which can last a number of years, before their healthcare representative could initiate VSED on their behalf.

Click here for FEN’s Supplemental Advance Directive for Dementia Care

Support and Opposition by Age

The following graphs show how people responded to questions 3 and 4 broken into age categories: 18-34, 35-54, 55-69, and 70+.