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Are Informal Caregivers of Persons With Dementia Open to Extending Medical Aid in Dying to Incompetent Patients? Findings From a Survey Conducted in Quebec, Canada

Bravo, Gina, PhD*,†; Rodrigue, Claudie, MSc; Arcand, Marcel, MD, MSc†,‡; Downie, Jocelyn, SJD§; Dubois, Marie-France, PhD*,†; Kaasalainen, Sharon, RN, PhD; Hertogh, Cees M., MD, PhD; Pautex, Sophie, MD#; Van den Block, Lieve, PhD**

Alzheimer Disease & Associated Disorders: July-September 2018 - Volume 32 - Issue 3 - p 247–254
doi: 10.1097/WAD.0000000000000238
Original Articles

Euthanasia is a controversial and complex issue, especially when involving incompetent patients. On December 10, 2015, Quebec became the first Canadian province to give access to medical aid in dying (MAiD) (ie, euthanasia performed by a physician) to competent patients who satisfy strictly defined criteria. Less than 2 years later, Quebec is considering extending MAiD to incompetent patients who made an advance request. With the objective of contributing scientific data to current societal debates, we conducted a survey among 471 informal caregivers of persons with dementia, reached through Alzheimer Societies. We used a series of vignettes featuring a person with Alzheimer disease to investigate respondents’ attitudes towards MAiD. The response rate was 69%. Two-thirds [68%; 95% confidence interval, 63%-73%] found it acceptable to extend MAiD to an incompetent patient at an advanced stage of Alzheimer disease who had made a written request while competent, and 91% (95% confidence interval, 87%-94%) found it acceptable at the terminal stage. Self-determination was the most widely endorsed argument in favor of access to MAiD for incompetent patients. Findings suggest strong support among informal caregivers for extending MAiD to incompetent patients, provided they are terminally-ill and had made a written request before losing capacity.

*Department of Community Health Sciences, Faculty of Medicine and Health Sciences

Department of Family Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke

Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, QC

§Schulich School of Law and Faculty of Medicine, Dalhousie University, Halifax, NS

Department of Family Medicine, School of Nursing, McMaster University, Hamilton, ON, Canada

Department of General Practice & Elderly Care Medicine, Vrije Universiteit Medical Center, and EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands

#Department of Community Medicine and Primary Care, Geneva University Hospital, Geneva, Switzerland

**VUB-UGhent End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium

Supported by an unrestricted grant from the Alzheimer Society of Canada (Grant #16 11).

The authors declare no conflicts of interest.

Reprints: Gina Bravo, PhD, Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, 1036 South Belvedere Street, Sherbrooke, QC, Canada J1H 4C4 (e-mail:

Received August 12, 2017

Accepted November 1, 2017

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