Depression is the leading risk factor for suicide in the elderly population. The risk of suicide increases with age, and older adults have the highest rate of suicide of any population. Other risk factors include perceived poor health status, unmarried status, Caucasian race, male gender, and lack of social support . Other life events that make certain elder populations more vulnerable to suicide are the loss of a spouse, physical illness, and dysfunctional impairment .
There is a distinction between assisted dying and assisted suicide. In Oregon, assisted dying is a term designed to explain the patient’s request to terminate their life when terminal illness is present and their suffering is beyond current treatment. Assisted suicide is a term given to those patients who wish to end their lives and are mentally competent, and do not have to have a terminal illness. Patients who are paralyzed, and those who are in early stages of neurological decline are examples . Controversy exists between professionals and the ethical considerations of terminating a life full of pain and terminal illness versus the newer trend of termination involving dementia and the decline of cognitive abilities. “The “slippery slope” view suggests that if legislation allowing assisted dying were passed, it would not be long before assistance would be permitted with less stringent criteria in place” .
There have been four cases to date of physician-assisted suicide (PAS) and patients with early dementia that were mentally competent. They were relatively young and considered to be suffering terribly. These situations bring to the table debate in determining competence and the role that psychiatrists can play in the determination of psychological competence. The San Diego study found in 49 suicides aged great than 60, 14 % had dementia, and only two cases had no neurological impairment .
Further research can answer the questions of suicide risk and early dementia in all patients. We know that depression is a risk for suicide in the elderly and the risks increase with age. Historically, when we think of assisted suicide or euthanasia, we think of the terminally ill and those patients who are in a great deal of pain or dysfunction. However, with the early onset of some dementias such as Alzheimer’s, we need to rethink as professionals the ethical implications of ending a chronic, dysfunctional neurological process that some patients do not wish to encounter. As a former healthcare professional and a daughter who lost her mother, I can speak to the mental demise and chronic dysfunction of neurological disease. I am a proponent of assisted suicide and euthanasia to those who have early onset dementia, and choose to end life prior to mental decline.