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Those are all valid points. But oddly enough none of them seems to be a problem in Switzerland, where assisted suicide is legal since the 40s (as mentioned in the article).

On a sidenote: You can write a "Patientenverfügung" (loosely transelated: a patient's will), in which you stipulate that you don't want to be kept alive artificially in case of grave illnes.

This is respected by hospitals and doctors. Case in point was my mother, who had terminal cancer. The doctors gave her morphine to ease the pain and otherwise didn't do anything to prolong her suffering.

She died in a dignified manner.

We have "living wills" in the United States and they're the same thing. The controversial issue is active euthanasia, not passive euthanasia. Mostly, anyway.

>Because then somebody who is impulsive might agree to be killed when he would've regretted it later if he were still alive.

We wouldn't always know in such cases, and there's often no way to know what a dead person would have thought years later if they would have lived.

That's not quite true. There are people who attempt suicide and survive. Many (though by no means all) express regret afterwards.

That's an excellent point. Obviously we do know sometimes.

But GP's point was that we don't observe bad consequences from the laws in Switzerland, all I'm saying is that it wouldn't show up when someone commits suicide.

Se also: https://en.wikipedia.org/wiki/Do_not_resuscitate

But what you describe for your mother is called Hospice here in the US. It is simply a lack of treatment when it is believed that treatment offers more suffering and no better outcome. It is the right of the patient to refuse treatment and enter into hospice care and be kept comfortable until they die. That is not assisted suicide.

You can create legal structures to prevent most stuff like that pretty easily:

* Force everyone who wants assisted death to go through medical discussion alone with physiologists / doctors, require it to be at least 20 sessions or whatever seems enough.

* Only make it available and legal for people with chronic pain or other diseases that make life suck.

* Require several doctors to be present, that don't usually work with eachother or have any other specific connection to eachother.

* Require to let the patient "press" the button that injects the overdose or whatever method is used.

Etc etc. The point is to make the process complicated and to remove any doubt that this person in question didn't want to die. Of course, it isn't completely safe but so is life and that is kind of the point.

What do you do about someone with, say, Alzheimer's, who may want to end their life precisely because they are beginning to drift in and out of lucidity? Maybe Switzerland has it all figured out but it is not that easy.

Go through the process and let death take you. It's better to help some people than to help no one at all. I don't have the perfect protocol of such a process, I am just writing an example to prove that my original point is valid.

I think people that have Alzheimer's and want to die should be able to be assisted.

OK, but you are sidestepping the issue here. As you've said, if you accept active euthanasia you'd probably consider the deterioration of Alzheimer's an acceptable reason. And most people take informed and uncoerced consent as important to the process. And yet how do you ensure that consent with someone who is losing their mental faculties?

Encourage people to plan ahead, in the same way that you should have a living will and other legal documents in place before you actually need them.

I think most people would have a hard time accepting active euthanasia one the basis of documents prepared in the past, particularly when you consider the significant possibility of duress, forgery, etc.

Forgery - require a notarized document, a video, etc. Tons of documentation, why not.

Duress - could apply equally to euthanasia today too, couldn't it? If not, then take whatever magical anti-duress method we use now and apply it to this.

As someone with experience of a relative with Alzheimer's, it's completely clear in every possible way that informed consent is no longer an option.

Alzheimer's creates a mental handicap that makes normal adult functioning impossible. You can literally ask the same question twice in two minutes and get two conflicting answers - with no memory of the previous answer, or even that the question was asked before.

In mid-stage Alzheimer's memory is so impaired that it's literally shorter than a spoken sentence. In late Alzheimer's even that disappears.

The solution in the UK is to hand over care decisions by Power of Attorney. If no relative is available for that, decisions are handed over to care and medical staff.

If assisted death is ever an option in the UK, it would have to be written into a living will while informed consent was still possible.

Obviously there are huge legal issues with that, especially if there's an inheritance involved.

That aside, people really do get to the point where they just want to die.

I've seen it twice now. In one case it was very clear indeed, and had been clear for at least a couple of years. In another it was less clear, but it was something my relative talked about openly.

Personally, having seen cancer and Alzheimer's close up, I'm really not convinced I'd want to wait around for a natural death from either.

I am sympathetic to that view; I am just really troubled by the idea of people pressuring relatives into euthanasia.

One potential solution is ahead-of-time decision making.

When young and lucid, make the decision of what criteria would cause you to prefer physician-assisted suicide. Write that down in a document. Allow that document to have legal force.

In the US, we already have the notion of Advanced Health Care Directives, which allow for things like power of attorney, nominating a proxy decision-maker, and criteria were a caretaker is allowed, or even required, to stop providing life-extending treatment. Health care providers generally follow these directives if made aware of them.

Thinking about this sort of thing ahead of time is not something that people want to do. But, for people who do complete one (with sufficiently-rigorous criteria), it solves some of the ethical issues around consent and incapacity.

By the way, I strongly recommend more people complete an AHCD. I had to care for a close relative at the end of her life, and the fact that her wishes were written down on paper was an incomparable gift to me. This should really become more routine.

Alzheimer's patients are still lucid, right? Just can't access all their memories?

No. Alzheimer's is a form of dementia. Here is the description of "moderate" symptoms from Wikipedia:

> Behavioural and neuropsychiatric changes become more prevalent. Common manifestations are wandering, irritability and labile affect, leading to crying, outbursts of unpremeditated aggression, or resistance to caregiving.[26] Sundowning can also appear.[31] Approximately 30% of people with AD develop illusionary misidentifications and other delusional symptoms.[26] Subjects also lose insight of their disease process and limitations (anosognosia).[26] Urinary incontinence can develop.[26] These symptoms create stress for relatives and carers, which can be reduced by moving the person from home care to other long-term care facilities.[26][32]

The first one is hard to fix, actually. Family can be really shitty to you, to the point you feel useless and unwanted and really want to be gone. People do that to their parents today, and elderly commit suicide for that reason today!

Clinically available assisted suicide could further embolden people to be really terrible to their elderly parents, and private screening with a doctor doesn't fix this.

Per your second point, there is certainly a strong profit motive for keeping terminally-ill patients alive longer than they otherwise might want on the part of health-care providers. End-of-life care costs are no joke.

While it is true that end-of-life care costs are indeed out of control, to say that there is a "strong profit motive" for keeping terminally-ill patients alive seems to me a very, very cynical view.

Simpler still: "the autopsy showed poison, so put the spouse in prison."