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