Assessing Public's Attitudes Towards Euthanasia and Assisted Suicide of Persons With Dementia Based on Their Advance Request: An Experimental Survey of US Public
Open accessAbstract
Objective Advance request euthanasia and/or assisted suicide (AR-EAS) in persons with dementia is highly controversial. Results of typical public opinion surveys may not reflect the ethical and practical issues involved in the practice. We tested the impact of incorporating such issues in the assessment of public attitudes toward legalization of AR-EAS.Design Online survey (April 27-30, 2020) of 1,711 adults recruited via CloudResearch PrimePanel, matched to U.S. population in age, sex, race and/or ethnicity, education, household income, and political affiliation. After assessing initial attitudes toward legalization of AR-EAS, respondents viewed one of six randomly assigned scenarios depicting an ethical or practical issue in AR-EAS; acceptability of EAS in each scenario as well as general attitudes toward AR-EAS legalization were then elicited.Results Approximately 54.4% initially agreed/strongly agreed with AR-EAS legalization; agreement was associated with lower dementia quality-of-life rating, younger age, not being religious, liberal politics, and $75,000-$99,999 income range. After viewing the scenarios, a minority in each scenario arm found the AR-EAS depicted acceptable (20.7%-39.1%; p<0.0001 for all six arms, in comparison with initial legalization question response). Support (agree/strongly agree) for AR-EAS legalization after reading specific scenarios was generally lower (range 36.5%-49.3%; p≤0.0002); change in support for legalization was associated with initial support for legalization, acceptability of AR-EAS in the scenarios, dementia quality-of-life ratings, and race.Conclusion Informing the public of the ethical and practical complexities in AR-EAS may have significant effects on their attitudes toward legalization. Future surveys should ensure that the public's views reflect sufficient exposure to these complexities.
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There is an ethical distinction between helping a dying person die peacefully and providing death to a non-dying person.
“the ethical distinction between helping a dying person die peacefully versus providing death to a non-dying person”
From Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders (2022) · cites this paper as [21]
The introductory passage (page unavailable) distinguishes U.S. assisted-dying rules for terminally ill patients from proposals involving non-terminally ill people with dementia, and says expansion compounds the controversy. It attributes that added controversy to cognitive decline and advance requests; it does not articulate the claimed ethical distinction between helping a dying person die peacefully and providing death to a non-dying person. (LLM, conf=0.72)
Experimental — accuracy not yet measuredAmong the US general population, one-third supported legalizing MAiD-NT for people with physical disability (e.g., cerebral palsy) and dementia or mental illness (e.g., depression).
“In contrast, among the US general population, one-third supported legalizing MAiD-NT for people with physical disability (e.g., cerebral palsy) and dementia or mental illness (e.g., depression) [28].”
From Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders (2022) · cites this paper as [28]
The Results section (Effect of scenarios on attitudes towards advance request EAS policy; page not provided) reports that 36.5%–49.3% supported legalization after reading scenarios about advance-request euthanasia or assisted suicide for people with dementia. The initial figure was 54.4%, not one-third. The paper does not report support for legalization for people with cerebral palsy, other physical disabilities, or mental illness, so the broader claim is unsupported. (LLM, conf=0.86)
Experimental — accuracy not yet measuredOther studies report that family members tend to support their loved ones' MAiD MD-SUMC requests, citing relief of suffering and the perception of a dignified, controlled death.
“Other studies similarly report that family members tend to support their loved ones’ MAiD MD-SUMC requests, citing relief of suffering and the perception of a dignified, controlled death.”
From Medical Assistance in Dying for the Sole Underlying Condition of Mental Disorder (MAiD MD-SUMC): an analysis and qualitative evidence synthesis (2026) · cites this paper as [52]
The paper’s introductory discussion (page unavailable) reports that 90% of relatives in one survey considered advance-request euthanasia permissible. But it also says relatives were more favorable in theory than in practice: when an advance directive was present, most asked that it not be followed. The paper does not attribute relatives’ views to relief of suffering or a dignified, controlled death. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMAiD-NT may put vulnerable or marginalized people at risk of seeking death as a relief from poverty, loneliness, or other psychosocial stressors.
“the difficulty that MAiD-NT may put vulnerable or marginalized people at risk of seeking death as a relief from poverty, loneliness, or other psychosocial stressors”
From Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders (2022) · cites this paper as [21]
The Methods (Survey measures; page unavailable) examine public responses to advance-request euthanasia scenarios involving people with dementia. The Discussion (page unavailable) addresses uncertainty about patients’ wishes and visible suffering, but does not address whether people might seek death to escape poverty, loneliness, or other psychosocial stressors. Searches for those terms and related financial or social pressures found no supporting passage. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThe prognosis of non-terminal conditions such as most mental illnesses is unpredictable.
“the unpredictability of prognosis of non-terminal conditions such as most mental illnesses”
From Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders (2022) · cites this paper as [21]
The Methods and Results sections examine public attitudes toward advance-request euthanasia for people with dementia, not the predictability of illness prognosis. Searches for prognosis, non-terminal conditions, and mental illness found no passage addressing the claim. (LLM, conf=0.76)
Experimental — accuracy not yet measured
Grassi et al identified substantial international differences in public support for MAiD MD-SUMC: a majority of Dutch respondents (53%) supported MAiD eligibility for psychiatric patients, while only one-third of respondents in the USA expressed similar support for individuals with mental disorders or physical disabilities.
“Grassi et al10 identified substantial international differences: while a majority of Dutch respondents (53%) supported MAiD eligibility for psychiatric patients, only one-third of respondents in the USA expressed similar support for individuals with mental disorders or physical disabilities.”
From Medical Assistance in Dying for the Sole Underlying Condition of Mental Disorder (MAiD MD-SUMC): an analysis and qualitative evidence synthesis (2026) · cites this paper as [52]
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References 27 · Cited by 24
- Authors
- Mangino, D. R., Bernhard, T., Wakim, P., & Kim, S. Y.
- Affiliations
- National Institutes of Health (US)
- Corresponding author
- Kim, Scott YH
- Venue
- The American Journal of Geriatric Psychiatry
- Publisher
- Elsevier BV
- Published
- 2021-04
- Volume
- 29
- Issue
- 4
- Pages
- 384-394
- ISSN
- 1064-7481 (ISSN-L)
- PMC
- PMC7854974
- OpenAlex
- W3046217963
- Cited by
- 24
- References
- 27
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 3 · 2023: 5 · 2022: 5 · 2021: 2
- FWCI
- 2.25
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Geriatric Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Keywords
- dementia, public attitudes, legalization, ethical considerations, practical problems, quality of life, political ideology, income, race, informed consent
- MeSH terms
- Adolescent, Adult, Aged, Attitude, Dementia, Euthanasia, Female, Humans, Male, Middle Aged, Public Opinion, Quality of Life, Surveys and Questionnaires, United States, Suicide, Assisted, Young Adult
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