“Physician-assisted death” (PAD) covers both physician-assisted suicide (PAS) and euthanasia. In PAS the patient takes lethal drugs made available through a physician's prescription; in euthanasia, the physician delivers the drugs, usually by injection. The term “physician-assisted suicide” has fallen out of favor in Oregon; proponents, wishing to distinguish it from suicide in general, often prefer “aid-in-dying.” We use both.Google Scholar

Aid-in-dying (or PAS) is legal in the United States in Oregon and Washington by statute: Oregon Death With Dignity Act, Or. Rev. Stat. §§ 127.800–897 (1997) Washington Death with Dignity Act, Wash. Rev. Code §§ 70.245.010–904 (2009). It is legal by a decision of the state supreme court in Montana: Baxter v. Montana No. DA 09–0051 (2009). In British Columbia it is conditionally legal as of June 2012 by order of the Supreme Court of British Columbia: Carter v. Canada (Attorney General) 2012 BCSC 886 (June 15, 2012), available at <http://thaddeuspope.com/images/2012bcsc886.pdf> (last visited January 28, 2013). In Switzerland, PAS and assisted suicide more generally are legal by statute, without restriction to terminal illness; voluntary self-administration is still required (that is, only assisted suicide, not euthanasia, is allowed). Hurst, S. A. Mauron, A., “Assisted Suicide and Euthanasia in Switzerland: Allowing a Role for Non-Physicians,” BMJ 326, no. 7383 (February 1, 2003): 271–273. In Belgium, where euthanasia administered by a physician is legal, the patient must still be legally competent and conscious at the moment of making the request for it. See the Belgian Act on Euthanasia of May 28, 2002, translated into English” in Ethical Perspectives 9, nos. 2–3 (2002): 182–188. Recently, legislation has been introduced in Belgium that would expand euthanasia to minors and those suffering from dementia; see <http://www.google.com/hostednews/afp/article/ALeqM5jLP19K4BFQIdHPAhZwzLruOyt2CQ> (last visited May 18, 2013).+(last+visited+January+28,+2013).+In+Switzerland,+PAS+and+assisted+suicide+more+generally+are+legal+by+statute,+without+restriction+to+terminal+illness;+voluntary+self-administration+is+still+required+(that+is,+only+assisted+suicide,+not+euthanasia,+is+allowed).+Hurst,+S.+A.+Mauron,+A.,+“Assisted+Suicide+and+Euthanasia+in+Switzerland:+Allowing+a+Role+for+Non-Physicians,”+BMJ+326,+no.+7383+(February+1,+2003):+271–273.+In+Belgium,+where+euthanasia+administered+by+a+physician+is+legal,+the+patient+must+still+be+legally+competent+and+conscious+at+the+moment+of+making+the+request+for+it.+See+the+Belgian+Act+on+Euthanasia+of+May+28,+2002,+translated+into+English”+in+Ethical+Perspectives+9,+nos.+2–3+(2002):+182–188.+Recently,+legislation+has+been+introduced+in+Belgium+that+would+expand+euthanasia+to+minors+and+those+suffering+from+dementia;+see++(last+visited+May+18,+2013).>Google Scholar

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Unlike Mrs. D. and Julian, who are based on actual people, Helen is a fictitious example. How realistic is Helen? We should point out that when one of us presented this paper, a physician in the audience experienced with patients in dementia said that he had never met a demented person like Helen.Google Scholar

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An alternative approach would be to stipulate that AEDs be implemented only in the latest, advanced stages of dementia. This would have the advantage of not requiring clinicians to make subjective decisions about the strength of desires; they would base their decisions to uphold AEDs on clear medical diagnoses. Moreover, this approach would reach the same results we have recommended, upholding the AEDs of Ruth, Walter, and Lotte, but not Margo or Helen. From a philosophical perspective, however, our sliding scale approach supplies moral reasons why some AEDs should be implemented and others not.Google Scholar

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