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Attitudes toward physician-assisted deaths vary among those with Alzheimer’s biomarker

The majority of cognitively normal individuals with elevated amyloid-beta, an Alzheimer’s disease biomarker, stated that they neither thought about physician-assisted death for themselves nor would they, recent study data showed

However, about one in five participants with higher amyloid-beta levels reported they would consider physician-assisted death if they became cognitively impaired, researchers found.

“Seven states have legalized physician-assisted death (PAD) for competent, terminally ill individuals; these criteria exclude persons with dementia,” Emily A. Largent, JD, PhD, RN, from the University of Pennsylvania Perelman School of Medicine, and colleagues wrote in JAMA Neurology. “However, there is ethical and policy discussion around expanding access to PAD to people with Alzheimer disease.”

The researchers reported the attitudes toward physician-assisted death among cognitively normal participants recruited from the Anti-Amyloid Treatment in Asymptomatic Alzheimer’s (A4) study and its companion study, Longitudinal Evaluation of Amyloid Risk and Neurodegeneration (LEARN).

Overall, 50 A4 participants with elevated amyloid-beta and 30 LEARN participants without completed a semi-structured interview 4 to 12 weeks after learning their amyloid

imaging results. Of these, 47 A4 participants and 30 LEARN participants completed a follow-up interview at 12 months, which included a question about physician-assisted death.

Nearly two-thirds of respondents with higher amyloid-beta levels reported that they had not and would not think about physician-assisted death for personal, religious or philosophical reasons, according to the results. However, many respondents stated that physician-assisted death could be right for others in similar circumstances.

Roughly 20% of participants with elevated amyloid-beta reported they would consider physician-assisted death if they became cognitively impaired, if they were suffering or if they were a burden to others. In addition, many participants with elevated amyloid-beta reported more end-of-life planning.

Some participants with higher amyloid-beta levels reported that they might consider suicide if they developed cognitive impairment symptoms, but didn’t know if they could act on it.

About the same number of participants without elevated amyloid-beta as those with elevated amyloid-beta reported that they might have pursued physician-assisted death or suicide, Largent and colleagues wrote.

“Our findings suggest that learning one’s amyloid imaging result does not change baseline attitudes regarding the acceptability of PAD,” the researchers wrote. “However, among those who indicate a personal openness to PAD, an elevated amyloid imaging result and the associated risk of cognitive decline are viewed as relevant to PAD-related decision making.” – by Savannah Demko

Disclosures: Largent reported grants from National Institute on Aging and from the Alzheimer’s Association. Please see the study for all other authors’ relevant financial disclosures.