A family affair: repeated interviews with people with dementia and a euthanasia wish and their families

This study examines the reasons of people with dementia request euthanasia and how thesereasons change over time with a special focus on reasons related to family. In addition, itexamines how family relates to their loved one’s euthanasia wish. Seven people with dementiaand a euthanasia wish in the Netherlands were interviewed, and three years later, two ofthem and five family members were interviewed again. Four themes were identified usingthematic analyses: (1) Protecting the relationship from the impact of dementia; (2) Privatedomain as the primary setting to discuss euthanasia; (3) Implicit expectation to respect andagree with the euthanasia wish; (4) Experienced responsibilities of family regarding theeuthanasia wish. Professionals should be aware of the position of family and theinterrelatedness of the person’s concern for family happiness and families’ moral commitmentto agree and support the wish.This study examines the reasons of people with dementia request euthanasia and how these reasons change over time with a special focus on reasons related to family. In addition, it examines how family relates to their loved one’s euthanasia wish. Seven people with dementia and a euthanasia wish in the Netherlands were interviewed, and three years later, two of them and five family members were interviewed again. Four themes were identified using thematic analyses: (1) Protecting the relationship from the impact of dementia; (2) Private domain as the primary setting to discuss euthanasia; (3) Implicit expectation to respect and agree with the euthanasia wish; (4) Experienced responsibilities of family regarding the euthanasia wish. Professionals should be aware of the position of family and the interrelatedness of the person’s concern for family happiness and families’ moral commitment to agree and support the wish

Commentary: Can an effective end-of-life intervention for advanced dementia be viewed as moral?

We comment on Dr. Terman's considerations on the moral justification of ceasing assisted feeding and hydration for people with advanced dementia. The core idea of his paper is that an advance directive can solve future dilemmas regarding assisted feeding. We submit that this static instrument is unfit for the complex and dynamic nature of assessing how to deal with refusals to eat, in particular for people with dementia. It overvalues the past in relation to the present situation and leaves no room for the possibility of changing wishes. Moreover, the perspectives of professional caregivers and families are not addressed because the focus is entirely on individual autonomy in early dementia. Multiple perspectives should be considered in interpreting directives and the actual situation in light of the patient's view of life in order to realistically account for what is morally justifiable in care in advanced dementia

The Embodied Character of ‘Acknowledging God’: A Contribution to Understanding the Relationship between Transcendence and Embodiment on the Basis of Hosea

In this article I follow Bornemark’s approach to clarify the embodied character of religion ‘via the text’ by turning to the book of Hosea. Hosea is especially suitable for studying the controversy over the body in religion because it has traditionally been interpreted as rejecting a religious cult of bodily fertility as opposed to the true ethical religion of Israel. I investigate different motives of embodiment in the text. Subsequently I deal with the critical question of whether the project of revaluating the bodily guarantees better understanding of Hosea and (biblical) religion. I explore the body-related notions of ‘dependence’ and ‘discernment’ as a more specific alternative, which also sheds light on current difficulties in understanding religion

Commentary to: “Timely dying in dementia: Use patients' judgments and broaden the concept of suffering.” Timely dying, suffering in dementia, and a role for family and professional caregivers in preventing it

Abstract Broadening the concept of suffering in dementia to five types of suffering including suffering of family caregivers as proposed by Terman et al., may help raise awareness on a need to relieve suffering when living with dementia and adopt a holistic approach. However, as objective criteria in advance care plans for severe enough suffering to stop assisted feeding or other life‐sustaining treatment in people with advanced dementia, these still need interpretation in the context of, for example, available treatment, and change in coping. New is the proposal to broaden severe enough suffering to suffering of family, including “bi‐directional empathic suffering.” We believe this creates new dilemmas regarding responsibility and may increase feelings of guilt. Quantifying suffering by adding up moderate suffering could further complicate matters. Therefore, we argue that a health care professional should guide the process and assume responsibility over current decisions to follow a person's previous wishes

Commentary: Can an effective end‐of‐life intervention for advanced dementia be viewed as moral?

Abstract We comment on Dr. Terman's considerations on the moral justification of ceasing assisted feeding and hydration for people with advanced dementia. The core idea of his paper is that an advance directive can solve future dilemmas regarding assisted feeding. We submit that this static instrument is unfit for the complex and dynamic nature of assessing how to deal with refusals to eat, in particular for people with dementia. It overvalues the past in relation to the present situation and leaves no room for the possibility of changing wishes. Moreover, the perspectives of professional caregivers and families are not addressed because the focus is entirely on individual autonomy in early dementia. Multiple perspectives should be considered in interpreting directives and the actual situation in light of the patient's view of life in order to realistically account for what is morally justifiable in care in advanced dementia