The Intersection between Voluntary Assisted Dying, Suicide and Advance Care Planning in Huntington’s Disease
Publicado en línea: 01 jun 2024
Páginas: 8 - 28
DOI: https://doi.org/10.21307/ajon-2024-002
© 2024 Ruth C Hosken, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Source: Werth & Holdwick, 2000
| Criteria for Rational Suicide |
|---|
The person considering suicide has an unremitting “hopeless” condition. Hopeless conditions include, but are not necessarily limited to, terminal illnesses, severe physical and/or psychological pain, physically or mentally debilitating and/or deteriorating conditions, or quality of life no longer acceptable to the individual. The person makes the decision as a free choice (i.e., is not pressured by others to choose suicide). The person has engaged in a sound decision-making process. This process should include the following:
Consultation with a mental health professional who can make an assessment of mental competence (which would include the absence of treatable major depression) Non-impulsive consideration of all alternatives Consideration of the congruence of the act with one’s personal values Consideration of the impact on significant others Consultation with objective others (e.g., medical and religious professionals) and with significant others |
Stages of Huntington’s Disease (Nance et al, 2011)
| Pre-manifest | Early Stage | Mid Stage | Late Stage |
|---|---|---|---|
| Known to carry the HD gene mutation but symptoms are not yet apparent | Largely functional: May continue to work, drive, handle money, and live independently. | Loss of ability to work or drive, manage their own finances or perform their own household chores. Can usually still manage to eat, dress, and undertake own personal hygiene |
Require assistance in all activities of daily living. |
| Subtle changes in mood and cognition may be reported or observed | Symptoms may include: minor involuntary movements subtle loss of coordination, difficulty thinking through complex problems, possible depression, irritability, or disinhibition. | Chorea may be prominent. Difficulties with: swallowing, balance, increased risk of falls, weight loss and problem solving Likely depression, irritability and apathy |
Chorea may be severe, but more often it is replaced by rigidity, dystonia, and bradykinesia. Generally non-verbal |