Euthanasia and other end of life in patients suffering from dementia

•The practice of euthanasia or assisted suicide has been in existence for many years.•Advance directives’ validity in cases of dementia has been a much debated subject.•Contemporary competence is regarded as a safeguard against mistake and abuse.•Ethical issues arise when evaluating the euthanasia request of a demented person.•More debate is needed about the issue of suffering in dementia. Medicine aims to relieve patient suffering and cure illness. To relieve suffering is the heart of what doctors do. However, respect for individual autonomy and self-determination are fundamental principles in Western medical ethics and decision-making, often expressed as a desire for control over the timing and manner of death. Patients who become demented often formulate advance euthanasia and assisted suicide directives. Dealing with such request is quite complex because of the specific medical and conflicting ethical questions they raise. Some specific medical and ethical issues arise regarding these substantive requirements when evaluating the euthanasia request of a person suffering from dementia. In jurisdictions that allow euthanasia, the most fundamental prerequisite for a person to make autonomous decisions is capacity. Whether anyone with moderate or severe dementia, and even some with mild dementia, could be deemed to be competent by these criteria is debatable, but during the course of their disease people with dementia sooner or later lose their capacity to make self-determined decisions.