Will We Care For or Kill People with Dementia?

This article was published by National Review online on September 19, 2025.

By Wesley J Smith

I understand that people are terrified of dementia. Believe me, I get it. My mother died of Alzheimer’s. But I can’t wrap my head around the fact that advocacy for killing/suicide as the answer to the difficulties caused by the condition is becoming ubiquitous.

Noted bioethicist and lawyer Thaddeus Mason Pope has written an essay, to be published in an edited volume, on this very issue. It lists eleven ways people can “avoid late-stage dementia,” and almost all involve intentionally ending life.

Remember when we were told that advance medical directives are the key to not receiving life-extending treatment one does not want? They are, but that’s not good enough for Pope, because it doesn’t guarantee death:

This strategy is risky and uncertain. While patients with dementia can refuse antibiotics, they might never get an infection requiring antibiotics. In other words, advance directives for patients with dementia may be impotent because no triggering condition in their advance directive is ever satisfied. They may never need treatment they have refused. Consequently, traditional advance directives cannot reliably achieve the goals of patients seeking to avoid late-stage dementia.

Not only that, but he barely touches on the kind of compassionate care that can be provided to dementia patients, such as hospice, properly delivered. He even damns hospice with faint praise:

While physical suffering is usually sufficiently addressed with hospice and palliative support, this long duration imposes a burden on the patient and their family. And it imposes a significant financial cost, as the patient typically has nursing and doula support.

Get it? This is an argument not to avoid suffering but to not be a “burden” and to put oneself out of loved ones’ misery.

I should also note that hospice is covered by Medicare, Medicaid, and private insurance, which costs the patient very little. As to additional expenses, when my mother was dying, we also had a “visiting angel” kind of service to provide companionship. It cost some money, sure, but it wasn’t prohibitive and the service made my mother extremely happy, even toward the end. Besides, given the troubles the hospice sector is currently experiencing, we need better promotion of its proper application, not an “easier” way out that involves killing. 

In his essay, Pope pushes euthanasia (eventually chosen by a surrogate), suicide (assisted and otherwise), killing by self-starvation (VSED), death by inert gasses, going to a suicide clinic in Switzerland, being denied spoon feeding, and intentional malnourishment, among other gems.

So why do I give this awfulness publicity? I believe that people need to be aware of the darkness that is deepening, and that unthinkable actions once (properly) deemed abandonment are now being advocated at the highest levels of cultural influence. People with dementia need to be assured that they are valued and will be cared for, not deemed a killable caste.

It is all so discouraging. We are moving from do no harm to “do harm medicine,” and the question must be asked: In coming years, will we care for or kill dementia patients? I believe that the morality of society will depend on the answer to that question.