Medical aid in dying, decisional capacity, and supported decision making

In some countries, individuals must demonstrate contemporaneous decisional capacity to be eligible for medical aid in dying. This eligibility requirement excludes many individuals, such as those with moderate dementia, from accessing this end-of-life option. Some scholars have thus argued for the use of advance directives for assisted dying in these jurisdictions, but advance directives risk locking someone into prior preferences that conflict with their current interests. This chapter explores another option for individuals with impaired decisional capacity to access medical aid in dying. Specifically, this chapter explores the potential for supported decision making to enable individuals with cognitive impairments to make a contemporaneous choice about medical aid in dying. This chapter will use the United States as a case study to show how supported decision-making laws and medical aid-in-dying laws intersect. The chapter concludes by suggesting that countries carefully consider how their medical aid-in-dying and supported decision-making laws work together to ensure autonomy, equality, and well-being for persons with cognitive disabilities at the end of life.