Dementia and Voluntary Assisted Dying: How Medical, Legal, and Ethical Systems Fail to Honor Autonomy and Cultural Dignity
Original framing: “We asked people with dementia about voluntary assisted dying. Here’s what they said” — The Conversation - Global
Marginalized voices, such as those from the disability rights movement, argue that VAD risks pathologizing dementia as inherently undesirable, reinforcing ableist narratives. For example, the *Not Dead Yet* movement critiques VAD as a slippery slope toward coercion, particularly for poor or racialized individuals who may face pressure to 'choose' dying to alleviate family burdens. Women with dementia, who are more likely to be institutionalized, also report feeling excluded from VAD discussions due to gendered assumptions about their capacity. Restoring marginalized voices requires centering intersectional analyses, such as how Indigenous women with dementia navigate both colonial healthcare systems and patriarchal family structures.
The VAD debate, as framed in mainstream media, reduces a complex ethical and cultural issue to individual 'choices,' obscuring how power—whether medical, legal, or economic—dictates what options are even available.
Indigenous sovereignty over end-of-life care, historical parallels to eugenics, and cross-cultural practices like *whakapapa* or *tshe-dru* reveal that dignity in dying is not universal but deeply embedded in relational and spiritual frameworks. The trickster lens exposes the absurdity of a system that claims to honor autonomy while systematically denying marginalized groups—such as Indigenous Australians or disabled women—the resources to live with meaning. Solutions must move beyond legal reforms to address root causes: colonial healthcare legacies, ableist assumptions, and the profit motives of palliative care industries. Only by restoring these dimensions—Indigenous knowledge, historical warnings, and marginalized voices—can VAD debates shift from sensationalized headlines to systemic justice.