It's interesting that you asked me the question, because I had a discussion about this today with my nurse. Her work consists of looking after people with dementia. Her argument was that we don't have adequate care. She doesn't want to depend on malevolent people, who are sometimes in long-term care homes, or LTCHs, or in homes for the aged. Her fear was of finding herself in a context of malevolence, that people would give her poor care, that they would have contempt for her or not offer her adequate care.
In fact, my patients are all over age 65. However, it is frequently the case that our patients' children make this kind of request. Often, they have been looking after their family members for a long time, they have become very worn out and they see dementia as a pretty heavy burden to bear. They don't want their family to experience the same thing. I understand that.
The care to provide for persons suffering from dementia calls for a lot of resources and involves very specialized care. There are different types of dementia. There is what some call “happy dementia”, which doesn't call for a lot of care. However, when behavioural problems and psychological problems are associated with dementia, it calls for very specialized care. People who are not trained in this field may indeed find the situation extremely difficult. They project it onto themselves and tell themselves that their family members didn't receive the care they needed and they don't want to experience that. That is where the fear of decline comes into play, that I was talking about a little earlier. They decide to request medical assistance in dying for themselves, because they internalize that vision of ageism and ableism. They don't want to be disabled or aged in Canadian society as it now is and they especially don't want to suffer from a mental illness in Canadian society as it is now. Canadian society is in fact very stigmatizing, and even contemptuous, for people who have challenges in their daily lives.
In geriatrics, my area of expertise, and in geriatric psychiatry and palliative care, if people receive good care, they could be well and get better and no longer be seen as a burden by their family. The family could then regain its place, whether we are talking about children, spouse or family caregiver. People should not have to carry this mental load on an everyday basis.
I understand this fear of decline and desire to avoid it, but as I told my nurse, we have to fight and talk to the government to get improvements to geriatric care and geriatric psychiatric care and palliative care in Canada. Improving care would make it possible to reduce the fear of decline that people in their fifties often talk to us about.