A systematic review of reasons for and against euthanasia and physician-assisted suicide in older people with a non-terminal condition.

Objective: Some European jurisdictions have legalised euthanasia and physician-assisted suicide (EUT/PAS) for people with dementia and 'multiple geriatric syndromes'. We therefore sought to determine the published rationales for and against providing EUT/PAS to older people without a terminal illness.

Method: A systematic review was undertaken according to PRISMA guidelines. Content, thematic and discourse analyses were used to identify papers that delineated ethical arguments for and against the provision of EUT/PAS to older people without a terminal illness, and to synthesise arguments into overarching themes.

Results: Seventeen studies were included, eight of which were written by medical practitioners, the rest by ethicists. All but two of the papers were written by authors from western nations. A total of 70 arguments were identified, 16 (22.9%) being in favour of EUT/PAS, and 54 (77.1%) against. The themes identified were: a person with dementia had a duty to die, precedent capacity, ageism, abuse/coercion, psychological factors, healthcare economics, sociocultural factors and legislation.

Conclusion: Despite broad scepticism about the provision of EUT/PAS to older people without a terminal illness, the literature is preliminary. There is a need for ethicists and policymakers to engage with a range of older people with physical, cognitive and social needs, as well as their supporters.