People with dementia aren’t currently eligible for voluntary assisted dying. Should they be?
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Dementia is the second leading cause of death for Australians aged over 65. More than 421,000 Australians currently live with dementia and this figure is expected to almost double in the next 30 years.
There is ongoing public discussion about whether dementia should be a qualifying illness under Australian voluntary assisted dying laws. Voluntary assisted dying is now lawful in all six states, but is not available for a person living with dementia.
The Australian Capital Territory has begun debating its voluntary assisted dying bill in parliament but the government has ruled out access for dementia. Its view is that a person should retain decision-making capacity throughout the process. But the bill includes a requirement to revisit the issue in three years.
The Northern Territory is also considering reform and has invited views on access to voluntary assisted dying for dementia.
Several public figures have also entered the debate. Most recently, former Australian Chief Scientist, Ian Chubb, called for the law to be widened to allow access.
Others argue permitting voluntary assisted dying for dementia would present unacceptable risks to this vulnerable group.
Australian laws exclude access for dementia
Current Australian voluntary assisted dying laws exclude access for people who seek to qualify because they have dementia.
In New South Wales, the law specifically states this.
In the other states, this occurs through a combination of the eligibility criteria: a person whose dementia is so advanced that they are likely to die within the 12 month timeframe would be highly unlikely to retain the necessary decision-making capacity to request voluntary assisted dying.
This does not mean people who have dementia cannot access voluntary assisted dying if they also have a terminal illness. For example, a person who retains decision-making capacity in the early stages of Alzheimer’s disease with terminal cancer may access voluntary assisted dying.
What happens internationally?
Voluntary assisted dying laws in some other countries allow access for people living with dementia.
One mechanism, used in the Netherlands, is through advance directives or advance requests. This means a person can specify in advance the conditions under which they would want to have voluntary assisted dying when they no longer have decision-making capacity. This approach depends on the person’s family identifying when those conditions have been satisfied, generally in consultation with the person’s doctor.
Another approach to accessing voluntary assisted dying is to allow a person with dementia to choose to access it while they still have capacity. This involves regularly assessing capacity so that just before the person is predicted to lose the ability to make a decision about voluntary assisted dying, they can seek assistance to die. In Canada, this has been referred to as the “ten minutes to midnight” approach.
But these approaches have challenges
International experience reveals these approaches have limitations. For advance directives, it can be difficult to specify the conditions for activating the advance directive accurately. It also requires a family member to initiate this with the doctor. Evidence also shows doctors are reluctant to act on advance directives.
Particularly challenging are scenarios where a person with dementia who requested voluntary assisted dying in an advance directive later appears happy and content, or no longer expresses a desire to access voluntary assisted dying.
Allowing access for people with dementia who retain decision-making capacity also has practical problems. Despite regular assessments, a person may lose capacity in between them, meaning they miss the window before midnight to choose voluntary assisted dying. These capacity assessments can also be very complex.
Also, under this approach, a person is required to make such a decision at an early stage in their illness and may lose years of otherwise enjoyable life.
Some also argue that regardless of the approach taken, allowing access to voluntary assisted dying would involve unacceptable risks to a vulnerable group.
More thought is needed before changing our laws
There is public demand to allow access to voluntary assisted dying for dementia in Australia. The mandatory reviews of voluntary assisted dying legislation present an opportunity to consider such reform. These reviews generally happen after three to five years, and in some states they will occur regularly.
The scope of these reviews can vary and sometimes governments may not wish to consider changes to the legislation. But the Queensland review “must include a review of the eligibility criteria”. And the ACT bill requires the review to consider “advanced care planning”.
Both reviews would require consideration of who is able to access voluntary assisted dying, which opens the door for people living with dementia. This is particularly so for the ACT review, as advance care planning means allowing people to request voluntary assisted dying in the future when they have lost capacity.
This is a complex issue, and more thinking is needed about whether this public desire for voluntary assisted dying for dementia should be implemented. And, if so, how the practice could occur safely, and in a way that is acceptable to the health professionals who will be asked to provide it.
This will require a careful review of existing international models and their practical implementation as well as what would be feasible and appropriate in Australia.
Any future law reform should be evidence-based and draw on the views of people living with dementia, their family caregivers, and the health professionals who would be relied on to support these decisions.
Ben White, Professor of End-of-Life Law and Regulation, Australian Centre for Health Law Research, Queensland University of Technology; Casey Haining, Research Fellow, Australian Centre for Health Law Research, Queensland University of Technology; Lindy Willmott, Professor of Law, Australian Centre for Health Law Research, Queensland University of Technology, Queensland University of Technology, and Rachel Feeney, Postdoctoral research fellow, Queensland University of Technology
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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How To Leverage Placebo Effect For Yourself
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Placebo Effect: Making Things Work Since… Well, A Very Long Time Ago
The placebo effect is a well-known, well-evidenced factor that is very relevant when it comes to the testing and implementation of medical treatments:
NIH | National Center for Biotechnology Information | Placebo Effect
Some things that make placebo effect stronger include:
- Larger pills instead of small ones: because there’s got to be more going on in there, right?
- Thematically-colored pills: e.g. red for stimulant effects, blue for relaxing effects
- Things that seem expensive: e.g. a well-made large heavy machine, over a cheap-looking flimsy plastic device. Similarly, medication from a small glass jar with a childproof lock, rather than popped out from a cheap blister-pack.
- Things that seem rational: if there’s an explanation for how it works that you understand and find rational, or at least you believe you understand and find rational ← this works in advertising, too; if there’s a “because”, it lands better almost regardless of what follows the word “because”
- Things delivered confidently by a professional: this is similar to the “argument from authority” fallacy (whereby a proposed authority will be more likely trusted, even if this is not their area of expertise at all, e.g. celebrity endorsements), but in the case of placebo trials, this often looks like a well-dressed middle-aged or older man with an expensive haircut calling for a young confident-looking aide in a lab coat to administer the medicine, and is received better than a slightly frazzled academic saying “and, uh, this one’s yours” while handing you a pill.
- Things with ritual attached: this can be related to the above (the more pomp and circumstance is given to the administration of the treatment, the better), but it can also be as simple as an instruction on an at-home-trial medication saying “take 20 minutes before bed”. Because, if it weren’t important, they wouldn’t bother to specify that, right? So it must be important!
And now for a quick personality test
Did you see the above as a list of dastardly tricks to watch out for, or did you see the above as a list of things that can make your actual medication more effective?
It’s arguably both, of course, but the latter more optimistic view is a lot more useful than the former more pessimistic one.
Since placebo effect works at least somewhat even when you know about it, there is nothing to stop you from leveraging it for your own benefit when taking medication or doing health-related things.
Next time you take your meds or supplements or similar, pause for a moment for each one to remember what it is and what it will be doing for you. This is a lot like the principles (which are physiological as well as psychological) of mindful eating, by the way:
How To Get More Nutrition From The Same Food
Placebo makes some surprising things evidence-based
We’ve addressed placebo effect sometimes as part of an assessment of a given alternative therapy, often in our “Mythbusting Friday” edition of 10almonds.
- In some cases, placebo is adjuvant to the therapy, i.e. it is one of multiple mechanisms of action (example: chiropractic or acupuncture)
- In some cases, placebo is the only known mechanism of action (example: homeopathy)
- In some cases, even placebo can’t help (example: ear candling)
One other fascinating and far-reaching (in a potentially good way) thing that placebo makes evidence-based is: prayer
…which is particularly interesting for something that is fundamentally faith-based, i.e. the opposite of evidence-based.
Now, we’re a health science publication, not a theological publication, so we’ll consider actual divine intervention to be beyond the scope of mechanisms of action we can examine, but there’s been a lot of research done into the extent to which prayer is beneficial as a therapy, what things it may be beneficial for, and what factors affect whether it helps:
Prayer and healing: A medical and scientific perspective on randomized controlled trials
👆 full paper here, and it is very worthwhile reading if you have time, whether or not you are religious personally
Placebo works best when there’s a clear possibility for psychosomatic effect
We’ve mentioned before, and we’ll mention again:
- psychosomatic effect does not mean: “imagining it”
- psychosomatic effect means: “your brain regulates almost everything else in your body, directly or indirectly, including your autonomic functions, and especially notably when it comes to illness, your immune responses”
So, a placebo might well heal your rash or even shrink a tumor, but it probably won’t regrow a missing limb, for instance.
And, this is important: it’s not about how credible/miraculous the outcome will be!
Rather, it is because we have existing pre-programmed internal bodily processes for healing rashes and shrinking tumors, that just need to be activated—whereas we don’t have existing pre-programmed internal bodily processes for regrowing a missing limb, so that’s not something our brain can just tell our body to do.
So for this reason, in terms of what placebo can and can’t do:
- Get rid of cancer? Yes, sometimes—because the body has a process for doing that; enjoy your remission
- Fix a broken nail? No—because the body has no process for doing that; you’ll just have to cut it and wait for it to grow again
With that in mind, what will you use the not-so-mystical powers of placebo for? What ever you go for… Enjoy, and take care!
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Breaking The Age Code – by Dr. Becca Levy
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The author, a social psychologist, sets out to not only bust ageist expectations, but also boost life expectancy by 7.5 years.
How? By examining the extent to which how we think about our age affects our actual aging. Lest this sound wishy-washy, there are 52 pages of scientific references at the back.
We’ve written about this before at 10almonds, for example about the famous “Counterclockwise” study that saw reversals in biological markers of aging after a one-week intervention that consisted only of a (albeit rather intensive) mental reframe with regard to their age.
This book goes into such ideas much more than we can in a single article here, and in more ways, both on the personal level and the societal level.
The style is (despite its heavy leanings on hundreds of scientific studies) quite conversational in tone, with many personal anecdotes padding the pages a little, but it does get the message across and helps to illustrate things.
Bottom line: if you’d like a fresh take on aging, to make a big difference to yours, this book tackles that.
Click here to check out Breaking The Age Code, and break the age code!
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The Mindful Body – by Dr. Ellen Langer
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Fear not, this is not a “think healing thoughts” New Age sort of book. In fact, it’s quite the contrary.
The most common negative reviews for this on Amazon are that it is too densely packed with scientific studies, and some readers found it hard to get through since they didn’t find it “light reading”.
Counterpoint: this reviewer found it very readable. A lot of it is as accessible as 10almonds content, and a lot is perhaps halfway between 10almonds content in readability, and the studies we cite. So if you’re at least somewhat comfortable reading academic literature, you should be fine.
The author, a professor of psychology (tenured at Harvard since 1981), examines a lot of psychosomatic effect. Psychosomatic effect is often dismissed as “it’s all in your head”, but it means: what’s in your head has an effect on your body, because your brain talks to the rest of the body and directs bodily responses and actions/reactions.
An obvious presentation of this in medicine is the placebo/nocebo effect, but Dr. Langer’s studies (indeed, many of the studies she cites are her own, from over the course of her 40-year career) take it further and deeper, including her famous “Counterclockwise” study in which many physiological markers of aging were changed (made younger) by changing the environment that people spent time in, to resemble their youth, and giving them instructions to act accordingly while there.
In the category of subjective criticism: the book is not exceptionally well-organized, but if you read for example a chapter a day, you’ll get all the ideas just fine.
Bottom line: if you want a straightforward hand-holding “how-to” guide, this isn’t it. But it is very much information-packed with a lot of ideas and high-quality science that’s easily applicable to any of us.
Click here to check out The Mindful Body, and indeed grow your chronic good health!
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Ex-Cyclone Alfred has left flooding in its wake. Here’s how floods affect our health
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Ex-Cyclone Alfred is bringing significant rainfall to southeast Queensland and the Northern Rivers of New South Wales. Flooding has hit Lismore, Ballina, Grafton, Brisbane and Hervey Bay, which received 150 mm of rainfall in two hours this morning.
Tragically, a 61-year-old man died after being swept away in floodwaters near Dorrigo in northern New South Wales.
More heavy rain and flash flooding is expected in the coming days as the weather system moves inland and weakens.
Climate change is making these weather events more intense and frequent. Earlier this year, far north Queensland experienced major flooding. As residents of the Northern Rivers, this latest disaster is especially tough because only three years ago we faced the catastrophic 2022 floods.
We’ve studied the impact of floods on human health and wellbeing, and found floods are linked to a range of physical and mental health effects in both the short- and long-term.
So what might you experience if you live in an area affected by these floods?
We reviewed the evidence
We recently reviewed research on the physical and mental health impacts of floods across mainland Australia. We included 69 studies in our review, published over 70 years. The majority were from the past ten years, examining the effects of floods in Queensland and NSW.
These studies suggest people can expect a range of health impacts. Immediate physical health effects of floods include drowning, falls and injuries.
Chronic diseases such as diabetes or renal disease can also worsen due to factors such as reduced access to transport, health-care services, medications and hospitals.
Exposure to contaminated floodwaters can lead to skin infections, while respiratory problems can occur due to mould and damp housing in the aftermath of floods.
Floods also create ideal conditions for mosquito borne infections such as Ross River virus and Murray Valley encephalitis, while also spreading infectious diseases including leptospirosis, a bacterial infection from contaminated soil.
There are mental health consequences too
Our review showed floods also affect mental health. The more you’re exposed to floodwaters in your home or business, the worse the mental health impacts are likely to be.
The After the Flood study examined mental health and wellbeing outcomes six months after the 2017 flood in the Northern Rivers. It found people who had floodwater in their home, yard or business, or who were displaced from their home for a more than six months, were much more likely to have probable post-traumatic stress disorder, anxiety or depression, compared to those who didn’t experience flooding or weren’t displaced.
Repeated natural disasters could compound these mental health consequences. Southeast Queensland and the Northern Rivers in NSW have experienced multiple disasters over recent years. The Northern Rivers faced major flooding in 2017, bushfires in 2020, further major floods in 2022, and now Cyclone Alfred in 2025. These repeated disasters have taken a toll on our community, creating a seemingly never-ending cycle of recovery, rebuilding and preparation for the next disaster.
Our understanding of the unique challenges faced by communities which experience multiple disasters is still growing. However, a recent Australian study showed exposure to repeated disasters has a compounding effect on people’s mental health, leading to worse mental health outcomes compared to people who experience a single disaster.
Mums and babies
The health effects of floods extend far beyond the initial emergency and beyond the infections and mental health consequences you might expect.
The Queensland Flood Study tracked pregnant women exposed to the 2011 Brisbane floods. Researchers assessed mothers’ stress related to the flood and tracked them and their children at six weeks old, six months, 16 months, 2.5 years, four and six years. It found some links between prenatal stress and developmental outcomes in children.
Some evidence suggests maternal stress from floods can affect children’s development. Nastyaofly/Shutterstock While the health effects after flooding are diverse, the research to date is not comprehensive. We need to learn more about how floods contribute to or exacerbate existing chronic illnesses, disability and long-term mental health issues.
The impacts are inequitable
Flooding exposes and worsens existing inequalities. Socially vulnerable groups are more likely to be exposed to flooding in their homes and have less access to resources to respond and recover from these events, putting some groups at higher risk of negative health impacts afterwards.
Some research has looked at the disproportionate impacts on people with disabilities and their carers, First Nations communities and people from disadvantaged backgrounds.
After the 2017 Northern Rivers floods, for example, people with disability and their carers were more likely than others to:
- experience disrupted access to food, support networks and essentials such as health care and social services
- continue to be distressed about the flood six months after it happened
- be at relatively high risk of post-traumatic stress disorder six months after the flood.
However, targeted flood research exploring the experiences of these vulnerable groups in Australia is limited.
Moving forward, it’s vital we examine the varied impacts of flood events for more vulnerable groups, so we can better support them in the wake of devastating events such as Cyclone Alfred.
If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.
Jodie Bailie, Senior Research Fellow, The University Centre for Rural Health and The Centre for Disability Research and Policy, University of Sydney; Jo Longman, Senior Research Fellow, The University Centre for Rural Health, University of Sydney; Rebecca McNaught, Research Fellow, Rural and Remote Health, University of Sydney, and Ross Bailie, School of Public Health, Honorary Professor, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Cherries vs Cranberries – Which is Healthier?
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Our Verdict
When comparing cherries to cranberries, we picked the cherries.
Why?
In terms of macros, cherries have a little more protein (but it’s not much) while cranberries have a little more fiber. Despite this, cherries have the lower glycemic index—about half that of cranberries.
In the category of vitamins, cherries have a lot more of vitamins A, B1, B2, B3, B9, and a little more choline, while cranberries have more of vitamins B5, B6, C, E, and K. A modest win for cherries here.
When it comes to minerals, things are more divided: cherries have more calcium, copper, iron, magnesium, phosphorus, potassium, and zinc, while cranberries have more manganese. An easy win for cherries here.
This all adds up to a total win for cherries, but both of these fruits are great and both have their own beneficial properties (see our main features below!)
Want to learn more?
You might like to read:
- Cherries’ Very Healthy Wealth Of Benefits!
- Health Benefits Of Cranberries (But: You’d Better Watch Out)
Take care!
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‘Disease X’: What it is (and isn’t)
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What you need to know
- In January 2024, the World Economic Forum hosted an event called Preparing for Disease X to discuss strategies to improve international pandemic response.
- Disease X is a term used in epidemiology to refer to potential disease threats. It is not a real disease or a global conspiracy.
- Preparation to prevent and respond to future pandemics is a necessary part of global health to keep us all safer.
During the World Economic Forum’s 54th annual meeting in Davos, Switzerland, global health experts discussed ways to strengthen health care systems in preparation for future pandemics. Conspiracy theories quickly began circulating posts about the event and the fictional disease at its center, so-called Disease X.
What is Disease X?
In 2018, the World Health Organization added Disease X to its list of Blueprint Priority Diseases that are public health risks. But, unlike the other diseases on the list, Disease X doesn’t exist. The term represents a hypothetical human disease capable of causing a pandemic. Although experts don’t know what the next Disease X will be, they can make educated guesses about where and how it may emerge—and how we can prepare for it.
Why are we hearing about Disease X now?
COVID-19 has been the deadliest infectious disease outbreak of the 21st century. It’s also an example of a Disease X: a previously unknown pathogen that spreads rapidly around the world, claiming millions of lives.
When the WEF hosted a panel of experts to discuss Disease X, it was the first exposure that many people had to a concept that global health experts have been discussing since 2018.
Even before the routine pandemic preparedness event took place, online conspiracy theorists began circulating false claims that those discussing and preparing for Disease X had sinister motives, underscoring how widespread distrust of global health entities has become in the wake of the COVID-19 pandemic.
Why does Disease X matter?
Epidemiologists use concepts like Disease X to plan for future outbreaks and avoid the mistakes of past outbreaks. The COVID-19 pandemic and the recent non-endemic outbreak of mpox highlight the importance of global coordination to efficiently prevent and respond to disease outbreaks.
Pandemics are inevitable, but the scale of their destruction doesn’t have to be. Major disease outbreaks are likely to become more frequent due to the impacts of climate change. Preparing for a pandemic now helps ensure that the world is better equipped to handle the next one.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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