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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Everything You Need To Know About The Menopause – by Kate Muir
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Kate Muir has made a career out of fighting for peri-menopausal health to be taken seriously. Because… it’s actually far more serious than most people know.
What people usually know:
- No more periods
- Hot flushes
- “I dunno, some annoying facial hairs maybe”
The reality encompasses a lot more, and Muir covers topics including:
- Workplace struggles (completely unnecessary ones)
- Changes to our sex life (not usually good ones, by default!)
- Relationship between menopause and breast cancer
- Relationship between menopause and Alzheimer’s
“Wait”, you say, “correlation is not causation, that last one’s just an age thing”, and that’d be true if it weren’t for the fact that receiving Hormone Replacement Therapy (HRT) or not is strongly correlated with avoiding Alzheimer’s or not.
The breast cancer thing is not to be downplayed either. Taking estrogen comes with a stated risk of breast cancer… But what they don’t tell you, is that for many people, not taking it comes with a higher risk of breast cancer (but that’s not the doctor’s problem, in that case). It’s one of those situations where fear of litigation can easily overrule good science.
This kind of thing, and much more, makes up a lot of the meat of this book.
Hormonal treatment for the menopause is often framed in the wider world as a whimsical luxury, not a serious matter of health…. If you’ve ever wondered whether you might want something different, something better, as part of your general menopause plan (you have a plan for this important stage of your life, right?), this is a powerful handbook for you.
Additionally, if (like many!) you justifiably fear your doctor may brush you off (or in the case of mood disorders, may try to satisfy you with antidepressants to treat the symptom, rather than HRT to treat the cause), this book will arm you as necessary to help you get what you need.
Grab your copy of “Everything You Need To Know About The Menopause” from Amazon today!
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Healthy Harissa Falafel Patties
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You can make these as regular falafel balls if you prefer, but patties are quicker and easier to cook, and are great for popping in a pitta.
You will need
For the falafels:
- 1 can chickpeas, drained, keep the chickpea water (aquafaba)
- 1 red onion, roughly chopped
- 2 tbsp chickpea flour (also called gram flour or garbanzo bean flour)
- 1 bunch parsley
- 1 tbsp harissa paste
- Extra virgin olive oil for frying
For the harissa sauce:
- ½ cup crème fraîche or plant-based equivalent (you can use our Plant-Based Healthy Cream Cheese recipe and add the juice of 1 lemon)*
- 1 tbsp harissa paste (or adjust this quantity per your heat preference)
*if doing this, rather than waste the zest of the lemon, you can add the zest to the falafels if you like, but it’s by no means necessary, just an option
For serving:
- Wholegrain pitta or other flatbread (you can use our Healthy Homemade Flatbreads recipe)
- Salad (your preference; we recommend some salad leaves, sliced tomato, sliced cucumber, maybe some sliced onion, that sort of thing)
Method
(we suggest you read everything at least once before doing anything)
1) Blend the chickpeas, 1 oz of the aquafaba, the onion, the parsley, and the harissa paste, until smooth. Then add in the chickpea flour until you get a thick batter. If you overdo it with the chickpea flour, add a little more of the aquafaba to equalize. Refrigerate the mixture for at least 30 minutes.
2) Heat some oil in a skillet, and spoon the falafel mixture into the pan to make the patties, cooking on both sides (you can use a spatula to gently turn them), and set them aside.
3) Mix the harissa sauce ingredients in a small bowl.
4) Assemble; best served warm, but enjoy it however you like!
Enjoy!
Want to learn more?
For those interested in more of what we have going on today:
- Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
- Capsaicin For Weight Loss And Against Inflammation
- Hero Homemade Hummus ← another great option
Take care!
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Inhaled Eucalyptus’s Immunomodulatory and Antimicrobial Effects
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝At the first hint of a cough or a cold, I resort to steam inhalation. Some people add herbs or aromatic oils to the boiling water. What do you recommend?❞
First of all, please do be careful:
Western science’s view is predominantly “this is popular and/but evidence for its usefulness is lacking”:
But! Traditional Chinese Medicine indicates shuanghuanglian, yuxingcao and qingkailing, which the China Food and Drug Administration has also approved:
Chinese Medicine in Inhalation Therapy: A Review of Clinical Application and Formulation Development
Indian scientists are also looking at modern scientific applications of certain Ayurvedic herbs:
Promising phytochemicals of traditional Indian herbal steam inhalation therapy to combat COVID-19
In terms of what is likely more available to you, there are several reasons to choose eucalyptus over popular alternatives:
Immune-modifying and antimicrobial effects of Eucalyptus oil and simple inhalation devices
For the sake of being methodical, here’s an example product on Amazon, though we’re sure you’d have no trouble finding this in your local pharmacy if you prefer.
Take care!
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Water Water Everywhere, But Which Is Best To Drink?
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Well Well Well…
In Tuesday’s newsletter, we asked you for your (health-related) opinion on drinking water—with the understanding that this may vary from place to place. We got the above-depicted, below-described, set of responses:
- About 65% said “Filtered is best”
- About 20% said “From the mains is best”
- About 8% said “Bottled is best”
- About 3% said “Distilled is best”
- About 3% said “Some other source is best”
Of those who said “some other source is best”, one clarified that their preferred source was well water.
So what does the science say?
Fluoridated water is bad for you: True or False?
False, assuming a normal level of consumption. Rather than take up more space today though, we’ll link to what we previously wrote on this topic:
You may be wondering: but what if my level of consumption is higher than normal?
Let’s quickly look at some stats:
- The maximum permitted safety level varies from place to place, but is (for example) 2mg/l in the US, 1.5mg/l in Canada & the UK.
- The minimum recommended amount also varies from place to place, but is (for example) 0.7mg/l in Canada and the US, and 1mg/l in the UK.
It doesn’t take grabbing a calculator to realize that if you drink twice as much water as someone else, then depending on where you are, water fluoridated to the minimum may give you more than the recommended maximum.
However… Those safety margins are set so much lower than the actual toxicity levels of fluoride, that it doesn’t make a difference.
For example: your writer here takes a medication that has the side effect of causing dryness of the mouth, and consequently she drinks at least 3l of water per day in a climate that could not be described as hot (except perhaps for about 2 weeks of the year). She weighs 72kg (that’s about 158 pounds), and the toxicity of fluoride (for ill symptoms, not death) is 0.2mg/kg. So, she’d need 14.4mg of fluoride, which even if the water fluoridation here were 2mg/l (it’s not; it’s lower here, but let’s go with the highest figure to make a point), would require drinking more than 7l of water faster than the body can process it.
For more about the numbers, check out:
Acute Fluoride Poisoning from a Public Water System
Bottled water is the best: True or False?
False, if we consider “best” to be “healthiest”, which in turn we consider to be “most nutrients, with highest safety”.
Bottled water generally does have higher levels of minerals than most local mains supply water does. That’s good!
But you know what else is generally has? Microplastics and nanoplastics. That’s bad!
We don’t like to be alarmist in tone; it’s not what we’re about here, but the stats on bottled water are simply not good; see:
We Are Such Stuff As Bottles Are Made Of
You may be wondering: “but what about bottled water that comes in glass bottles?”
Indeed, water that comes in glass bottles can be expected to have lower levels of plastic than water that comes in plastic bottles, for obvious reasons.
However, we invite you to consider how likely you believe it to be that the water wasn’t stored in plastic while being processed, shipped and stored, before being portioned into its final store-ready glass bottles for end-consumer use.
Distilled water is the best: True or False?
False, generally, with caveats:
Distilled water is surely the safest water anywhere, because you know that you’ve removed any nasties.
However, it’s also devoid of nutrients, because you also removed any minerals it contained. Indeed, if you use a still, you’ll be accustomed to the build-up of these minerals (generally simplified and referenced as “limescale”, but it’s a whole collection of minerals).
Furthermore, that loss of nutrients can be more than just a “something good is missing”, because having removed certain ions, that water could now potentially strip minerals from your teeth. In practice, however, you’d probably have to swill it excessively to cause this damage.
Nevertheless, if you have the misfortune of living somewhere like Flint, Michigan, then a water still may be a fair necessity of life. In other places, it can simply be useful to have in case of emergency, of course.
Here’s an example product on Amazon if you’d like to invest in a water still for such cases.
PS: distilled water is also tasteless, and is generally considered bad, tastewise, for making tea and coffee. So we really don’t recommend distilling your water unless you have a good reason to do so.
Filtered water is the best: True or False?
True for most people in most places.
Let’s put it this way: it can’t logically be worse than whatever source of water you put into it…
Provided you change the filter regularly, of course.
Otherwise, after overusing a filter, at best it won’t be working, and at worst it’ll be adding in bacteria that have multiplied in the filter over however long you left it there.
You may be wondering: can water filters remove microplastics, and can they remove minerals?
The answer in both cases is: sometimes.
- For microplastics it depends on the filter size and the microplastic size (see our previous article for details on that).
- For minerals, it depends on the filter type. Check out:
The H2O Chronicles | 5 Water Filters That Remove Minerals
One other thing to think about: while most water filtration jugs are made of PFAS-free BPA-free plastics for obvious reasons, for greater peace of mind, you might consider investing in a glass filtration jug, like this one ← this is just one example product on Amazon; by all means shop around and find one you like
Take care!
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Our blood-brain barrier stops bugs and toxins getting to our brain. Here’s how it works
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Our brain is an extremely complex and delicate organ. Our body fiercely protects it by holding onto things that help it and keeping harmful things out, such as bugs that can cause infection and toxins.
It does that though a protective layer called the blood-brain barrier. Here’s how it works, and what it means for drug design.
The Conversation, Rattiya Thongdumhyu/Shutterstock, Petr Ganaj/Pexels First, let’s look at the circulatory system
Adults have roughly 30 trillion cells in their body. Every cell needs a variety of nutrients and oxygen, and they produce waste, which needs to be taken away.
Our circulatory system provides this service, delivering nutrients and removing waste.
Fenestrated capillaries let nutrients and waste pass through. Vectormine/Shutterstock Where the circulatory system meets your cells, it branches down to tiny tubes called capillaries. These tiny tubes, about one-tenth the width of a human hair, are also made of cells.
But in most capillaries, there are some special features (known as fenestrations) that allow relatively free exchange of nutrients and waste between the blood and the cells of your tissues.
It’s kind of like pizza delivery
One way to think about the way the circulation works is like a pizza delivery person in a big city. On the really big roads (vessels) there are walls and you can’t walk up to the door of the house and pass someone the pizza.
But once you get down to the little suburban streets (capillaries), the design of the streets means you can stop, get off your scooter and walk up to the door to deliver the pizza (nutrients).
We often think of the brain as a spongy mass without much blood in it. In reality, the average brain has about 600 kilometres of blood vessels.
The difference between the capillaries in most of the brain and those elsewhere is that these capillaries are made of specialised cells that are very tightly joined together and limit the free exchange of anything dissolved in your blood. These are sometimes called continuous capillaries.
Continuous capillaries limit the free exchange of anything dissolved in your blood. Vectormine/Shutterstock This is the blood brain barrier. It’s not so much a bag around your brain stopping things from getting in and out but more like walls on all the streets, even the very small ones.
The only way pizza can get in is through special slots and these are just the right shape for the pizza box.
The blood brain barrier is set up so there are specialised transporters (like pizza box slots) for all the required nutrients. So mostly, the only things that can get in are things that there are transporters for or things that look very similar (on a molecular scale).
The analogy does fall down a little bit because the pizza box slot applies to nutrients that dissolve in water. Things that are highly soluble in fat can often bypass the slots in the wall.
Why do we have a blood-brain barrier?
The blood brain barrier is thought to exist for a few reasons.
First, it protects the brain from toxins you might eat (think chemicals that plants make) and viruses that often can infect the rest of your body but usually don’t make it to your brain.
It also provides protection by tightly regulating the movement of nutrients and waste in and out, providing a more stable environment than in the rest of the body.
Lastly, it serves to regulate passage of immune cells, preventing unnecessary inflammation which could damage cells in the brain.
What it means for medicines
One consequence of this tight regulation across the blood brain barrier is that if you want a medicine that gets to the brain, you need to consider how it will get in.
There are a few approaches. Highly fat-soluble molecules can often pass into the brain, so you might design your drug so it is a bit greasy.
The blood-brain barrier stops many medicines getting into the brain. Ron Lach/Pexels Another option is to link your medicine to another molecule that is normally taken up into the brain so it can hitch a ride, or a “pro-drug”, which looks like a molecule that is normally transported.
Using it to our advantage
You can also take advantage of the blood brain barrier.
Opioids used for pain relief often cause constipation. They do this because their target (opioid receptors) are also present in the nervous system of the intestines, where they act to slow movement of the intestinal contents.
Imodium (Loperamide), which is used to treat diarrhoea, is actually an opioid, but it has been specifically designed so it can’t cross the blood brain barrier.
This design means it can act on opioid receptors in the gastrointestinal tract, slowing down the movement of contents, but does not act on brain opioid receptors.
In contrast to Imodium, Ozempic and Victoza (originally designed for type 2 diabetes, but now popular for weight-loss) both have a long fat attached, to improve the length of time they stay in the body.
A consequence of having this long fat attached is that they can cross the blood-brain barrier, where they act to suppress appetite. This is part of the reason they are so effective as weight-loss drugs.
So while the blood brain barrier is important for protecting the brain it presents both a challenge and an opportunity for development of new medicines.
Sebastian Furness, ARC Future Fellow, School of Biomedical Sciences, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Sweet Dreams Are Made of THC (Or Are They?)
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small 😎
❝I’m one of those older folks that have a hard time getting 7 hrs. I know a lot of it my fault…like a few beers at nite…🥰am now trying THC gummies for anxiety, instead of alcohol……less calories 😁how does THC affect our sleep,? Safer than alcohol…..I know your next article 😊😊😊😊❣️😊alot of us older kids do take gummies 😲😲😲thank you❞
Great question! We wrote a little about CBD gummies (not THC) before:
…and went on to explore THC’s health benefits and risks here:
For starters, let’s go ahead and say: you’re right that it’s safer (for most people) than alcohol—but that’s not a strong claim, because alcohol is very bad for pretty much everything, including sleep.
So how does THC measure up when it comes to sleep quality?
Good news: it affects the architecture of sleep in such a way that you will spend longer in deep sleep (delta wave activity), which means you get more restorative and restful sleep!
See also: Alpha, beta, theta: what are brain states and brain waves? And can we control them?
Bad news: it does so at the cost of reducing your REM sleep, which is also necessary for good brain health, and will cause cognitive impairment if you skip too much. Normally, if you are sleep-deprived, the brain will prioritize REM sleep at the cost of other kinds of sleep; it’s that important. However, if you are chemically impaired from getting healthy REM sleep, there’s not much your brain can do to save you from the effects of REM sleep loss.
See: Cannabis, Cannabinoids, and Sleep: a Review of the Literature
This is, by the way, a reason that THC gets prescribed for some sleep disorders, in cases where the initial sleep disruption was because of nightmares, as it will reduce those (along with any other dreams, as collateral damage):
One thing to be careful of if using THC as a sleep aid is that withdrawal may make your symptoms worse than they were to start with:
Updates in the use of cannabis for insomnia
With all that in mind, you might consider (if you haven’t already tried it) seeing whether CBD alone improves your sleep, as while it does also extend time in deep sleep, it doesn’t reduce REM nearly as much as THC does:
👆 this study was paid for by the brand being tested, so do be aware of potential publication bias. That’s not to say the study is necessarily corrupt, and indeed it probably wasn’t, but rather, the publication of the results was dependent on the company paying for them (so hypothetically they could have pulled funding from any number of other research groups that didn’t get the results they wanted, leaving this one to be the only one published). That being said, the study is interesting, which is why we’ve linked it, and it’s a good jumping-off-point for finding a lot of related papers, which you can see listed beneath it.
CBD also has other benefits of its own, even without THC:
CBD Oil: What Does The Science Say?
Take care!
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