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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Small Pleasures – by Ryan Riley
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When Hippocrates said “let food be thy medicine, and let medicine be thy food”, he may or may not have had this book in mind.
In terms of healthiness, this one’s not the very most nutritionist-approved recipe book we’ve ever reviewed. It’s not bad, to be clear!
But the physical health aspect is secondary to the mental health aspects, in this one, as you’ll see. And as we say, “mental health is also just health”.
The book is divided into three sections:
- Comfort—for when you feel at your worst, for when eating is a chore, for when something familiar and reassuring will bring you solace. Here we find flavor and simplicity; pastas, eggs, stews, potato dishes, and the like.
- Restoration—for when your energy needs reawakening. Here we find flavors fresh and tangy, enlivening and bright. Things to make you feel alive.
- Pleasure—while there’s little in the way of health-food here, the author describes the dishes in this section as “a love letter to yourself; they tell you that you’re special as you ready yourself to return to the world”.
And sometimes, just sometimes, we probably all need a little of that.
Bottom line: if you’d like to bring a little more joie de vivre to your cuisine, this book can do that.
Click here to check out Small Pleasures, and rekindle joy in your kitchen!
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Turkish Saffron Salad
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Summer is upon us, and we need salad options. Coleslaw’s all well and good, until you’re the 4th person to bring it to the pot luck. Tzatziki’s great—and healthier than a standard coleslaw, being based in yogurt rather than mayonnaise as most Western coleslaws are (Eastern European coleslaws, for example, more often use a vinaigrette), but today our tastebuds are traveling to Turkey for this gut-healthy, phytochemical-rich, delicious dish.
You will need
- 12 oz carrots, cut into very thin batons (alternatively: use a peeler to peel it into super-thin strips)
- 2 oz chopped nuts (pistachios are traditional, almonds are also used sometimes; many other nuts would work too e.g. walnuts, hazelnuts, etc; not peanuts though)
- 2 cups kefir yogurt (if unavailable, substitute any 2 cups plain unsweetened yogurt; comparable plant yogurt is fine if you’re vegan; those healthy bacteria love plant yogurts as much as animal ones)
- 1 bulb garlic, grated
- 1 tsp chili flakes
- 1 pinch saffron, ground, then soaked in 1 tbsp warm water for a few hours
- 2 tbsp olive oil for cooking; ideally Extra Virgin, but at least Virgin
Method
(we suggest you read everything at least once before doing anything)
1) Put the olive oil and carrots into a saucepan and heat gently, stirring. You want to soften the carrots just a little and absorb the olive oil, without actually fully cooking the carrots; this will probably only take 2–3 minutes at most. Take it off the heat and transfer it to a bowl to cool.
When the mixture has cooled…
2) Add the kefir yogurt, garlic, chili flakes, and saffron water into the carrots, mixing thoroughly.
3) Add the chopped nuts as a garnish
(after mixing thoroughly, you will probably see more of the yogurt mixture and less of the carrots; that’s fine and correct))
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Making Friends With Your Gut (You Can Thank Us Later)
- The Many Health Benefits Of Garlic
- Capsaicin For Weight Loss And Against Inflammation
- Why You Should Diversify Your Nuts!
- Saffron For The Brain (& More) ← do not underestimate saffron’s neuroprotective qualities, and many other beneficial properties!
Take care!
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The Best 4 Pool Exercises to Strengthen Your Core & Tone Up
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A lot of people don’t love working on their core strength, but exercising in the pool can make it a lot more enjoyable, as well as minimizing risk of injury.
Dr Alyssa Kuhn, arthritis specialist, also advises “being in the water also helps to control for balance and can offload the joints so they aren’t as painful”:
The gentlest exercise
The specific exercises she recommends are:
Wood Chops
Stagger your feet, clasp your hands, and submerge them in the water. Now, move your hands diagonally from one side to the other. This engages your core and balance using water resistance. Perform 10–20 reps per side, exhaling on the hardest part.
Front Kick with Opposite Arm Press
Kick one leg forward while pushing the opposite arm out or overhead—higher kicks increase difficulty by requiring more balance. If balance isn’t sufficient for you yet, hold onto the pool wall if needed. Either way, engage the core to lift the leg. Do 20–30 reps alternating sides.
Wall Push-Ups
Place your hands on the pool wall, shoulder-width apart. Keep feet together and hips slightly tucked for core engagement. Next, move your chest toward the wall and push back while maintaining a straight body—avoid arching your back. Do 10–20 reps.
Arm Circles
Stand with your feet wider than shoulder-width. Clasp your hands, extend your arms, and submerge them in the water. Make large circular motions for resistance training. This can be done with straight or bent arms for different difficulty levels. Do 10–20 circles in each direction.
For more on each of these plus visual demonstrations, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Osteoporosis & Exercises: Which To Do (And Which To Avoid)
Take care!
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There are ‘forever chemicals’ in our drinking water. Should standards change to protect our health?
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Today’s news coverage reports potentially unsafe levels of “forever chemicals” detected in drinking water supplies around Australia. These include human-made chemicals: perfluorooctane sulfonate (known as PFOS) and perflurooctanic acid (PFOA). They are classed under the broader category of per- and polyfluoroalkyl substances or PFAS chemicals.
The contaminants found in our drinking water are the same ones United States authorities warn can cause cancer over a long period of time, with reports warning there is “no safe level of exposure”.
In April, the US Environmental Protection Agency (USEPA) sent shock waves through the water industry around the world when it announced stricter advice on safe levels of PFOS/PFOA in drinking water. This reduced limits considered safe in supplies to zero and gave the water industry five years to meet legally enforceable limits of 4 parts per trillion.
So, should the same limits be enforced here in Australia? And how worried should we be that the drinking in many parts of Australia would fail the new US standards?
What are the health risks?
Medical knowledge about the human health effects of PFOS/PFOA is still emerging. An important factor is the bioaccumulation of these chemicals in different organs in the body over time.
Increased exposure of people to these chemicals has been associated with several adverse health effects. These include higher cholesterol, lower birth weights, modified immune responses, kidney and testicular cancer.
It has been very difficult to accurately track and measure effects of different levels of PFAS exposure on people. People may be exposed to PFAS chemicals in their everyday life through waterproofing of clothes, non-stick cookware coatings or through food and drinking water. PFAS can also be in pesticides, paints and cosmetics.
The International Agency for Research on Cancer (on behalf of the World Health Organization) regards PFOA as being carcinogenic to humans and PFOS as possibly carcinogenic to humans.
Is our drinking water safe? What about long-term risks? Volodymyr TVERDOKHLIB/Shutterstock Our guidelines
Australian drinking water supplies are assessed against national water quality standards. These Australian Drinking Water Guidelines are continuously reviewed by industry and health experts that scan the international literature and update them accordingly.
All city and town water supplies across Australia are subject to a wide range of physical and chemical water tests. The results are compared to Australian water guidelines.
Some tests relate to human health considerations, such as levels of lead or bacteria. Others relate to “aesthetic” considerations, such as the appearance or taste of water. Most water authorities across Australia make water quality information and compliance with Australian guidelines freely available.
What about Australian PFOS and PFOA standards?
These chemicals can enter our drinking water system from many potential sources, such as via their use in fire-fighting foams or pesticides.
According to the Australian Drinking Water Guidelines, PFOS should not exceed 0.07 micrograms per litre in drinking water. And PFOA should not exceed 0.56 micrograms per litre. One microgram is equivalent to one part per billion.
The concentration of these chemicals in water is incredibly small. And much of the advice on their concentration is provided in different units. Sometimes in micrograms or nannograms. The USEPA uses parts per trillion.
In parts per trillion (ppt) the Australian Guidelines for PFOS is 70 ppt and PFOA is 560 ppt. The USEPA’s new maximum contaminant levels (enforceable levels) are 4 ppt for both PFOS and also PFOA. Previous news reports have pointed out Australian guidelines for these chemicals in drinking water are up to 140 times higher than the USEPA permits.
Yikes! That seems like a lot
Today’s news report cites PFOS and PFOA water tests done at many different water supplies across Australia. Some water samples did not detect either chemicals. But most did, with the highest PFOS concentration 15.1–15.6 parts per trillion from Glenunga, South Australia. The highest PFOA concentration was reported from a small water supply in western Sydney, where it was detected at 5.17–9.66 parts per trillion.
Australia and the US are not alone. This is an enormous global problem.
One of the obvious challenges for the Australian water industry is that current water treatment processes may not be effective at removing PFOS or PFOA. The Australian Drinking Water Guidelines provide this advice:
Standard water treatment technologies including coagulation followed by physical separation, aeration, chemical oxidation, UV irradiation, and disinfection have little or no effect on PFOS or PFOA concentrations.
Filtering with activated carbon and reverse osmosis may remove many PFAS chemicals. But no treatment systems appear to be completely effective at their removal.
Removing these contaminants might be particularly difficult for small regional water supplies already struggling to maintain their water infrastructure. The NSW Auditor General criticised the planning for, and funding of, town water infrastructure in regional NSW back in 2020.
Where to from here?
The Australian water industry likely has little choice but to follow the US lead and address PFOS/PFAS contamination in drinking water. Along with lower thresholds, the US committed US$1 billion to water infrastructure to improve detection and water treatment. They will also now require:
Public water systems must monitor for these PFAS and have three years to complete initial monitoring (by 2027) […]
As today’s report notes, it is very difficult to find any recent data on PFOS and PFOA in Australian drinking water supplies. Australian regulators should also require ongoing and widespread monitoring of our major city and regional water supplies for these “forever chemicals”.
The bottom line for drinking tap water is to keep watching this space. Buying bottled water might not be effective (2021 US research detected PFAS in 39 out of 100 bottled waters). The USEPA suggests people can reduce PFAS exposure with measures including avoiding fish from contaminated waters and considering home filtration systems.
Correction: this article previously listed the maximum Australian Drinking Water Guidelines PFOA level as 0.056 micrograms per litre. The figure has been updated to show the correct level of 0.56 micrograms per litre.
Ian A. Wright, Associate Professor in Environmental Science, Western Sydney University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Minimize Aging’s Metabolic Slump
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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 know that metabolism slows with age, are there any waypoints or things to look out for? I don’t know whether I should be eating less, or doing less, or taking some other approach entirely. What’s recommended?❞
Age and sex count for a lot with this one! As metabolism is in large part directed by hormones:
- For men, declining testosterone (often from around 45 onwards) can result in a metabolic slump
- For women, declining estrogen with the menopause does have an effect, but progesterone is the bigger factor for metabolism in the sense you are talking about.
In both cases, simply taking more of those hormones can often help, but please of course speak with an endocrinologist if that seems like a possible option for you, as your circumstances (and physiology) may vary.
If you’d like to go to that conversation well-armed with information, here are some good starting points, by the way:
- The Testosterone Drop, & Topping Up Testosterone
- Menopausal HRT: Bioidentical vs Animal (It Makes A Difference!)
And if you’re wondering about the natural vs pharmaceutical approaches…
- What Does “Balance Your Hormones” Even Mean?
- What You Should Have Been Told About The Menopause Beforehand
About your metabolic base rate
We tend to think of “fast metabolism good, slow metabolism bad”, and that’s a reasonable general premise… but it’s not necessarily always so.
After all, if you could double your metabolism and keep it there all the time, without changing anything else, well… You’ve heard the phrase “burning the candle at both ends”? So, having at least some downtime is important too.
See for example: Sleep Deprivation & Diabetes Risk
What’s critical, when it comes to base metabolic rate, is that your body must be capable of adequately processing what you are putting into it. Because if your body can’t keep up with the input, it’ll just start storing the excess chemical energy in the quickest and easiest way possible.
…which is a fast track to metabolic disorder in general and type 2 diabetes in particular. For more on the science and mechanics of this, see:
How To Prevent And Reverse Type 2 Diabetes
As for portion sizes…
Your body knows what you need, so listen to it. There is no external source of knowledge that can tell you how much food you need better than your own body itself can tell you.
You may be wondering “how exactly do I listen to my body, though?”, in which case, check out:
The Kitchen Doctor: Interoception & Mindful Eating
As for exercise…
When you exercise, your metabolic rate temporarily increases. After most kinds of exercise, your metabolism slumps again afterwards to compensate.
There are two ways to avoid this:
- Exercise Less, Move More ← it’s about maximizing time spent not sitting still
- High Intensity Interval Training ← a special kind of exercise, the only one known to keep the metabolism running high for a couple of hours afterwards, with no counter-slump
…which makes it pretty effective indeed
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How Not to Age – by Dr. Michael Greger
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First things first: it’s a great book, and it’s this reviewer’s favorite of Dr. Greger’s so far (for posterity: it’s just been published and this reviewer has just finished reading the copy she got on pre-order)
Unlike many popular physician authors, Dr. Greger doesn’t rehash a lot of old material, and instead favours prioritizing new material in each work. Where appropriate, he’ll send the reader to other books for more specific information (e.g: you want to know how to avoid premature death? Go read How Not To Die. You want to know how to lose weight? How Not To Diet. Etc).
In the category of new information, he has a lot to offer here. And with over 8,000 references, it’s information, not conjecture. On which note, we recommend the e-book version if that’s possible for you, for three reasons:
- It’s possible to just click the references and be taken straight to the cited paper itself online
- To try to keep the book’s size down, Dr. Greger has linked to other external resources too
- The only negative reviews on Amazon, so far, are people complaining that the print copy’s text is smaller than they’d like
For all its information-density (those 8,000+ references are packed into 600ish pages), the book is very readable even to a lay reader; the author is a very skilled writer.
As for the content, we can’t fit more than a few sentences here so forgive the brevity, but we’ll mention that he covers:
- Slowing 11 pathways of aging
- The optimal anti-aging regimen according to current best science
- Preserving function (specific individual aspects of aging, e.g. hearing, sight, cognitive function, sexual function, hair, bones, etc)
- “Dr. Greger’s Anti-Aging Eight”
In terms of “flavor” of anti-aging science, his approach can be summed up as: diet and lifestyle as foundation; specific supplements and interventions as cornerstones.
Bottom line: this is now the anti-aging book.
Click here to check out How Not To Age, and look after yourself with the best modern science!
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