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.

We live in a society that glorifies dieting, with around 42% of adults globally having tried to lose weight. Messages about dieting and weight loss are amplified on social media, with a never-ending cycle of weight loss fads and diet trends.

Amid often conflicting messages and misinformation, if you’re looking for diet advice online, it’s easy to become confused and overwhelmed.

So before diving into the latest weight loss trend or extreme diet, consider these four questions to help you make a more informed decision.

1. Is the diet realistic?

Have you considered the financial cost of maintaining the diet or lifestyle, and the time and resources that would be required? For example, do you need to purchase specific products, supplements, or follow a rigid meal plan?

If the diet is coming from someone who is trying to sell you something – such as a particular weight-loss product you need in order to follow the diet – this could be a particular red flag.

Many extreme diet recommendations come from a place of privilege and overlook food access, affordability, cooking skills, where you live, or even your culture and ethics.

If the diet has these sorts of issues it can lead to frustration, stress, stigmatisation and feelings of failure for the person trying to adhere to the diet. But the problem may be with the diet itself – not with you.

2. Is there evidence to support this diet?

Self-proclaimed “experts” online will often make claims focused on specific groups, known as target populations. This might be 30- to 50-year-old men with diabetes, for example.

In some cases, evidence for claims made may come from animal studies, which might not be applicable to humans at all.

So be aware that if research findings are for a group that doesn’t match your profile, then the results might not be relevant to you.

It takes time and a lot of high-quality studies to tell us a “diet” is safe and effective, not just one study. Ask yourself, is it supported by multiple studies in humans? Be critical and question the claims before you accept them.

For accurate information look for government websites, or ask your GP or dietitian.

3. How will this diet affect my life?

Food is much more than calories and nutrients. It plays many roles in our lives, and likewise diets can influence our lives in ways we often overlook.

Socially and culturally, food can be a point of connection and celebration. It can be a source of enjoyment, a source of comfort, or even a way to explore new parts of the world.

So when you’re considering a new diet, think about how it might affect meaningful moments for you. For example, if you’re going travelling, will your diet influence the food choices you make? Will you feel that you can’t sample the local cuisine? Or would you be deterred from going out for dinner with friends because of their choice of restaurant?

4. Will this diet make me feel guilty or affect my mental health?

What is your favourite meal? Does this diet “allow” you to eat it? Imagine visiting your mum who has prepared your favourite childhood meal. How will the diet affect your feelings about these special foods? Will it cause you to feel stressed or guilty about enjoying a birthday cake or a meal cooked by a loved one?

Studies have shown that dieting can negatively impact our mental health, and skipping meals can increase symptoms of depression and anxiety.

Many diets fail to consider the psychological aspects of eating, even though our mental health is just as important as physical health. Eating should not make you feel stressed, anxious, or guilty.

So before starting another diet, consider how it might affect your mental health.

Moving away from a dieting mindset

We’re frequently told that weight loss is the path to better health. Whereas, we can prioritise our health without focusing on our weight. Constant messages about the need to lose weight can also be harmful to mental health, and not necessarily helpful for physical health.

Our research has found eating in a way that prioritises health over weight loss is linked to a range of positive outcomes for our health and wellbeing. These include a more positive relationship with food, and less guilt and stress.

Our research also indicates mindful and intuitive eating practices – which focus on internal cues, body trust, and being present and mindful when eating – are related to lower levels of depression and stress, and greater body image and self-compassion.

But like anything, it takes practice and time to build a positive relationship with food. Be kind to yourself, seek out weight-inclusive health-care professionals, and the changes will come. Finally, remember you’re allowed to find joy in food.

Melissa Eaton, Accredited Practising Dietitian; PhD Candidate, University of Wollongong; Verena Vaiciurgis, Accredited Practising Dietitian; PhD Candidate, University of Wollongong, and Yasmine Probst, Associate Professor, School of Medical, Indigenous and Health Sciences, University of Wollongong

This article is republished from The Conversation under a Creative Commons license. Read the original article.