updated 11/12/2008 6:45:44 PM ET 2008-11-12T23:45:44

Alzheimer's battered Graeme Wylie so much that he could no longer recall his own birthday or remember that he had children. But, his partner said, Wylie did know this: Life was no longer worth living.

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So, Shirley Justins obliged her sweetheart of 20 years, handing him a lethal dose of drugs. What she called an act of love, an Australian judge labeled manslaughter and sentenced the 60-year-old Justins to spend several days a week in jail for nearly two years.

Supreme Court of New South Wales Justice Roderick Howie insisted the case was not about euthanasia's morality. Instead, he wrote in his decision Wednesday, it centered on whether the 71-year-old Wylie had the mental capacity to decide that he wanted to die.

Assisted suicide is illegal in Australia, as it is in most of the world. Some places, like Oregon and Washington in the United States, allow physician-assisted suicide. The Netherlands decriminalized doctor-assisted suicide in 1993.

Wylie's case, however, prompted debate about a delicate dilemma in an already morally complicated question: At what point does a person advancing through Alzheimer's — a degenerative, terminal disease that is the most common cause of dementia — lose their ability to decide to die?

"They wouldn't be able to make it for themselves; somebody would make it for them," said Dr. Rosanna Capolingua, president of the doctors' professional group the Australian Medical Association. "And would we be able to do that?"

Capolingua said a person suffering advanced Alzheimer's could not be trusted to make the choice attributed to Wylie, raising the question of influence by outsiders.

‘She did deceive our family’
In Wylie's case, his daughter said, she was kept out of the critical decision.

"She did deceive our family, she did deceive Dad," Wylie's daughter, Tania Shakespeare, said after the sentencing. "I'm heartbroken that I wasn't able to say goodbye to my father."

Alzheimer's patients are particularly vulnerable as their cognition level can vary daily, said Roy Jones, director of the Research Institute for the Care of Older People, a nonprofit group in the United Kingdom.

"I think the problem is that as the course of Alzheimer's progresses, the person's ability to make decisions for themselves becomes more and more difficult and ultimately impossible," Jones said. "I don't think there's an easy answer."

Wylie, a former commercial airline pilot and the father of two daughters, was diagnosed with Alzheimer's in March 2003. Over the next two years, according to the judge's sentencing report, his mental faculties declined; he stopped reading newspapers and had difficulty making conversation.

By 2005, tests showed he had "severe cognitive impairment." That September, he tried to cut his wrists, but survived.

Alzheimer's diseaseThat month, he told Justins he wanted to enlist the help of Dignitas, a Swiss organization that helps incurably ill people end their lives. It is legal in Switzerland for foreigners to travel to the country to commit assisted suicide, and dozens do so each year.

Dr. Philip Nitschke, a pro-euthanasia campaigner nicknamed "Dr. Death" by the Australian media, assessed Wylie and found that although he couldn't remember his date of birth, or whether he had children, he still had the presence of mind to decide his own fate.

But Dignitas rejected Wylie's application, saying it was unclear whether he had the cognitive ability to decide to die.

Wylie later tried to poison himself on lawnmower fumes, but again, survived. In March 2006, Justins handed him a lethal dose of a barbiturate and watched him drink it. She said he died within seconds.

"I believe that generally the offender was caring and supportive of the deceased and compliant to his wishes," Justice Howie wrote. "There is little doubt that he was genuine in seeking death through the Dignitas application."

Nevertheless, the judge found, shortly after the Dignitas application was rejected, Wylie's mental state had deteriorated to the point where he could no longer make a decision about ending his life. Justins, he argued, should have realized the situation had changed.

Nitschke, who followed the case closely and met Wylie several times, said there was no doubt about Wylie's wishes.

"He got what he wanted — a peaceful death," Nitschke told The Associated Press. "You can have significant dementia, but still know in an overwhelming way that your one desire is (for) a peaceful death."

Copyright 2008 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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