On April 21, the Netherlands Supreme Court approved euthanasia for incompetent people with dementia who had made a previous request for euthanasia while legally competent.
The case concerned the euthanasia death of a 74-year-old woman with dementia. She had stated in her power of attorney document that she wanted euthanasia, but when the doctor came to inject her, she resisted. The doctor attempted to sedate the woman by putting the drugs in her coffee but she continued to resist. The doctor had the family hold her down while he lethally injected her.
In January 2017, a Netherlands Regional Euthanasia Review Committee decided that the doctor had contravened the rule of law but that she had done it in “good faith.” However, according to Reuters, “[P]rosecutors asked for a Supreme Court ruling in order to have a legal precedent because the law was still unclear on the issue, they said.”
The Dutch Supreme Court, Reuters continued.
ruled that doctors could legally carry out euthanasia on people with advanced dementia who had earlier put their wishes in writing even if they could no longer confirm them because of their illness.
The ruling is a landmark in Dutch euthanasia legislation which up to now had required patients to confirm euthanasia requests. This had not been considered possible for mentally incapacitated patients like advanced dementia sufferers.
“A doctor can carry out an (earlier) written request for euthanasia from people with advanced dementia,”
Noteworthy, according to Reuters, the conditions for euthanasia “include that a patient is experiencing unbearable suffering with no hope of recovery, and wishes to die.”
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Professor Theo Boer, a former member of a Netherlands Regional Euthanasia Review Committee (2005 – 14), wrote about his concerns with the Supreme Court decision that were published by Trouw in the Netherlands (Google translated).
The Supreme Court recently ruled on coffee euthanasia. A 74-year-old patient with dementia had stated in a living will that she wanted euthanasia if she ended up in a nursing home. When that indeed happened and she became incapacitated, she gave varying signals: most of the time she didn’t want to live, but sometimes she was having a good time. Although the doctor had put something calming in her coffee, the woman resisted during the euthanasia. The Supreme Court ruled that the doctor had acted correctly by taking the patient’s advance directive as a compass.
Boer expresses his concern that the number of euthanasia deaths for people with advanced dementia will increase. He questions how these decisions will be made, based on the fact that these people are incompetent. He then expresses his concern for what he calls, “dubious euthanasia.” Boer writes:
This also increases the risk of dubious euthanasia. Because people with advanced dementia are by definition not competent … the practical request for euthanasia comes from the family. The doctor (nursing home doctor or doctor of the Expertise Center for Euthanasia) may be independent, but he will rely heavily on their judgment when weighing the agony of suffering. After all, the doctor usually did not know the patient before. That opens the door to framing. Despite good intentions, family value judgments (“I would never want to be demented,” “What kind of life is that?”) Take on a strong role. It cannot be excluded that financial and emotional considerations are a motivating force.
Boer then expresses that the Dutch Supreme Court decision proves that there is not a “border” to euthanasia even as other countries, when debating euthanasia, social distance themselves from the Dutch euthanasia program.
Boer concludes by pointing out that this decision will likely lead to new opportunities to expand euthanasia. Based on “legal equality and compassion,” why would euthanasia be limited to people with dementia who previously requested euthanasia when people who did not request euthanasia also suffer?
The only “bright line” is rejecting euthanasia. Once it is legal it is unfair or it lacks “compassion” to deny it to others, who are also “suffering.”