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Dementia patients can still be euthanized, even if they change their minds, Dutch court rules


Sfam_photo | Shutterstock

John Burger - published on 04/25/20

Netherlands Supreme Court clarifies euthanasia law in case that involved Alzheimer's nursing home resident.

One should always be careful about what one is signing, but in the Netherlands, especially so, when it comes to life and death.

If a Dutch resident has written that he would like to have physician-assisted suicide or euthanasia, that desire will likely be carried out, even if the patient has since entered into a state of dementia and has changed his mind.

The Netherlands’ Supreme Court ruled this week that, “A physician may carry out a written request beforehand for euthanasia in people with advanced dementia.”

But the killing would have to be done under the Netherlands’ already established rules, including the stipulation that the patient must have “unbearable and endless suffering” and that at least two doctors must have agreed to carry out the procedure. The patient must have requested euthanasia before he could no longer express his will as a result of advanced dementia.

Previously, patients would need to confirm their request before a doctor carried out the death sentence.

The case decided on Tuesday involved a nursing home doctor who has since been acquitted for carrying out a euthanasia on a resident of the home in 2016. The 74-year-old woman had been diagnosed with Alzheimer’s four years earlier, and wrote a statement that she wanted to be euthanized before entering a nursing home. She added that she wanted to decide “while still in my senses and when I think the time is right.”

Prosecutors argued that the doctor did not do enough to confirm the woman’s consent, saying that once she was admitted to the home, she gave “mixed signals,” CNN reported.

In fact, during the euthanasia, she had to be restrained by family members.

Though the doctor was cleared of any wrongdoing in 2019, the case was referred to the Supreme Court in an effort to establish legal precedent.

“A doctor may respond to a written request for granting euthanasia to people with advanced dementia. In such a situation, all legal requirements for euthanasia must be met, including the requirement that there is hopeless and unbearable suffering. The doctor is then not punishable,” the Hague-based court said Tuesday, according to CNN:

The ruling also noted that doctors can legally follow through with the procedure if the patient can no longer agree to it, due to their illness. “Even if it is clear that the request is intended for the situation of advanced dementia, and that situation is reached so that the patient is no longer is able to form and express a will, there can be circumstances where no follow-up on the request is possible,” it said. René Héman, president of the Royal Dutch Medical Association welcomed the ruling, but warned that the situation remained complicated for doctors. “It is good that there is now a ruling from the Supreme Court. But even with more legal clarity, not all complicated dilemmas around euthanasia in the case of dementia are gone. With every request to end a life, a doctor must still make an individual assessment if euthanasia is appropriate and if all due care criteria are met,” Héman said in a statement. “Doctors act according to professional standards and also on their moral compass. The doctor’s own consideration is and remains very important,” he added.

But Cardinal Willem Jacobus Eijk of Utrecht said that the ruling creates confusion and raises questions about consent, especially for the most vulnerable at the end of life, according to Catholic News Agency.

Cardinal Eijk questioned whether a statement signed four years earlier by a patient would still express the actual will of the patient.

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