Dutch High Court Allows Euthanasia for Some Dementia Patients

Patients suffering from advanced degenerative diseases must request euthanasia in writing prior to becoming legally incompetent.

An exterior view of the Supreme Court in The Hague, Netherlands. (AP Photo/Mike Corder)

THE HAGUE, Netherlands (CN) — The Netherlands Supreme Court on Tuesday upheld a landmark euthanasia ruling in the case of a doctor charged with murder for performing euthanasia on a patient with severe dementia. 

It was the first time a doctor had been criminally charged since the passage of the Termination of Life on Demand Review Act, which legalized euthanasia in the Netherlands in 2002.

Willem van Schendel, vice president of the Supreme Court, read the verdict out loud before a mostly empty courtroom in The Hague. The Dutch courts are only opened for a limited number of cases in an effort to prevent the spread of Covid-19. 

“A physician may respond to a written request for euthanasia for people with advanced dementia. In such a situation, all requirements set by the law with regard to euthanasia must be met, including the requirement that there is hopeless and unbearable suffering,” van Schendel said. 

A 74-year-old woman, who was not identified by the court, had signed an advanced directive following her diagnosis with Alzheimer’s disease in 2012 that if she was admitted to a nursing home with dementia, she wished to be euthanized.

However, after she was admitted to a nursing home, she gave conflicting statements as to whether she wanted the assisted suicide. According to nursing home staff, the woman sometimes said that she wished to die, but other times said she was not ready. In consultation with two other doctors and the woman’s family, she died by euthanasia in 2016.

Her 68-year-old doctor, identified only as Catharina A., was found not guilty of murder in September. The charges were based on a review, mandatory in all euthanasia cases, that found euthanasia should not have been performed as the patient’s statements were unclear. 

“Euthanasia in the case of disability remains a complex process that requires extreme caution. But with today’s ruling, doctors in the Netherlands can be less afraid,” said Steven Pleiter, director of the Euthanasia Expertise Center.

The case has had a chilling effect on euthanasia in the Netherlands, with an increasing number of doctors refusing to perform the procedure.

The public prosecutor did not appeal The Hague district court’s verdict but the attorney general brought the case before the Supreme Court in order to have the highest court in the country rule on the matter. 

In Tuesday’s ruling, the Supreme Court laid out the main principles for providing euthanasia to patients who are suffering from advanced degenerative diseases.

Before becoming legally incompetent, the patient must have issued a written directive stating that they wanted to be euthanized. Doctors must also take into consideration statements made by the patients during the advanced stages of their disease, but a lack of clarity in what a patient says, as was the situation with the woman in the case before the court, doesn’t mean a physician must refuse to perform euthanasia. 

Further, the court wrote that “criminal prosecution is not always the most appropriate response to a possible case of careless medical conduct,” an apparent criticism of the public prosecutor for bringing the case in the first place. 

Beyond upholding the lower court’s ruling that there was no crime, the Supreme Court overruled a decision by the Central Disciplinary Board for Healthcare that the doctor had not followed the proper euthanasia procedure. The disciplinary board had issued a formal warning to the doctor, who has since retired.  

While euthanasia is legal in the Netherlands, there are strict conditions. Patients who wish to undergo euthanasia must first meet with their doctor, who will evaluate them. They must be experiencing “unbearable suffering with no prospect of improvement.” A second doctor must confirm that the patient is voluntarily undertaking the procedure and is eligible.

The patient’s death, which can either be the result of the doctor administering a fatal drug or providing the drug to the patient to administer themselves, is then evaluated by a review committee, composed of a medical doctor, an ethicist and a legal expert.

“With a careful method, in accordance with the law, it is clear that you can treat deeply demented people on the basis of a living will,” Pleiter said.

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