The threshold for euthanasia in the Netherlands is already low. And a Dutch court just lowered it even further.
On 10 September, a panel of three judges found a doctor “not guilty” of breaking the law in the way she administered a lethal injection to one of her patients. The trial represented the first time a doctor was prosecuted since the Netherlands legalized euthanasia in 2002. The case centered on the question of whether a patient who is mentally incompetent can receive a lethal injection.
Under Dutch law, a person can write a legal declaration requesting euthanasia should they develop advanced dementia in the future. If a doctor determines a patient with such a legal declaration has “unbearable suffering,” they can proceed to euthanize them – even though the patient is unable to orally confirm that they still wish to die.
The patient at the center of the case was a woman with Alzheimer’s. Her condition had become so advanced that she no longer recognized her own face in the mirror. When she was still mentally competent, she had written up a legal declaration. She had also had several conversations with her GP about euthanasia over a period of several years. However, she kept saying she was not yet ready to die.
Once her condition became advanced, she had to be removed to a care home. The doctor who ultimately gave her the lethal injection worked in the care home. The woman’s husband raised the issue of euthanasia with the doctor when the woman was admitted. The doctor then spent seven weeks consulting with second opinions to determine if the woman met the criteria of “unbearable suffering” before ending her life on 22 April 2016.
The doctor began by secretly administering a sedative to the woman via her coffee to put her to sleep. However, the woman awakened when the lethal drugs were added to her IV and began to struggle. She was restrained by her husband and daughter so the doctor could finish.
The Dutch committee that oversees euthanasia found the doctor “negligent” in the way she handled the case. The Netherlands’ Board of Medical Examiners also issued her a reprimand.
However, the court acquitted her of breaking Dutch euthanasia law and thus set an important precedent. Legal declarations can be used to administer euthanasia to patients who are not able to give consent and are perhaps totally unaware of what is being done to them.
Euthanasia for patients with advanced dementia is still extremely rare in the Netherlands. There were only 15 reported instances of this since legalization in 2002 (out of a total of 62,000). However, the numbers are likely to increase in the years that come. One poll found that over 10% of Dutch adults have a legal declaration requesting euthanasia in the event of advanced dementia. Given the amount of media coverage the recent trial and verdict attracted, more people may decide to write them.
Up to now, the status of these legal declarations had been ambiguous. Even some euthanasia supporters are opposed to them because it is not possible to determine if the patient still wishes to end their life. Last year, ethicist Berna van Baarsen resigned from her position on the Dutch committee that oversees the practice of euthanasia because she does not believe advanced dementia patients should be eligible. “That’s my boundary, based on ten years of reflection and reading dossiers,” she said.
However, on 10 September, the Dutch court sent a clear message that legal declarations can be used as a substitute for oral consent to put a mentally incompetent person to death.
A study showed that 92% of the Dutch population accepts euthanasia. However, many are uncomfortable with the way the threshold for eligibility continues to be lowered. Perhaps the verdict will lead more people to stop and ask, “Where does this end?”