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Dutch make it easier to kill patients with advanced dementia

Like many countries around the world, the Netherlands has been imposing shutdowns to slow the spread of COVID-19, a virus that is particularly dangerous to the elderly. Thus, it is ironic that the Dutch have simultaneously issued new euthanasia guidelines making it much easier to kill the elderly.

Last year, Dutch doctor Marinou Arends was prosecuted for giving euthanasia to a 74-year-old woman in 2016. The patient’s Alzheimers had become so advanced that she no longer recognized her own face in the mirror. One of the aspects of the case that attracted the most criticism was the fact that Arends began by secretly adding a sedative to the woman’s coffee. Thus, the woman had no idea she was about to be put to death. However, she awakened when the lethal drugs were added to her IV and began to struggle. Her husband and daughter restrained her so Arends could finish. The Dutch media nicknamed the case “the coffee euthanization.” Arends was found “not guilty” of breaking the euthanasia law and we are now seeing the impact of that verdict.

The Dutch committee that oversees the practice of euthanasia has issued new guidelines for dementia patients in line with the verdict. And it is basically anything goes – the committee has given explicit permission to doctors to secretly administer sedatives ahead of a lethal injection if they believe the patient may become restless or aggressive.

A person can write a legal declaration requesting euthanasia should they develop advanced dementia in the future. Under the old guidelines, even if a patient had a legal declaration, a doctor had to get a final verbal affirmation that the patient still wished to die. Arends had failed to obtain this from the patient she euthanized, and that is part of the reason why she was prosecuted. The committee’s new guidelines allow doctors to skip the verbal affirmation if a dementia patient is no longer able to give it.

The new guidelines also give doctors more room to interpret a legal declaration. In the Arends case, the patient had written that she wanted to die “when I am still somewhat mentally competent and I decide the time is right.” Arends had not honored this part of the legal declaration because the patient was no longer mentally competent when she was put to death. Because Arends was acquitted, doctors will now be permitted to ignore these types of stipulations.

Under Dutch law, even if a patient has a legal declaration requesting euthanasia, a doctor must determine the patient is “suffering unbearably with no prospect of improvement” before administering a lethal injection. In its new guidelines, the oversight committee indicates it will never question any doctor’s determination that a dementia patient is suffering unbearably.

Jacob Kohnstamm, chairman of the committees that oversee euthanasia, explained the new standard in an interview with Dutch media:

“The doctor does not have to worry about us as oversight committee and the court should stay at arm’s length on the question of unbearable suffering with no prospect of improvement. This is a medical-professional judgment by the doctor. The court and the oversight committee cannot stand in the place of the doctor. The question is: has this doctor acted reasonably in this situation?”

Up to now, euthanasia for dementia patients had been extremely rare in the Netherlands, and it was very controversial. Even some euthanasia supporters were opposed because advanced dementia patients are unable to give consent. In 2018, ethicist Berna van Baarsen resigned from her position on the oversight committee over this issue. “That’s my boundary, based on ten years of reflection and reading dossiers,” she said at the time.

The new guidelines brush aside those concerns. Euthanasia for advanced dementia is likely to become much more common now that it is much easier to obtain. Perhaps euthanasia supporters like van Baarsen will stop and ask, “Where does this end?”

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Euthanasia in the Netherlands: So bad even some supporters are now opposed

The Netherlands is a pioneer in the field of euthanasia. In 2002, it was the first country in the world to legalize physician-assisted suicide, and today it is becoming a case study in the slippery slope that quickly follows. The quick slide down has prompted even some prominent euthanasia supporters to ask, “Where does this end?” One such supporter is ethicist Berna van Baarsen. For the last ten years, she served on one of the euthanasia-oversight committees established by the 2002 law. The committees are supposed to review each reported instance of euthanasia to ensure the doctor followed all the legal requirements. As a member of one of these committees, van Baarsen obviously supports euthanasia. However, she resigned in January because she objects to the way euthanasia is now increasingly being administered to patients with advanced dementia. “That’s my boundary, based on ten years of reflection and reading dossiers,” she said in an interview with the journal Medisch Contact. She is using her resignation to make a public statement…and perhaps to ease her conscience. Under Dutch law, a patient must have unbearable suffering to become eligible for euthanasia. They must also make a request to die that their doctor believes is voluntary and carefully considered. A Dutch person can draft a written declaration stating they wish to be euthanized when they develop advanced dementia and, thus, are no longer able to make an oral request. To date, such written declarations have only resulted in a handful of deaths, but the numbers are likely to rise in coming years. The Dutch Right to Die Society (NVVE) claims that one in twenty Dutch people has a written declaration requesting euthanasia, usually for the case of advanced dementia. It is these written declarations that are giving van Baarsen her moral qualms. “In this phase {i.e., advanced dementia}, it is impossible to determine if the patient is suffering unbearably because they are no longer able to express this,” she told Dutch newspaper Trouw. Van Baarsen is not alone. Last year, 220 doctors published an open letter in a major Dutch newspaper to express their unwillingness to euthanize patients with advanced dementia. “Giving a deadly injection to a patient with advanced dementia on the basis of their written declaration? To someone who cannot confirm that they wish to die? No, we’re not going to do that. Our moral abhorrence at ending the life of a defenseless person is too great.” Patients with advanced dementia typically are not aware that they are being killed. A doctor begins by secretly administering a sedative, usually via the patient’s food. A 2016 case that attracted considerable controversy involved a woman with Alzheimer’s who woke up from the sedative and began struggling. She was restrained by family members so the doctor could administer the fatal injection. Sadly, van Baarsen’s proposed solution is for dementia patients who truly wish to die to orally request euthanasia while they are still able to do so – her solution would have patients killed even sooner. She does not understand that legalized euthanasia in the Netherlands has undermined the valuing of human life. A few tweaks to existing law will never solve the much bigger problem....