Dutch doctors cleared to euthanise dementia patients who have advance directives


Dutch doctors will be able to sedate demented patients and then euthanise them, if they have made advance directives, according to new official guidelines. This follows a Supreme Court ruling earlier this year which quashed the conviction of a retired nursing home doctor for murder.

The doctor, Marinou Arends, euthanised a 74-year-old woman, even though she was resisting, on the basis of advance care directives which she had written before she entered the nursing home. Although the doctor had secretly sedated her, the woman still had to be held down by her son-in-law so that she could be given the lethal injection. The patient had said she wanted euthanasia “when the time was ripe”, but she had not been clear about what she regarded as unbearable suffering.

Dr Arends was the only doctor to have been prosecuted since euthanasia was legalised in the Netherlands in 2002.

The court exonerated her, ruling that she had acted legally. It declared that if a demented patient is incapable of giving consent, doctors may proceed in accordance with prior written request even if they seem happy or even if they resist.

The regional euthanasia review committees (RTE) now advise giving doctors more leeway to follow their own judgement in practice.

“In giving euthanasia to a patient who is no longer mentally competent as a result of advanced dementia, it is not necessary for the doctor to agree with the patient the time or manner in which euthanasia will be given,” says the new RTE guideline. “This kind of discussion is pointless because such a patient will not understand the subject.”

Jacob Kohnstamm, chairman of the RTE, said the clarification stressed doctors’ reasonable, professional judgement and could relieve fears of prosecution in these rare cases.

"It’s only two or three cases a year but this might help doctors to have less fear of a penal case," he said in the Telegraph (London).   

“Doctors can now worry less that they are putting a noose around their own necks with euthanasia,” he said. “They can be less afraid of the justice system and the review committees.”

According to Dutch media, the new guidelines will affect very few people each year, as most doctors advise that patients with dementia should go at “five to 12” while they are still compos mentis. Last year there were 6,361 cases of euthanasia, representing 4.2% of deaths. Of these, 160 people had early stage dementia and just two were at an advanced or very advanced stage. These, of course, are the reported deaths – a good proportion of euthanasia cases are not reported.

So far this year, the RTE has approved one euthanasia for a woman between 70 and 80 with advanced Alzheimer’s, based on her advance directive, at the request of her husband.  

Michael Cook is editor of BioEdge




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