In a new article in the Journal of Medical Ethics, researchers from the National Institutes of Health offer an insightful analysis of one of the most controversial cases of euthanasia to have occured in the Netherlands.
Bioethicists David Gibbs Miller, Rebecca Dresser and Scott Kim analyse the official medical records of a severely demented woman who was euthanized in Holland in 2016. The woman, who was in her 70s, had her life ended by a geriatrician in aged care facility after having written an advance directive indicating her wishes for receiving euthanasia.
The advance care directive was written several years before her death, and there has been much discussion about whether it remained binding.
The most controversial feature of the case, however, was the manner in which the woman was euthanised. The supervising doctor mixed sedatives into the coffee of the woman without her knowledge. When the sedatives did not work, the doctor administered a stronger drug subcutaneously.
While the doctor was administering the lethal dose, the patient tried to get up and had to be restrained by family members.
The authors observe that there is insufficient scrutiny of the process by which Advance Care Directives are prepared:
...physicians and the RTE [Dutch regional euthanasia review committees] accept a low threshold of decisional capacity for preparing AEDs. The RTE’s Code of Practice states that in early dementia, "the patient generally…is decisionally competent in relation to his request for euthanasia". This apparent presumption of capacity in early AD (and in the case [of this patient], a much more advanced state) is incompatible with existing data on Alzheimer’s disease and decisional capacity.
The authors also question whether an Advance Care Directive should override the contemporaneous wishes of a severely demented patient:
The failure to provide adequate protection to a vulnerable patient was exacerbated by the failure to respect her contemporaneous interests and statements. By privileging the AED as the expression of Mrs A’s ‘real self ’—a judgement that itself was dubious in light of her questionable capacity and understanding when she made the AED—physicians failed to protect her … when they disregarded her contemporaneous statements and actions.
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