A group of US-based researchers have published a detailed review of Dutch cases of euthanasia for patients with dementia. Their findings show that euthanasia doctors in many cases ‘read in’ what they think an incapacitated patient would say about receiving assistance in dying.
The study was published in August in the American Journal of Gereatric Psychiatry and reviewed 75 case reports submitted to the Dutch euthanasia review committees between 2011 and 2018. 59 of the cases involved a concurrent request for euthanasia and 16 were based on an advanced care directive.
Concerning the concurrent requests, the study authors state that “in some of these cases, the patient’s past conversations were used to confirm competence to request [euthanasia/assisted suicide]”. That is, the validity of a patient’s decision was determined with reference to past statements rather than standard competency tests.
The authors provide an example from a 2014 case report where the physician stated:
“[the] patient was not competent at [the time of her evaluation] but she had been until recently. Her desire for euthanasia had been so consistent lately that the reduced competence should not be a stumbling block...”.
The Dutch regional euthanasia review committees appear to condone this approach, having stated that patients can be competent even when they are “unable to present supporting arguments” for their request.
The study authors, however, claim that this approach could be problematic as it is based on the “potentially confusing process” of trying to verify and interpret a patient’s past statements about euthanasia. It also runs afoul of the idea of informed consent, as valid consent had not been obtained from many of the patients who were euthanised.
The study authors, furthermore, found significant problems with euthanasia advance care directives. The authors write that “advance euthanasia directives often included trigger criteria that could make their implementation difficult, such as ‘losing her dignity’”.
Furthermore, even when a clearer trigger criterion (e.g., ‘admission to a nursing home’) is met, advance euthanasia directives only speak to the voluntary and well-considered criterion and the physicians must still assess the patient is experiencing unbearable suffering. Indeed, the euthanasia review committees have stated that admission to a nursing home is insufficient to meet the unbearable suffering criterion in Dutch euthanasia law.
Xavier Symons is deputy editor of BioEdge
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