Researchers cast spotlight on Dutch euthanasia for dementia


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




MORE ON THESE TOPICS | consent, dementia, euthanasia, law, netherlands

This article is published by Xavier Symons and BioEdge under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation. Commercial media must contact us for permission and fees. Some articles on this site are published under different terms.

 
 Search BioEdge

 Subscribe to BioEdge newsletter
rss Subscribe to BioEdge RSS feed

 
comments powered by Disqus