Dutch High Court Allows Euthanasia for Dementia Patients

Dutch High Court Allows Euthanasia for Dementia Patients

The Netherlands Supreme Court on Tuesday upheld a landmark euthanasia ruling in the case of a doctor charged with murder for performing euthanasia on a patient with severe dementia.

THE HAGUE, Netherlands (CN) — The Netherlands Supreme Court on Tuesday upheld a landmark euthanasia ruling in the case of a doctor charged with murder for performing euthanasia on a patient with severe dementia.

It was the first time a doctor had been criminally charged since the passage of the Termination of Life on Demand Review Act, which legalized euthanasia in the Netherlands in 2002.

Willem van Schendel, vice president of the Supreme Court, read the verdict out loud before a mostly empty courtroom in The Hague. The Dutch courts are only opened for a limited number of cases in an effort to prevent the spread of Covid-19.

“A physician may respond to a written request for euthanasia for people with advanced dementia. In such a situation, all requirements set by the law with regard to euthanasia must be met, including the requirement that there is hopeless and unbearable suffering,” van Schendel said.

A 74-year-old woman, who was not identified by the court, had signed
an advanced directive following her diagnosis with Alzheimer’s disease
in 2012 that if she was admitted to a nursing home with dementia, she
wished to be euthanized.

However, after she was admitted to a nursing home, she gave
conflicting statements as to whether she wanted the assisted suicide.
According to nursing home staff, the woman sometimes said that she
wished to die, but other times said she was not ready. In consultation
with two other doctors and the woman’s family, she died by euthanasia in
2016.

Her 68-year-old doctor, identified only as Catharina A., was found
not guilty of murder in September. The charges were based on a review,
mandatory in all euthanasia cases, that found euthanasia should not have
been performed as the patient’s statements were unclear.

“Euthanasia in the case of disability remains a complex process that
requires extreme caution. But with today’s ruling, doctors in the
Netherlands can be less afraid,” said Steven Pleiter, director of the
Euthanasia Expertise Center.

The case has had a chilling effect on euthanasia in the Netherlands,
with an increasing number of doctors refusing to perform the procedure.

The public prosecutor did not appeal The Hague district court’s
verdict but the attorney general brought the case before the Supreme
Court in order to have the highest court in the country rule on the
matter.

In Tuesday’s ruling, the Supreme Court laid out the main principles
for providing euthanasia to patients who are suffering from advanced
degenerative diseases.

Before becoming legally incompetent, the patient must have issued a
written directive stating that they wanted to be euthanized. Doctors
must also take into consideration statements made by the patients during
the advanced stages of their disease, but a lack of clarity in what a
patient says, as was the situation with the woman in the case before the
court, doesn’t mean a physician must refuse to perform euthanasia.

Further, the court wrote that “criminal prosecution is not always the
most appropriate response to a possible case of careless medical
conduct,” an apparent criticism of the public prosecutor for bringing
the case in the first place.

Beyond upholding the lower court’s ruling that there was no crime,
the Supreme Court overruled a decision by the Central Disciplinary Board
for Healthcare that the doctor had not followed the proper euthanasia
procedure. The disciplinary board had issued a formal warning to the
doctor, who has since retired.