Dutch approve euthanasia for a patient with Alzheimer's disease
BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7499.1041-a (Published 05 May 2005) Cite this as: BMJ 2005;330:1041Data supplement
Dutch committee approves euthanasia for a patient with Alzheimer’s disease
Utrecht
Tony Sheldon
The Netherlands’ first reported case of a doctor complying with a request for assisted suicide from a patient with Alzheimer’s disease was lawful, a report has said. The case was reported to the Netherlands’ assessment committee system, which consists of five regional committees and checks whether doctors have followed the requirements of the law. If members of the relevant committee judge that the legal requirements have been met, they do not forward the case to the public prosecution service.
Committee members have defended their decision, maintaining that approval for the case did not show that the country was on a “slippery slope” towards a general acceptance of euthanasia for cases of Alzheimer’s disease.
The case emerged in the 2004 annual report of the five committees of doctors, lawyers, and ethicists to whom doctors must report euthanasia. The committees judged that four out of 1886 cases of euthanasia and assisted suicide in 2004 failed the legal requirements, and, as the law requires, forwarded these to the public prosecution service.
But, in contrast, the case of a patient with Alzheimer’s disease was considered to have met requirements as a “well-considered and voluntary request” to die. The patient was also considered to be “suffering hopelessly and unbearably,” which is another of the criteria that makes euthanasia lawful.
The committees’ report states that, in general, patients with Alzheimer’s disease could not always comply with the requirements but that “in specific circumstances” they could. The 65 year old patient had had Alzheimer’s disease for three years. Since his diagnosis he had said that he did not wish to endure the full course of his illness and had in the previous year repeatedly asked for help to commit suicide. The doctor judged him to be suffering unbearably. He was conscious that he could no longer function independently and faced the future prospect of increasing dementia.
A second opinion from a doctor trained through the national support and consultation with euthanasia programme, however, did not recognise such suffering. This doctor argued that the patient’s awareness of his suffering would decline as the disease progressed and doubted that the patient was competent to express his wishes.
Further consultations with a psychologist, a nursing home doctor, and a gerontopsychiatrist, however, all concluded that the patient was suffering unbearably because he was conscious that the disease was removing control over his life. They believed too that he remained competent.
Reina de Valk, the committees’ coordinating chairwoman, said, “We cannot speak of a slippery slope.” She argued that the judgment did not change the requirements that needed to be met and that the public prosecution services had always accepted the possibility, albeit a small one, that allowing euthanasia for a patient in the early stages of Alzheimer’s disease would be lawful. But, although many patients express, in advance directives, that they would like to be given euthanasia if they developed dementia, in practice, few requests to doctors by patients are made.
Requests for euthanasia from patients in the early stages of dementia would always remain “exceptional” because of the “many complex factors,” especially timing, that play a role, Ms de Valk told the BMJ. “At the time a request is made unbearable suffering must exist, not just the fear of future suffering and the patient must remain competent to express their wishes.”
Henk Jochemsen, director of the Lindeboom Institute for Medical Ethics, which opposes euthanasia, said the report showed a “tension” between the two requirements: “I do not believe it is possible to maintain both.” He believes that the judgment involved a “considerable stretching” of the requirements, which is worrying because of the increasing pressures on doctors from an ageing society.
The annual report shows that a halt after four years of decline in the total number of euthanasia cases reported. This may indicate an increased willingness by doctors to report cases. The previous peak of 2216 cases reported in 1999 had declined steadily to 1815 in 2003.
See more
- Voluntary euthanasia deaths in Quebec outstrip predictions by three to oneBMJ November 23, 2016, 355 i6331; DOI: https://doi.org/10.1136/bmj.i6331
- BMA annual meeting: Doctors vote to maintain opposition to assisted dyingBMJ June 22, 2016, 353 i3486; DOI: https://doi.org/10.1136/bmj.i3486
- California’s new assisted suicide law is challenged in courtBMJ June 21, 2016, 353 i3471; DOI: https://doi.org/10.1136/bmj.i3471
- BMA annual meeting: “Bizarre” conference motion could “stifle” debate on physician assisted dyingBMJ June 20, 2016, 353 i3431; DOI: https://doi.org/10.1136/bmj.i3431
- Failure to enact assisted suicide law leaves Canada’s doctors in limboBMJ June 13, 2016, 353 i3273; DOI: https://doi.org/10.1136/bmj.i3273
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