The Royal Dutch Medical Association (KNMG) has released guidelines for the euthanasia of patients with dementia who have made a written advance directive. It will no longer be necessary for the patient to agree at the moment of the euthanasia.

The new approach follows a court case in which a doctor was prosecuted for euthanising a woman with dementia who was struggling to resist a lethal injection. The doctor was acquitted even though, strictly speaking, she had committed a criminal offence.

The Regional Review Committees for euthanasia cases recently clarified its position in the light of this case. Doctors are to be deemed the best judge of whether a dementia patient is “suffering unbearably” – one of the legal requirements for euthanasia – and they do not have to ask the patient.

“At all times, euthanasia for incapacitated patients with advanced dementia is only possible on the basis of a written request for euthanasia drawn up by the patient himself when he was still mentally competent,” says the KNMG.

The KNMG seems to be giving doctors a lot of leeway in interpreting the patient’s wishes. Its website states: “The doctor must try to determine the intentions of the patient from the written request for euthanasia. The doctor must pay attention to all circumstances and not only to the literal wording of the written request for euthanasia.”

And what if a demented patient is uncooperative at the moment of euthanasia? The KNMG guidance says that they can be sedated to bypass any unpleasantness: “if there are indications that the patient may develop restlessness, agitation or aggression during the euthanasia, a doctor may use premedication in exceptional situations. The need for this must be carefully weighed up by the doctor and substantiated in the file.”

International helplines can be found at www.befrienders.org. In the US, the National Suicide Prevention Lifeline is at 800-273-8255 or chat for support. You can also text HOME to 741741 to connect with a crisis text line counsellor. In the UK and Ireland, Samaritans can be contacted on 116 123 or email jo@samaritans.org or jo@samaritans.ie. In Australia, the crisis support service Lifeline is 13 11 14.