February 24, 2024

Dutch court rules patients with advanced dementia can be euthanised

Patients need not be competent to be euthanised.

The Supreme Court of the Netherlands has ruled that patients with advanced dementia can be euthanised, in a decision that clarifies one of the most controversial aspects of the country’s euthanasia law. 

On Tuesday, the Hague-based court ruled that a doctor who had euthanised a elderly patient with severe dementia in 2015 was acting lawfully, and that an early written request for euthanasia is sufficient for patients who have suffered severe cognitive decline. 

“A physician may carry out a written request beforehand for euthanasia in people with advanced dementia”, the Court found. 

The same rules for euthanasia apply as in any other case, the court said. Patients must be experiencing “unbearable and endless suffering” and that at least two doctors must have agreed to carry out the procedure.

The patient must also have requested euthanasia before they could “no longer express their will as a result of advanced dementia”.

The case centred on a 74-year-old woman who was euthanised in a nursing home after developing advanced dementia. 

The woman had drawn up a living will some years before her admission to the aged care facility and had regularly stated that she wanted to die. The doctor who euthanised her said she had spoken three times to the patient about her wish to die, but not about her living will because “she could not remember anything about it”. The patient’s long and short-term memory was very poor and she no longer recognised her husband, the doctor said. 

Yet the Supreme Court ruling has been met with concern from ethicists. Bioethicist Charles Camosy from Fordham University said that the ruling was part of a legal “slippery slope” in the Netherlands. He warned that doctors would in some cases misjudge the quality of life of people with dementia: “Doctors are notoriously bad at judging these things,” said Camosy. “Study after study finds that [doctors] rate the quality of life of their patients worse than the patients do themselves”.

Bioethicist Wesley J. Smith expressed deep concern that the law would permit people with dementia to be euthanised against their will. He noted that the 74-year-old woman at the centre of the case resisted when her doctor administered a lethal injection

Dutch court rules patients with advanced dementia can be euthanised
Xavier Symons
Creative commons