Dutch geriatrician faces charges over euthanasia case

A specialist in elderly care medicine could face prosecution under the Netherlands’ euthanasia laws after ending the life a 74 year old nursing home patient with advanced dementia.

The woman was considered no longer competent to consent but had previously signed a living will requesting euthanasia. Yet Dutch public prosecutors have launched a criminal investigation, claiming a “serious suspicion” that a criminal offence had been committed.

This is the Netherlands’ first such investigation under the reporting arrangements established in the 2002 euthanasia law.

The move came after a report by the Regional Euthanasia Review Committees, charged with overseeing euthanasia practice and to whom doctors have a legal obligation to report their actions. They concluded that the nursing home doctor “did not act in accordance with the criteria of due diligence” required by the law. They dismissed the living will as “ambiguous and contradictory.”

Though rare, euthanasia for patients with advanced dementia is possible under Dutch law so long as there is an unambiguous written request made at a time when the doctor is convinced the patient was still competent. Three cases, of which the investigation is one, were reported in the Regional Euthanasia Review Committees’ 2016 annual report.1

The report explained how the woman had last made a written living will a year before her death, stating that she wished to use her legal right to euthanasia when “I consider the time is right.” As her condition deteriorated she was admitted to a nursing home. She was anxious and depressed. Several medical opinions accepted that she was suffering hopelessly and unbearably. She told staff that she wanted to die; but when asked by her doctor, she replied, “Not yet.” She no longer seemed to understand the word euthanasia.

The euthanasia went ahead and, according to the review committees, was not carried out with due care. A sedative, midazolam (Dormicum), was initially administered to the patient in her coffee without her knowledge. Later, she awoke as a thiopental drip was being inserted and tried to sit up. Family members helped to hold her while the infusion was completed. The report concluded that the doctor should have stopped if the patient “reacted negatively,” stating, “Coercion and the appearance of coercion must be avoided at all costs when terminating someone’s life.”

The current investigation comes amid an “intense discussion” and “increased resistance” among Dutch doctors over euthanasia for patients with advanced dementia on the basis of written wills, said the Dutch Medical Association. In January a “manifesto” was published, signed by 33 doctors and led by a psychiatrist, Boudewijn Chabot, urging, “Ending the lives of defenceless people must not become normal.”

A spokesperson for the Dutch Medical Association said that, although euthanasia in general was widely accepted among doctors and society, in the specific cases of patients with advanced dementia where decisions are based on written wills, doctors experienced more emotional problems now than they did five years ago. Although euthanasia in such cases was technically legal, doctors felt a “strong moral objection” if they could “no longer communicate properly” with their patient, the association said.

The association is to seek the views of its members to see whether the attitudes of those who signed Chabot’s manifesto are widely held.