Intended for healthcare professionals


Dutch approve euthanasia for a patient with Alzheimer's disease

BMJ 2005; 330 doi: (Published 05 May 2005) Cite this as: BMJ 2005;330:1041
  1. Tony Sheldon
  1. Utrecht

    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.

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