On April 23, the Dutch Supreme Court rendered a decision on the value of advance directives written by people with dementia by ruling that written requests are open to interpretation. Consequently, doctors can now legally carry out euthanasia on people with dementia if the patient has put his wishes in writing beforehand, even when they can no longer confirm them at a later date, due to their illness.
Consequently, in the Netherlands, one’s advance directives may be ignored under certain circumstances. The court’s ruling states: “this may concern, for example, the behavior of the patient or verbal statements from which it may be inferred that the patient’s current condition does not correspond to the situation specified in the request. In addition, the law requires that written end-of-life requests be carried out, only in the event of hopelessly unbearable suffering. For a patient with dementia, one must be particularly careful about the prerequisite of unbearable suffering.”
“In fact, the margin allowed for interpretation stipulates that even when the patient is no longer able to express himself, the requests written beforehand may be acted upon. The possibility of complying with a previous written end-of-life request also exists when the inability to express one’s will is caused by advanced dementia. In this case also, all the requirements set by the law on euthanasia must be respected. […] It follows from these legal requirements that, in these cases, the request for euthanasia must be made in writing in a situation where the patient can no longer express his will due to advanced dementia.”
This decision follows a landmark euthanasia case, “Koffie-euthanasia”, in which Dr. Catherine A. who performed euthanasia on a woman suffering from dementia was accused of murder. The patient had written advance directives for euthanasia before she found herself in a state of advanced dementia. The woman wrote that she wanted to have euthanasia performed “upon my request” and “when I myself think the time is right.” One year later when euthanasia was finally performed, her condition no longer allowed her to grasp the understanding of euthanasia. Without explicitly asking the patient if she wanted to die, a sedative was put in her coffee before the doctor began the IV of lethal drug. The woman struggled, and had to be restrained during the delivery of the IV.
Both the doctor and the procedure were declared to be wrong and unreasonable by The Hague Disciplinary Health Care Office and the Euthanasia Regional Control Commission. Nevertheless, The Hague Tribunal decided to acquit the doctor.