Edition 30 August 2018, by Phoebe Potter
A nursing home doctor who performed euthanasia on an incapacitated 74-year-old woman with dementia has been reprimanded for her actions. Though the law in the Netherlands prohibits both euthanasia and assisted suicide, since 2002 both have been allowed in exceptional circumstances. Critics have said, however, that the definition of ‘exceptional circumstances’ can be vague, and this is arguably what led to this doctor’s supposed mistake. The exceptional cases law, which came into force under the 2002 ‘Act on Life Termination and End of Life’, specifies six direct criteria which constitute the due care requirements that must be fulfilled before euthanasia can be performed.
In this situation, the confusion arose over the requirement that ‘the patient must have voluntarily and carefully submitted the euthanasia report’ as well as the way in which the euthanasia was administered. After consultation with the woman’s husband and daughter, the doctor introduced a sedative to the 74-year-old woman in her coffee without her knowledge, before giving her the deadly drugs. As the euthanasia drugs were administered, the woman woke up and seemed to resist, before her relatives calmed her and the doctor continued with the procedure. The doctor was acting under the understanding that the woman had given her permission for euthanasia in 2012, when she was originally diagnosed with Alzheimers’ and that she had signed a request for euthanasia and a treatment ban the same year.
The hereditary nature of Alzheimers’ meant that the woman had seen her mother go through the same experience, when she spent twelve years in a nursing home. The document she signed stated that ‘that experience seriously traumatized me and caused great grief to my family. By the time the quality of my life worsens to the above-mentioned situation, I may be voluntarily euthanized.’ A new statement signed in 2015, however, inserted the caveat that her life should be ended if she herself felt the time was right. After this, her situation quickly deteriorated and she became incapacitated and unable to indicate what she wanted. She regularly expressed to her husband the wish that she wanted to die, and yet sometimes added ‘but not yet’.
In its review of the case, the Regional Review Committee said that the doctor should have made more effort to discuss with her patient what she was going to do in order to give the her the opportunity to oppose it. Their statement declared that ‘in view of the irreversibility of termination of life and the ethical aspects associated with consciously ending the life of a fellow human being, a written euthanasia declaration should not be open to further explanation. There is in principle no room for interpretation.’
Bert Keizer, a Dutch writer and physician, declared that ‘for doctors this statement is beautiful; there is clarity at last, but for people with euthanasia who want to die if their dementia is advanced, this is a negative statement: if they are demented and can no longer indicate that they still want to die, then they will not be able to get euthanasia.’ The doctor who administered the euthanasia has only been reprimanded, because she retired a month after the incident happened, so further punishments such as suspension would not be suitable. The committee also noted that the doctor had always tried to put the interest of her patient first. Perhaps more importantly, a criminal investigation into the incident has been opened – the first since the euthanasia law came into force in 2002 – so the investigation will be left to the Public Prosecution Service.
Once the investigation has been completed, after the summer, it will be decided whether prosecution can be carried out. Due to confusion over the due care requirements, there have been calls for better support for doctors. The association of specialists in geriatric medicine, Verenso, and the KNMG doctor’s federation will soon start a project to facilitate nursing home physicians with better information regarding patients and euthanasia. ‘We want to equip doctors better, so that they are professionally supported with this type of request,’ said the chairman of Verenso, Nienke Nieuwenhuizen.