Dutch Supreme Court approves euthanasia in cases of advanced dementia

Dutch Catholics are criticizing the Netherland’s Supreme Court ruling on Tuesday that doctors may carry out euthanasia on people with severe dementia, provided they had previously prepared an advance directive.

“The Supreme Court leaves it up to the physicians involved, which increases their uncertainty,” said Dutch Cardinal Wim Eijk.

The Supreme Court’s ruling followed a landmark euthanasia case last year, in which a doctor who performed euthanasia on a woman suffering from severe dementia had been acquitted of murder.

In that case the patient had stated in a living will four years earlier that she wanted to die if she was ever admitted to a nursing home. When that happened, a doctor decided together with the woman’s husband to perform euthanasia on her, without asking her explicitly if she still wanted to die. According to the prosecutors, the woman, after being placed in the nursing home, gave “mixed signals” about wanting to die.

When the day came to end the woman’s life, a sedative was put in her coffee. To the doctor’s surprise the woman then woke up and had to be held down by family members to make sure the rest of the lethal drug could be administered.

After the doctor was acquitted of murder by a lower court in The Hague, prosecutors announced their decision to take the case to the Dutch Supreme Court, which decided in favor of the doctor.

Eijk, the point man for medical ethics questions within the Dutch bishops’ conference, said this ruling doesn’t take away the uncertainties facing doctors.

“The Supreme Court leaves the decision to the physicians involved, which increases their uncertainty,” said the cardinal. “The question is how certain they can be that their interpretation of a written advanced directive will be approved by a court if legal proceedings are brought against them for carrying out euthanasia on a patient with advanced dementia.”

Eijk said that although he hopes that this will make doctors less inclined to perform euthanasia, he acknowledged that the number of cases of euthanasia went up in 2019, compared to the previous year.

“I fear that this ruling will not lead to a decrease in the number of cases of euthanasia and medical assisted suicide,” he said.

Moral theologian Lambert Hendriks said he expects the verdict to “have a major impact on practice,” causing a major problem for society.

“People tend to say when they are still in good health, ‘I don’t want to live like that.’ But as soon as they get ill, their death wish disappears. Because when you’re ill, you don’t want to be told your life doesn’t matter anymore,” he said.

The theologian also said the position of the Church is clear.

“The Church is against any form of euthanasia, because she believes that the value of life should not be reduced to what one finds useful. Of course, the Church understands that life can be a burden when you’re suffering severely. Yet it is good and valuable that this person is alive,” said.

Hendriks added that he finds the whole case distressing.

“In the end, the woman in question did not feel good about it. The judge now said: ‘Then the doctor should have put more sedatives in her coffee’ … it’s horrifying,” he said.

Charles Camosy, a professor at Fordham University and bioethicist, told CNA that the Supreme Court decision is part of a legal “slippery slope.”

(Camosy is a frequent contributor to Crux.)

A person with advanced dementia or a severe brain injury, Camosy said, is unable to communicate consent to be euthanized, meaning that the doctor performing the euthanasia will be likely the one to decide if the patient is suffering severely enough to merit death.

“Doctors are notoriously bad at judging these things,” said Camosy.

He suggested that the Netherlands instead ramp up the number of caregivers for dementia patients, and work to empower families of dementia patients to provide care for them.

This article was translated for Crux by Susanne Kurstjens-van den Berk.