Netherlands

The Netherlands’ highest court has ruled that doctors can honour euthanasia requests for adults with advanced Alzheimer’s, provided they have signed a written request beforehand. 

Although it has always been possible in the Netherlands for a patient unable to express their will at the moment of death, to receive assistance to die, this ruling has brought further clarity on the law there. Doctors will now be able to help under strict conditions, including that the patient must have ‘unbearable and endless suffering’ and that at least two doctors must have agreed to carry out the procedure. The patient must also have made a declaration that they want assistance before they could ‘no longer express their will as a result of advanced dementia’. 

The latest figures show that the overall number of requests for assisted dying has fallen in the Netherlands, and only two people with severe dementia applied for an assisted death in 2018. 

This ruling follows from an earlier decision in the Netherlands, which acquitted a doctor for helping a 74-year-old woman end her life. The woman, who had been suffering from severe Alzheimer’s, had written a statement saying she wanted to die if she became incapacitated.

Commenting on the ruling, Trevor Moore chair of the campaign group My Death, My Decision said: 

‘Dying in a manner and timing of your own choice relates to the most fundamental of human rights – autonomy. No one should be forced to endure as an illness eclipses their very being or slowly erodes everything which once made them themselves. That’s why we support assisted dying for adults of sound mind who are either incurably suffering or terminally ill, and that’s why the law must change.’ 

‘However, we believe mental capacity is an essential safeguard within any system which permits assisted dying. We encourage everyone in the UK, suffering from Alzheimer’s, who wants greater control over their end of life care, to set out their wishes in an advance decision or through a lasting power of attorney.’

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My Death, My Decision’s Campaigns and Communication Manager, Keiron McCabe, responds to the latest Guardian long-read “Death on demand: has euthanasia gone too far?”

Christopher Bellaigue raises an important question for those of us who advocate for assisted dying reform. In a society which permits euthanasia, what are the acceptable limits to autonomy? As the Netherlands has demonstrated, this question yields no easy answers, and its answer will differ depending upon one’s moral, social and religious background. Yet whilst Bellaigue is right to have raised such an important question, he is wrong to have drawn such a quick conclusion.

Bellaigue presents a bleak picture of the Netherlands. Drawing upon a declining rate of euthanasia, he connects the “long-term consequences” of Euthanasia, and a lack of resolve and “willingness” from doctors, to suggest the country now “doubts” its decision to legalise assistance to die. Paradoxically, he also writes about a rising rate of Euthanasia, and that “in 2017, some 1,900 Dutch people killed themselves”. The implication being that euthanasia “cheapen[s] life itself”, and encourages higher levels of suicide. Leaving aside these paradoxes, these connections are misleading.  Since 2004, there has been a 249% increase in the number of notifying physicians, involved in Euthanasia and the Dutch suicide rate remains at about the same level as it was before the law changed.

Bellaigue also suggests that in 2002 the Netherlands should have “stipulate[d] that patients must be competent at the time” they make a decision to end their life. The importance of this requirement is abundantly clear in the context of Dementia, as Bellaigue raises, because it is only in the early-stages of Dementia that someone can retain the capacity to make an autonomous decision. Yet, it is misleading to suggest that competence is unnecessary, at the time of death, in the Netherlands. Whilst the requirement of “competence” may not be clear upon first inspection, since the 2002 law does not explicitly use the term, the 2018 Dutch Euthanasia code is clear that mental competence is encapsulated within the legal requirement for a patient to make a “voluntary and well-considered request”.

At no point is Bellaigue’s warning clearer, than his concern that euthanasia is leading to “death on demand”, a conception which incidentally had been discussed since 2010 but never realised. Few advocates of a right to die, condone an entirely unencumbered entitlement. Most would argue, as I would, that alongside any right to a die, there must be a stringent and robust set of safeguards to protect those who are most vulnerable. Determining the limits of that right is a difficult task. For some, assistance may turn upon the presence of a terminal illness; whilst for others, the permission of a loved one may be essential.

I believe that the answer lies in empowering mentally competent adults, who suffer from incurable health problems, with the freedom to determine the course of their own lives. It is our ability to act autonomously which gives life meaning. Both in the sense of taking responsibility for our actions, and in owning our individual destinies. When an incurable illness robs someone of that ability, and their quality of life falls permanently below a level that they find can acceptable, it is wrong to force them to live against their will.

Euthanasia is a complex and difficult question, which demands a sensitive and careful discussion. It is incumbent upon us all to make sure we hold ourselves to that standard.