A landmark euthanasia trial has opened in the Netherlands seeking to pinpoint what to do with dementia patients who stated their wish to die under certain circumstances but later might have had second thoughts.
The case in The Hague district court centres on a 74-year-old woman who was given fatal doses of drugs three years ago despite some indications she might have changed her mind.
The Netherlands was the world’s first country to legalise euthanasia in 2002. It can only be carried out under strict conditions set down in Dutch law.
The unidentified doctor in the case, a 68-year-old woman who has since retired, is accused of making insufficient efforts to find out whether the patient still wanted to die.
She is charged with breaching the euthanasia law and, if the judge rules the request of the patient was insufficient, that charge could, in theory, become murder.
But the prosecution is not seeking a penal sentence against the doctor and does not question her good faith. Instead, the prosecution’s case is about setting out a better legal framework for the future.
“We think the doctor has not acted carefully enough and thus passed a threshold. But at the same time, we also say that this threshold is not very clear,” said public prosecution spokeswoman Marilyn Fikenscher, underscoring the arguments that the doctor acted with good intentions.
“She does not need to be punished,” Fikenscher said.
The daughter of the patient who died also strongly defended the doctor.
It is the first such case since the legalisation of euthanasia – the intentional ending of a life if suffering becomes overwhelming -so long as it is carried out by a physician adhering to strict conditions.
Fulfilling patients’ wishes
The doctor is alleged to have put a sleeping drug into the elderly woman’s coffee in the presence of the patient’s relatives. But the patient woke up during the euthanasia procedure, and the doctor had to ask her husband and daughter to hold her down while the process was completed.
During Monday’s opening session in court, the doctor said she was fulfilling the patient’s euthanasia request, written in 2012.
By the time she died, the woman suffered from “deep dementia,” the doctor said, a condition in which brain functions such as analytical thought, abstract reasoning and planning are quickly ravaged.
The doctor testified that because the patient was not mentally competent, nothing the woman said around the time of her death was enough to invalidate the written statement. She said the patient could no longer fathom the meaning of such concepts as euthanasia and dementia.
But Dutch prosecutors argued the patient’s written request was unclear and contradictory. In 2012, upon learning of the onset of her Alzheimer’s, she filed a euthanasia declaration that said she “certainly did not want to be placed in an institution for demented elderly”.
“I want a humane farewell for my loved ones,” the patient wrote. She later added to the declaration that she wanted euthanasia to take place “when I, myself, consider the time ripe”.
The Netherlands is one of the five countries that allow doctors to kill patients at their request, and one of two, along with Belgium, that grant the procedure for people with mental illness.
Euthanasia involves doctors actively killing patients with an injection of drugs but, in assisted dying, patients are provided with a lethal solution that they must drink themselves.
The outcome of the trial is expected in two weeks.
Steven Pleiter, a board member at the Levenseinde Kliniek end-of-life hospital, said the case should not give the impression that the Netherlands takes such life-and-death issues lightly.
“This is the first case that [has happened] in about 50,000 cases of euthanasia, and so there is a very careful practice in the Netherlands,” Pleiter said.