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Dutch doctors are now permitted to sedate euthanasia patients if there is a chance they could “become agitated” as a doctor prepares to end their life.
The policy was updated by the Euthanasia Review Committee and applies to patients who have dementia or a similar condition.
The revised policies state that for dementia patients “it is not necessary for the doctor to agree with the patient the time or manner in which euthanasia will be given.”
The change follows a Dutch supreme court finding that a doctor who sedated a patient before euthanising her had not broken any laws.
Dr Marinou Arends had been convicted of murder after she euthanised a 74-year-old female patient with advanced Alzheimer’s disease in 2016.
The woman had two advance directives making it clear that she never wanted to be put in a care home with dementia. She said she wanted euthanasia when she felt ‘the time was ripe.’
But the woman repeatedly answered that she did not want to die when she was asked about the possibility of euthanasia.
A second specialist agreed she was ‘suffering unbearably’ in the home. Arends put a sleeping drug in her cup of coffee, and then euthanised the woman. Despite the sedative, the woman attempted to jerk away from the lethal drugs, and was held down by her son-in-law.
Arends was cleared of a murder charge Sept. 2019, a decision upheld in April by the Supreme Court. The court also tore up a written reprimand the doctor had been given.
Jacob Kohnstamm, who chairs the Dutch Euthanasia Review Committee, said that the new policies were needed as “doctors now have less to worry about putting their necks in a noose with euthanasia.”
“They need less fear of justice,” he said. “Or for the review committee.”
The decision has not been unanimously welcomed. When the case was first made public, in 2018, 220 doctors put their name to an advert in which they condemned any medical practitioner who “secretly” sedated patients being helped to die.
Dr Charles Camosy, a professor at Fordham University and bioethicist, told CNA that the supreme court decision is part of a legal “slippery slope” in the Netherlands on euthanasia.
Camosy said that patients with conditions, including mental deterioration, will be at the heart of future debate.
Euthanasia is legal in the Netherlands for anyone over the age of 12, or for anyone under the age of one.
In 2019 there were 6,361 cases of euthanasia in the Netherlands – just over 4% of the country’s total deaths. Of these, 91% were in cases of terminal medical conditions. The remainder of the cases involved severe psychiatric illness, including dementia.
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