A Dutch doctor who had drugged an 80-year-old dementia patient and had the patient’s family hold her down as she struggled against being delivered a lethal injection, is deemed not to have broken Holland’s euthanasia laws.

Euthanasia is a subject heavily steeped in ethical concerns that are often controversial. The case has emerged as Netherlands considers amending the law which would give anyone over 75 the right to assisted suicide.

Patient was mentally incapacitated, but “did not want to die”

Before the patient’s condition had deteriorated, she had expressed a desire for euthanasia when she deemed that “the time was right”. That statement did not account for when she lost the mental capacity to confirm her desire for euthanasia.

Medical records at the nursing home noted that she often showed signs of fear and anger, and she often roamed around the buildings at night. Senior doctors at the facility held the opinion that the patient was in unbearable suffering and considered her circumstances were such that the time was right for it.

The patient’s medical report stated that a female doctor had put a sedative drug in her coffee, after which she was administered a lethal injection. During the process, the patient regained consciousness and began fighting the doctor’s attempts. Her family then assisted in restraining her as the procedure was carried out.

It was noted that the doctor had not discussed any of this with the patient beforehand, citing an unwillingness that caused her unnecessary emotional distress.

The patient had also said “I don't want to die” several times during the few previous days before she was put to death.

The doctor “acted in good faith”

The law for euthanasia was introduced 17 years ago in the Netherlands; more than 5,500 people have since ended their lives. By Dutch law, each euthanasia case is reported to the Regional Review Committee by the doctor through a coroner, who ensures that the committee receives the relevant documents.

The case was referred to the Regional Review Committee, which concluded that the doctor was to be reprimanded as she had “crossed the line” in sedating the patient, and should have aborted the procedure when the patient struggled.

Nevertheless, they concluded that the doctor had not broken any laws.

"I am convinced that the doctor acted in good faith, and we would like to see more clarity on how such cases are handled in the future," said Regional Review Committee chairman Jacob Kohnstamm.

Kohnstamm added that he was not opposed to a trial for the physician, “Not to punish the doctor, who acted in good faith and did what she had to do, but to get judicial clarity over what powers a doctor has when it comes to the euthanasia of patients suffering from severe dementia.”

A new extension to the Dutch euthanasia law

The case arrives at a time when the Dutch are considering an extension to the euthanasia law which would give anyone over 75 the right to assisted suicide.

The proposal involves the necessity of fulfilling several conditions, with the first being a 'sustainable, well-considered and intrinsic' wish to die. To confirm this, a specially trained 'life-ending consultant' – which could be a doctor, a nurse, a psychologist or a psychotherapist - would hold at least two interviews with the person, with at least two months between.

Once it is ascertained that the person understands their decision and is not being pressured by their environment, their decision is verified by a second consultant or a checking committee.

Such a proposal is likely to find favour with the liberal coalition currently in power, but faces opposition from Christian parties and the Socialist Party, who say that such a law would contradict the duty of the government to protect the welfare of those in a vulnerable position.

“The proposal relies on the myth that this is an individual choice, but relatives, society and care workers are also involved,” said Gert-Jan Segers, a MP of the Christian Union. MIMS

Read more:
Should euthanasia for infants be legalised?
Ethical practices vs practical medical decisions: The debate presses on for Singapore
Palliative care: Why patients deserve the truth