Dutch Court decision on 'coffee euthanasia' opens the door to dubious practices

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Netherlands Supreme Court recently approved euthanasia for incompetent people with dementia who had made a previous request for euthanasia.

The case concerned the euthanasia death of a woman with dementia, who had stated in her power of attorney document that she wanted euthanasia but when the doctor came to inject her she resisted. The doctor attempted to sedate the woman by putting the drugs in her coffee but she continued to resist so the doctor had the family hold her down while the doctor lethally injected her.

In January 2017, a Netherlands Regional Euthanasia Review Committee decided that the doctor had contravened the rule of law but that she had done it in "good faith."

According to Reuters, the Supreme Court found that:

The Dutch Supreme Court on Tuesday ruled that doctors could legally carry out euthanasia on people with advanced dementia who had earlier put their wishes in writing even if they could no longer confirm them because of their illness. 

The ruling is a landmark in Dutch euthanasia legislation which up to now had required patients to confirm euthanasia requests. This had not been considered possible for mentally incapacitated patients like advanced dementia sufferers. 

“A doctor can carry out an (earlier) written request for euthanasia from people with advanced dementia,”

Theo Boer

Professor Theo Boer, a former member of a Netherlands Regional Euthanasia Review Committee (2005 - 14), wrote about his concerns about the Supreme Court decision that were published by Trouw in the Netherlands (google translated).

Boer describes the case in Trouw:

The Supreme Court recently ruled on coffee euthanasia. A 74-year-old patient with dementia had stated in a living will that she wanted euthanasia if she ended up in a nursing home. When that indeed happened and she became incapacitated, she gave varying signals: most of the time she didn't want to live, but sometimes she was having a good time. Although the doctor had put something calming in her coffee, the woman resisted during the euthanasia. The Supreme Court ruled that the doctor had acted correctly by taking the patient's advance directive as a compass.

Boer expresses his concern that the number of euthanasia deaths for people with advanced dementia will increase and he questions how these decisions will be made based on the fact that these people are incompetent. He then expresses his concern for what he calls, "dubious euthanasia." He writes:

This also increases the risk of dubious euthanasia. Because people with advanced dementia are by definition not competent (many are even aphrodisiac), the practical request for euthanasia comes from the family. The doctor (nursing home doctor or doctor of the Expertise Center for Euthanasia) may be independent, but he will rely heavily on their judgment when weighing the agony of suffering. After all, the doctor usually did not know the patient before. That opens the door to framing. Despite good intentions, family value judgments ("I would never want to be demented," "What kind of life is that?") Take on a strong role. It cannot be excluded that financial and emotional considerations are a motivating force.

Boer than expresses that the Dutch Supreme Court decision proves that there is not a "border" to euthanasia even as other countries, when debating euthanasia, social distance themselves from the Dutch euthanasia program.

Boer concludes by pointing out that this decision will likely lead to a new opportunities to expand euthanasia. Based on "legal equality and compassion" why would euthanasia be limited to people with dementia who previously requested euthanasia when people who did not request euthanasia also suffer?

The only bright line is rejecting euthanasia. Once it is legal it is unfair or it lacks "compassion" to deny it to others, who are also "suffering."