Euthanasia rarely approved for advanced dementia patients, despite lucid requests

Euthanasia is hardly ever approved for advanced dementia patients, despite the fact that the Ministries of Public Health and Security and Justice gave the go ahead that it can be given to dementia patients who requested it in a written declaration while they were still lucid. Since the euthanasia request declaration system was implemented end 2015, there's only been three known cases of it being used, the Volkskrant reports based on information from the euthanasia review committees RTE.

According to the newspaper, many doctors are unclear about what is allowed and what isn't, due to conflicting rules in law and doctors' guidelines. 

In 2012 doctors organization KNMG implemented its own rules on when to approve euthanasia. These rules were more strict than the legal requirements and stated that verbal or non-verbal communication with the patient was needed for euthanasia. End of 2015 the Ministries decided to clarify the matter by adding to the euthanasia guidelines that euthanasia can be approved for an advanced dementia patient if that patient made a declaration asking for euthanasia while the patient was still lucid, and if that patient is suffering unbearably. 

According to Jacob Kohnsthamm, chairman of the RTE, the problem lies in determining whether a dementia patient has "hopeless and unbearable suffering". "The unbearable suffering can often not be identified in these patients. At a moment where a deep dementia patient sits quietly in a corner in a nursing home, that's impossible", he said to the newspaper.

Steven Pleiter, director of the End of Life Clinic which handles complex euthanasia requests, confirms this. "For our doctors it is not a matter of not wanting, but not being able to. Many patients change as the dementia progresses. Sometimes patients will suddenly go: I do not want euthanasia, hoe did you get that? With one single patient the suffering was visible. But in many others it's not." he said to the Volkskrant.

Robert Schurink, chairman of the Dutch association for voluntary end of life NVVE, calls it disappointing that nothing change since the euthanasia declaration was given the go ahead in 2015. "People sign such a declaration with conviction. They thin that it is settled. But as soon as they pass the time of mental competence, doctors suddenly don't want to anymore. Minister [Edith Schippers of Public Health] wanted to solve this ambiguity in 2015 and indicated that it is allowed. But many doctors don't want to burn their fingers, even if there s visible suffering. They feel bound to the old standards of the KNMG and demand that the patient communicates himself."