NL expanding rules on euthanasia for dementia patients

The Netherlands' five regional euthanasia review committees RTEs announced that they are adjusting the assessment criteria in the Euthanasia Code on four points, specifically for doctors who get a euthanasia request from a dementia patient. The goal is to make it easier for doctors to grant such requests. "Doctors now have to worry less about putting their necks in a noose with euthanasia," RTEs chairman Jacob Kohnstamm said to the Volkskrant. "They can be less afraid of the judiciary. Or of the review committees."

The updated Euthanasia Code says that a dementia patient's statement requesting euthanasia does not have to be legally perfect. The statement, in which the patient describes the circumstances under which they want euthanasia, can sometimes be interpreted in multiple ways. Doctors will now have more room to interpret what the patient meant, for example by consulting family members.

Doctors will also be allowed to give a sedative to advanced dementia patients if they expect the patient will become aggressive or restless because they don't understand what's happening. The doctor also does not have to request a verbal confirmation from a patient with advanced dementia before the euthanasia procedure is performed. "Such a conversation is pointless, because such a patient lacks understanding of these topics," is stated in the code.

And it will be up to the doctor to assess whether a patient is suffering unbearably and hopelessly, the updated code reads. "The RTE should test that medical professional judgment with caution."

These adjustments were based on a Supreme Court ruling in a case against nursing home doctor Marinou Arends - the first doctor to be prosecuted for euthanasia in the Netherlands.

Arends was charged with murder after performing euthanasia on a patient with advanced dementia. The doctor put a sedative in the woman's coffee before the procedure, because she worried that the woman - who had attacked people in the nursing home - would fight the IV because she didn't understand what was happening. The review committee accused the doctor of "secretly" drugging the patient, and said that the patient's euthanasia request was also not clear.

The subsequent trial lasted for years. After the court in The Hague acquitted the doctor of all charges last year, the Supreme Court also ruled in her favor in April. During the trial, the Prosecutor also said that the case was less about getting a doctor convicted, and more about getting clarity for future cases. The RTEs adjusted their criteria after the ruling.

Every year, doctors perform euthanasia for around 6 thousand patients in the Netherlands. The review committees assess the cases afterwards, and pass cases to the Public Prosecutor if all the criteria was not met. According to Kohnstamm, euthanasia is very rare for people with advanced dementia, only happening two or three times a year.