Dutch doctors group issues new euthanasia guidelines concerning people with dementia

Doctors federation KNMG has taken a broader position on euthanasia when it concerns people with dementia. Under the new guideline, doctors can grant a request for euthanasia from people with dementia who submitted a written request to end their life when they were still lucid, but with whom discussion about this is no longer possible.

KNMG's broader position is, in its own words, "a practical translation" of a Supreme Court ruling. In April 2020, it ruled on what is allowable in such cases. Until now, the guideline to doctors was that if communication with the patient is no longer possible, euthanasia is not an option.

In its position, the KNMG primarily provides doctors with tools to ultimately reach a decision together with patients and their relatives. "This may mean that doctors sometimes decide not to perform euthanasia in complex situations based on those personal considerations, even though the law does provide that scope."

One of the conditions for euthanasia is that the patient must always discuss a written request in advance with the doctor. An independent doctor must also be involved in the euthanasia, and they must attempt to communicate with the patient about the euthanasia request and its execution. "Significant communication can also be possible with patients who are incapacitated," according to the KNMG.

The doctors' federation also states in the new position that the use of premedication, such as a sleeping aid, may be necessary just before euthanasia. In that case, there must be "indications that the patient may, for example, become upset or aggressive during the procedure, because the patient does not understand what is happening."

The Supreme Court ruling followed a case that started with the prosecution of a nursing home doctor who had performed euthanasia on a 74-year-old woman from The Hague who had advanced dementia. Before she got sick, she had clearly written down that she wouldn't want to live with advanced dementia if it came to that. But when the dreaded situation became a reality, she could not confirm her wish and also gave conflicting signals. The doctor eventually proceeded with euthanasia.