New euthanasia rules in the Netherlands will allow doctors to follow advance directives from patients with severe dementia rather than rely on their consent.
Doctors will also be allowed to sedate dementia patients before carrying out the procedure to stop them becoming agitated.
The publication of new guidelines follows a Supreme Court ruling in April which overturned a murder charge against Marinou Arends, a nursing home doctor.
Dr Arends had been convicted after carrying out euthanasia on a 74-year-old female dementia sufferer in a care home on the basis of advance directives she had drawn up.
The woman had said she wanted euthanasia “when the time was ripe”, but was not specific on what she considered unbearable suffering. The procedure was also controversial: she was given a sedative in her coffee and when she drew back from the lethal injection, a family member pushed her down.
The Dutch Supreme Court, however, ruled that the doctor acted within 2002 euthanasia law, saying if a patient is no longer capable of consent due to dementia, doctors can honour a prior written request.
The regional euthanasia review committees (RTE), which last year judged 6,361 cases in the Netherlands, now advises giving doctors more explicit latitude to follow their own judgement in practice.
Doctors do not, it says, have to consult patients with advanced dementia about the time and type of euthanasia because “this kind of conversation is pointless".
If they feel a patient will be disturbed, agitated or aggressive, advance medication is also “indicated”.
Jacob Kohnstamm, chairman of the RTE, said the clarification stressed doctors’ reasonable, professional judgement and could relieve fears of prosecution in these rare cases.
"It’s only two or three cases a year but this might help doctors to have less fear of a penal case," he told the Telegraph.
The RTE has approved one 2020 case where a woman between 70 and 80 with advanced Alzheimer’s had euthanasia, based on her prior directive but actually at the request of her husband.
The NVVE, which advocates for euthanasia, welcomed the ‘clarification’ and director Agnes Wolbert said: “This is good for doctors in practice because there is more certainty that their judgements and actions are within the law.”
But Dr Jaap Schuurmans, who has researched evidence of increasing pressure put on doctors from patients’ family members, said: “This freedom has been there in law from the beginning, but the law is being interpreted more and more broadly.
"Nobody can look inside the head of someone with dementia. It is an image that conjures up societal anxiety and dementia is not seen as a heroic death. But the question is: who is really suffering?”