AMSTERDAM — A Dutch woman suffering from Alzheimer’s disease, described by a “euthanasia review” panel as a “controlling” woman who caused trouble on her nursing home ward, was slipped a tranquilizer in her coffee — and her family members were asked to restrain her when she resisted a doctor giving her a fatal dose of medication.
In a case that was first reported by the Daily Mail, the woman in her 70s fought back against being killed by the lethal administration of drugs in a care facility in the Netherlands. The Dutch Regional Review Committee exonerated the doctor, who they said acted in “good faith.” But the case is one of 10 from 2016 that were sent to the inspector general for health and public prosecutor’s office seeking clarification on how doctors should proceed in similar situations in the future.
The unidentified patient was diagnosed with Alzheimer’s disease four years ago and wrote a living will, saying she did not want to go into a care home and that she wished to die when she considered the “time was right.”
Her condition deteriorated to the point where, according to her aging husband, he was unable to care for her full time and had her admitted to a nursing home, where she told staff that she wished to die, “but not now.” Although one doctor reported finding her “cheerful and peaceful,” other doctors said she was “gloomy” and “hopeless.”
A translation of the review describes her as a “small, resolute woman who had worked with children in the past” and who, on her nursing home ward, was continuously “directing and instructing the inmates, as if they were children.”
The woman was content and peaceful when her husband or an adult child visited her. However, she became fearful and angry if she couldn’t find her husband, and she would wander the corridors looking for him.
No ‘Cold Feet’
According to the report, her husband made the decision with the doctor that she was ready to die, although the report is clear that the patient had “never verbally requested euthanasia.”
The doctor ordered a sleeping drug called Dormicum for the patient’s cup of coffee, which she was not told about because she would have objected. She sat with her husband and adult son and his partner for an hour and 45 minutes after drinking the laced coffee, but the drug failed to put her to sleep. Instead, she was excited and made plans to spend the afternoon with them going out to eat.
The doctor then gave her an injection of the sedative. Sometime later the doctor returned to carry out the euthanasia using two more drugs. However, when the doctor went to inject the drug, thiopental, the woman woke from her semi-slumber, got a fearful look in her eyes and kicked the doctor. The report says that the family helped to hold her down while the doctor gave the drug and that the doctor did not think it was “appropriate to halt termination of life” since it had been considered for a long time and did not want her to “get cold feet.”
The report further states, according to a translation of the doctor’s testimony, “Even if the patient had said, ‘I don’t want to die,’ the doctor would have continued the termination.”
A ‘Horrible Picture’
The three-member review panel, consisting of a lawyer, an ethicist and a doctor drawn from 45 board members, said the woman doctor “crossed a boundary” by secretly administering a sedative to her patient and by “failing to cease the execution of the termination of life” when the patient “reacted negatively.”
“The patient was deeply demented,” Jacob Kohnstamm, chairman of the Regional Review Committee, explained to the Register. “You can’t expect an answer to the question, ‘Are you aware that there will be a little Dormicum in your coffee?’ So it is at least questionable whether it is fair to say that the sedative was administered secretly.”
Regarding the patient resisting her euthanasia, Kohnstamm compared it to flinching when getting a flu vaccine shot. “When I pull back automatically, does that mean I don’t want the flu shot?” he asked.
“The family and the doctor, they restrained her — they just held her for a second,” he said. “That’s, of course, a picture that is a horrible picture. But there is a dilemma: what to do if a person was really decisive, had written down her request asking the doctor to help her die if she would be in deep dementia?”
Kohnstamm’s hope is that the justice and health departments will issue clearer guidelines on what doctors are supposed to do in such circumstances, and he wants to “warn patients that if this is what you want, your living will must be very, very clear about it.”
“Decide for yourself five minutes before midnight, rather than five minutes after midnight,” Kohnstamm said.
He added that such cases were a rare minority among the Netherlands’ 5,500 euthanasia cases that occurred in the 2015-2016 year. Most cases were with terminal-cancer patients. “There is no slippery slope,” he said.
However, given that 250,000 people in the Netherlands, which legalized euthanasia in 2002, are currently diagnosed with Alzheimer’s, euthanasia on grounds of dementia can be expected to grow. Currently, it affects more than 40 million people globally, and more than 150 million people are expected to be diagnosed with the disease — which has no treatment — by mid-century.
The Netherlands’ justice and health ministries relaxed guidelines for performing euthanasia on people with dementia last year, so they now read: “In such cases, a doctor may carry out euthanasia, even if the patient cannot make this clear by word or gesture. But there must be a written euthanasia request which the patient completed earlier.”
The current case seems fit for testing the new guidelines, and the inquiry is expected not to sanction the doctor who “crossed the boundary,” but, rather, send a signal to doctors that that boundary line has been erased.
It is the latest in a string of harrowing cases of euthanasia that have come under public scrutiny, including a case of a woman in her 20s who was euthanized because treatments by doctors failed, and they deemed that her post-traumatic stress following sexual abuse was “hopeless.” Other high-profile Netherlands cases include a woman who was euthanized because of severe tinnitus, a 41-year-old man suffering from alcoholism and a pending case of a 39-year-old man who wants to be euthanized because he cannot accept his homosexual tendencies.
In neighboring Belgium, which also legalized euthanasia in 2002, cases have broadened to include children, a woman who was euthanized after sexual “transition” surgery failed to correct her gender-identity disorder, and two identical twin brothers in their 40s who chose death because they were told they had a condition that would make them go blind.
Do Not Despair
The Church has always considered euthanasia, like suicide, a “gravely evil choice,” while allowing that grave fear of hardship, suffering or torture can lessen the responsibility of persons who take their own life. “We should not despair of [their] eternal salvation” and should pray for them (Catechism of the Catholic Church, 2282-2283).
The Catechism is less temperate when it speaks to those who deal death by providing lethal drugs or otherwise enable a patient to commit “assisted suicide.” “All those who knowingly and willingly perform or assist in carrying out the act of terminating the patient’s life have committed murder” (Catechism, 2277).
Finally, the Catechism teaches that Catholics are obligated to oppose any law that tolerates or requires euthanasia in their jurisdiction by means of conscientious objection (2273).
Alistair Thompson, a spokesman for Care Not Killing, a U.K. group that opposes physician-assisted suicide and euthanasia, said lawmakers start off by supporting a law that allows euthanasia for people who are consenting adults who are mentally competent and have an untreatable and irreversible illness who have less than six months to live, and it evolves into something entirely different.
“The problem is that the law always evolves. It’s always pushed open, a little bit, and a little bit,” he told the Register. “Once you’ve crossed that Rubicon, it becomes people who are not mentally competent, people who are frail or weary of life.”
“It says: We care so little for people, that we allow it. ‘You’re old; your life must be over.’ ‘You’re disabled; your life must not be worth living.’ …This is another good example of why the law has to be clear: that we do not kill people who are ill or disabled.”
Register correspondent Celeste McGovern writes from Scotland.