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Relaxation of Dutch rules opens euthanasia to dementia sufferers

The fear of prosecution has previously made many doctors reluctant to administer lethal injections to patients who had lost their mental capacity (PA)

Dutch euthanasia rules have been relaxed to give doctors greater freedom to give lethal injections to dementia sufferers.

New government guidance assures doctors they can legally give lethal injections to patients who are no longer capable of expressing a desire to either live or die.

The patient must, however, have signed an advance directive, or ‘living will’, requesting euthanasia at a time when they still had mental capacity.

Earlier guidance had insisted that a person could only qualify for euthanasia when they could give their full consent.

The fear of prosecution made many doctors reluctant to directly take the lives of patients who had lost their mental capacity.

It also resulted in a court battle last year after staff at the Ter Reede dementia specialist care home in Flushing refused to arrange ending the life of an 80-year-old woman on the grounds that she was incapable of consenting to her death.

Her family argued, however, that the woman had harboured a “death wish” and successfully obtained a court order so she could die by euthanasia.

New guidance issued by Ministries of Health and of Security and Justice confirms that in dementia cases “a doctor may apply euthanasia even if a patient cannot explain it (a request) in words or gesture. But there has to be a written request for euthanasia that the patient has drawn up earlier”.

The guidance supersedes a 2012 document of the KNMG, the Dutch medical association, which states that patients must still be able to communicate their desire to die for a request for euthanasia to be valid.

Dr Rutger Jan van der Gaag, chairman of the KNMG, told NOS, the Dutch broadcaster, that the guidance gave clarity, adding that it was vital for doctors to understand the will of their patients.

The guidance was also welcomed by the NVVE, Dutch euthanasia campaign group, because it will make it harder for doctors to ignore euthanasia requests.

Margo Andriessen, the group’s president, said: “Many doctors believed that euthanasia could not be applied in dementia.

“Now it is again confirmed that it can when the patient is suffering severely, has prepared an advance directive … and has spoken frequently with the doctor. Doctors can no longer ignore this.”

The new guidance was met with horror, however, by UK anti-euthanasia campaigners who believe that the practice is out of control in the Netherlands and Belgium.

Lord Carlile of Berriew, the Lib Dem peer who a decade ago sat on a Lords committee which rejected euthanasia, said: “This is a shocking development, founded on the mistaken view that a lack of full reasoning ability is sufficient to justify euthanasia.’”

Nikki Kenward of Distant Voices, a disability rights group, said the Dutch government was offering a “cop-out” to people scared of growing old.

“The Dutch are prepared to accept death for dementia in the same way that we accept punishment for our crimes,” she said.

“Euthanasia is to be sold through fear and ignorance and grabbed by anyone who gets the diagnosis.”

Critics of euthanasia have continually raised alarm about the incremental liberalisation of the law since the Termination of Life on Request and Assisted Suicide Act in 2002 made the Netherlands the first country in the world to legalise the practice since Nazi Germany.

The Act was supposed to contain major safeguards, exempting doctors from prosecution only if certain criteria were met.

Besides having mental capacity, a patient must also be suffering unbearably, for instance – though increasing numbers of lonely, aged, bereaved, depressed or handicapped people have in practice fitted this category on the grounds they were suffering from “mental anguish”, with a woman in her 80s was killed in 2014 simply because she did not want to live in a care home.

In spite of the liberal interpretation of the law, doctors remained divided on the morality of euthanasia in situations where a patient had lost the ability to consent.

A survey last year found that of 547 doctors involved in euthanasia, only 52 per cent said they were willing to inject a patient who made an advance directive but was no longer able to express their will.

The liberal interpretation of the law has corresponded with a soaring incremental increase in the number of euthanasia deaths in the Netherlands.