2018-123, due care criteria complied with

Non-straightforward notification, decisional competence, impairment of functions which were central to the patient’s life.

The patient, a man in his seventies, was diagnosed with Alzheimer’s disease in 2014 after a period in which he experienced a number of symptoms. His condition continued to deteriorate.

His suffering consisted of progressive deterioration of his mental capacities, of which he was constantly aware. The patient, whose life had revolved around reading, precise articulation of his thoughts, study and discussion, was no longer able to do any of these things due to his disorder. He misplaced things increasingly often and had difficulty in finding the right words. He constantly felt restless, frustrated and distraught.

The patient suffered from the knowledge that there was no prospect of improvement in his situation and that the only prognosis was deterioration. He felt desperate and did not want to experience any further loss of dignity. The patient experienced his suffering as unbearable. The physician was satisfied that this suffering was unbearable to the patient and with no prospect of improvement according to prevailing medical opinion. There were no alternative ways to alleviate his suffering that were acceptable to the patient.

The patient had discussed euthanasia with the physician before. The physician had had several intensive conversations with him over a long period of time. During those conversations the patient was still able to put his thoughts into words. The physician did not doubt the patient’s decisional competence. About three months before his death, the patient asked the physician to actually perform the procedure to terminate his life.

Seven months before his death the patient had been seen by an independent psychiatrist due to mood-related problems. According to the independent psychiatrist these mood-related problems could be explained as a reaction to the disorder and its consequences. He was not suffering from clinical depression. The patient was able to clearly state and explain his reasons for his request for euthanasia, and the independent psychiatrist considered him to be decisionally competent regarding his request.

The physician consulted the same independent physician, who was also a SCEN physician, three times. The independent physician saw the patient for the first time about six months before he died. This was an early consultation: at the time the patient had not yet specifically requested euthanasia and he did not yet experience his suffering as unbearable.

The independent physician saw the patient for the second time about a month before he died. According to the independent physician, the patient was decisionally competent, not depressed, and consistent in his wish for euthanasia. However, the patient still had not yet specifically requested euthanasia, partly because he found it difficult to decide on a date.

The independent physician saw the patient for the third time about two weeks before he died. By now the patient was experiencing his suffering as unbearable and he specifically requested euthanasia. The independent physician was satisfied that the due care criteria had been complied with.

The committee found that the physician had acted in accordance with the due care criteria.