2016-94, general practitioner, dementia, voluntary and well-considered request, unbearable suffering without prospect of improvement

KEY POINTS: decisional competence, unbearable suffering

The patient, a woman in her sixties, became forgetful after suffering a TIA (temporary obstruction of a blood vessel in the brain) in late 2011. In early 2013 she was diagnosed with presenile dementia (dementia at a relatively young age).
In the years that followed, the disease progressed and more and more of her daily tasks had to be performed by others. In the autumn of 2015 it became clear that she would soon need daycare.

The patient’s suffering consisted of her not being able to function independently any more and having become fully dependent on others. For instance, she was no longer able to read or write, she had difficulty finishing spoken sentences, she could not drive a car nor could she dress herself. The patient felt trapped in her home. She realised that she was no longer able to take part in society independently and that she had lost control of her life. Having led a very independent life, the patient experienced her suffering as unbearable.

The physician was satisfied that this suffering was unbearable to her and with no prospect of improvement according to prevailing medical opinion.

From mid-2013 onwards the patient had discussed with the physician the fact that, in due course, she wanted euthanasia. She had also given the physician an advance directive. She updated the advance directive several times and added a separate signature to the clause on dementia in the directive.

In 2015 she spoke more emphatically about her wish and around two months before her death stated that she wanted euthanasia to be performed within three months. She absolutely did not want to go to daycare outside her home, nor did she want to go into a nursing home.
She repeated her specific wish for euthanasia in three subsequent conversations with the physician.

The physician concluded that the request was voluntary and well-considered. The independent physician stated that the woman was still able to make clear what made her suffering unbearable and that she wanted euthanasia.

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