The Dutch Supreme Court on Tuesday upheld a lower court decision in which a doctor who performed euthanasia on a patient with severe dementia was found not to have broken any laws.

The Supreme Court also tore up the written reprimand that the doctor, since retired, had been given by the medical sector’s disciplinary board.

The case first hit the headlines in 2016 because it was the first of its kind involving a doctor who carried out euthanasia on a patient with advanced dementia.

The public prosecution department had accused the doctor of murder arguing she should have done more to establish that the patient wanted to go through with the process.  Despite lower courts ruling in the doctor’s favour, the public prosector took the case to the Supreme Court, saying this was necessary not to dispute the verdict, but to clarify the law.

The Supreme Court ruling now establishes in law that a doctor may honour a written request for euthanasia if the patient is no longer capable of giving their assent because of advanced dementia. The ruling also sets out how all the requirements can be met in this specific situation.

Living will

The case centred on a 74-year-old woman who had drawn up a living will some years before her admission to the nursing home and had regularly stated that she wanted to die.

The doctor told the lower court last year court that she had spoken three times to her patient about her wish to die, but not about her living will because ‘she could not remember anything about it’. Her long and short-term memory was shot and she no longer recognised her husband, the doctor said.

The woman’s daughter said in a written statement in court that she had no doubt her mother wished to die. ‘The doctor freed my mother from the mental prison which she ended up in,’ the statement said.

Rare

Euthanasia for people with severe dementia is rare and accounted for just two cases in 2018. In that year, 2.4% of the 6,126 notifications of euthanasia involved someone with dementia.

Euthanasia is legal in the Netherlands under strict conditions. For example, the patient must be suffering unbearable pain and the doctor must be convinced the patient is making an informed choice. The opinion of a second doctor is also required.

Since the legislation was introduced in 2002, there have been a number of controversial cases, including a woman suffering severe tinnitus and a serious alcoholic.

Read the Supreme Court statement in English