Doctors organisation KNMG has amended its official position on euthanasia for people with severe dementia, giving its members more support and options to act in complex situations.

In particular, the new approach will allow doctors to consider euthanasia for patients with advanced dementia who have a written dementia request but can no longer make their wishes plain.

Until now, the KNMG has advised doctors not to carry out euthanasia procedures on patients with whom communication is impossible, following two cases in which doctors were said to have acted without due care.

The change in position follows a ruling by the Supreme Court in April 2020, in which judges said a doctor who ended the life of a patient with severe dementia had not committed a criminal offence. The patient was no longer in a position to confirm her written euthanasia request.

Last year, the regional euthanasia review committees (RTE), which check every case of euthanasia in retrospect to assess whether due care criteria have been correctly applied, changed four aspects of their code for doctors covering dementia following the Supreme Court ruling.

In particular, the RTE said, doctors can best judge whether a dementia patient is ‘suffering unbearably’ – one of the six legal requirements for euthanasia – and do not have to ask the patient in such cases.

Responsible

The new KNMG standpoint follows on from this and is aimed at helping its members to ‘take a responsible decision’ together with patient and relatives. In addition, the organisation said, patients with severe dementia must have made a written request for euthanasia when they were capable of doing so.

‘Patients often have very personal wishes and preferences regarding end of life care and it is important that the doctor and patient discuss this in good time,’ the KNMG said. 

The KNMG said it is important that every doctor can make their own professional and personal assessment, which may mean doctors sometimes decide not to perform euthanasia even though the law does provide that scope.

‘At the same time, the KNMG considers it important to support doctors who are willing to consider euthanasia in a complex situation,’ the association said.

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