Australian Doctor 14th February 2025 | Page 41

41 the larger part of the day , she showed signs of agitation , unrest , stress , anxiousness , sorrow , anger and panic .
ausdoc . com . au 14 FEBRUARY 2025

41 the larger part of the day , she showed signs of agitation , unrest , stress , anxiousness , sorrow , anger and panic .

“ She cried a lot , often said that she found it horrible and that it was breaking her down and said every day ( up to 20 times a day ) that she wanted to die .”
These contradictory signals made the case an important legal test of the sovereignty of the advance directive . Because of this , the prosecution ran with an agreement that a guilty finding would not result in the geriatrician being imprisoned .
The judges ruled that the physical and verbal displays the patient made before the lethal injection were case is different ,” he said .
But to critics , the level of discretion mixed with the level of ambiguity that exists has made advance directives sanctioning euthanasia controversial among Dutch doctors .
‘ Fundamentally impossible ’
Berna van Baarsen , a medical ethicist , quit her role on the review board back in 2018 declaring it “ fundamentally impossible ” for physicians to make accurate judgements about what is unbearable to patients suffering from dementia who cannot properly articulate their subjective experience .
She is not alone .
' You do not sleep very well the night before . You do not sleep very well the night after . It is a very intense thing .'
“ spasmodic reactions the patient was
A year earlier , more than 200
not consciously aware of ”.
Dutch doctors announced their
But the question remained
objection to euthanasia for advanced
whether the doctor had wrongly
dementia patients .
assumed the woman ( once she was
“ To someone who cannot con-
deemed decisionally incapable ) still
firm that he wants to die ? No , we are
had an “ explicit and serious desire ”
not going to do that . Our moral reluc-
for euthanasia .
tance to end the life of a defenceless
The judges sided with the doctor .
human being is too great ,” their state-
They said , in view of the state of
ment said .
profound dementia the patient was in
Dr Carmel Kouprie is a psychia-
at the time of her death , the accused
trist registrar and a committee mem-
“ did not have the obligation to obtain
ber at the Euthanasia and Psychiatry
information from the patient about
Commission , which is part of the
her present wish to live or to die ”.
Dutch Society for Psychiatry .
When it comes to incapacitated
Her work has given her insight
Voluntary manslaughter
Back in 2016 , there was a euthanasia
case involving a 74-year-old patient with dementia that subsequently
euthanasia on the patient without a further and consistent confirmation of her wish to die .”
As the trial ran , the court was told
she “ constantly says she wants to die , but after five minutes , she says not now ”.
Her GP also told the court she
patients , oral verification of their wishes to live and their suffering is impossible .
“ Setting this requirement [ to secure oral verification ] would be
into the way euthanasia affects the doctors who choose to perform it .
“ Euthanasia is very scary for a lot of doctors , and it feels like a risk , especially because you are
made headlines around the world .
that the woman ’ s advance directive
claimed to be “ doing well ” when
detrimental to the living will of
judged afterwards ,” she told Aus-
It involved a geriatrician who had
included a clause acknowledging the
asked about her condition and no
the patient , which is specifically
tralian Doctor .
performed euthanasia on a woman
degree of discretion her physician
longer understood what he meant
intended for the situation in which
“ I think the biggest thing is that
with dementia who had to be physi-
would have over the end of her life .
when he tried to ask her about
the person who drafted the living
someone is going to die because
cally restrained by her family .
“ By signing this request for eutha-
euthanasia .
will ends up in a state of unbeara-
of you .
The doctor was charged with vol-
nasia , I therefore consciously accept
When it was explained to her , she
ble and hopeless suffering and is no
“ You do not sleep very well the
untary manslaughter under article
the possibility that a physician might
said : “ No , I don ’ t want that .”
longer able to express his will ,” the
night before . You do not sleep very
293 of the Penal Code .
comply with the request , about
“ I explained to her that she would
court wrote .
well the night after . It is a very
The District Court of The Hague
which I might have come to think dif-
be admitted and that she then had
But there is an important point
intense thing .”
was told that the patient had written a directive asking to be euthanised if she had to enter a care home .
ferently in my present state of mind ,” she had stated .
But as her condition deteriorated
to stay there and that she earlier had expressed that she didn ’ t want that and then I started about euthanasia .
here . Ultimately , the case was not about the judges trying to establish whether the patient was experienc-
VAD in Australia
The VAD system in Australia is still in
Multiple independent physicians
at the start of 2016 , she began to issue
“ She said , ‘ Yes , I might [ have
ing unbearable suffering , whether
its infancy , where the eligibility cri-
and family members had agreed that
ambivalent and contradictory state-
wanted ] it then but not now ,’” the GP
the patient had “ wanted ” to die and
teria have been largely restricted to
her condition aligned with her direc-
ments about euthanasia .
told the court .
the conceptual issues of what that
those likely to die within 12 months
tive ’ s description of unbearable suf-
Her husband told the court that
Nursing staff also said that , during
means in the case of a patient with
who face unbearable suffering .
fering , and so a sedative was put in
advanced dementia .
But it is founded on the require-
her coffee .
It was about whether the doc-
ment that , at the moment of their
Despite this , the woman began
tor had gone through the processes
death , they are fully aware of what is
moving and making noises before the
laid down by the law to establish
about to be done to them .
drug was administered and had to be
whether the patient was experienc-
But the debate is evolving .
restrained while the lethal injection
ing unbearable suffering and was
Dementia Australia currently
was administered .
expressing consent .
stresses it has no position on the
The prosecution alleged the
It was an issue about whether the
question of euthanasia but says it
doctor had acted without proper
geriatrician had shown due care or if
supports what it describes as the right
assent by performing eutha-
she had been reckless .
of every person , including those liv-
nasia on a patient expressing
Dr Mulder said even with
ing with dementia , to exercise choice
“ contraindications ”.
the sovereignty assigned to the
over end-of-life care options , which it
“ A written living will has to be
advance care directive , doctors in
says may include VAD measures .
verified as long as an incapacitated
the Netherlands retain a significant
Clearly , the ethical debate sur-
patient is still able to express a spe-
degree of discretion in making the
rounding euthanasia in the context of
cific ( coherent ) wish to live or die ,”
final determination .
dementia is not simply about concep-
it argued .
“[ Physician ] discretion is only
tual abstractions .
“ Since the patient at some point in time made statements that can be taken to mean that she thought euthanasia went too far and that she did not want to die yet , the accused was not allowed to practise
Dr Thomas Mulder ( PhD ).
logical as [ consent ] would entirely depend on the specific circumstances of each case and no laws or guidelines could prescribe how to determine whether consent has been expressed in detail as every
If this news story has raised issues for you , or you are concerned about someone you know , call Lifeline on 13 11 14 . You can also contact your local Doctors ’ Health Advisory Service .