Dutch euthanasia rules changed after acquittal in sedative case

Doctors euthanising a patient with severe dementia may slip a sedative into their food or drink if there are concerns they will become “disturbed, agitated or aggressive”, under a change to the codes of practice in the Netherlands.

The review committee for cases of euthanasia refreshed its guidance in response to the case of a former nursing home doctor, Marinou Arends, who was prosecuted for murder and cleared after putting a sedative in her 74-year-old patient’s coffee before giving a lethal injection.

Arends was given a written reprimand by the Dutch medical board for acting on the basis of two “advance directives” in which the patient said only that she wished to die when she considered the time was right.

But in April the supreme court ruled that no laws had been broken and dismissed the medical board’s decision, ruling that if a patient is no longer capable of giving assent, a doctor need not take a literal interpretation of an advance directive if the circumstances do not match the eventual scenario.

In response to the court, Jacob Kohnstamm, the chair of the euthanasia review committee, said his body needed to update its code for doctors involved in euthanasia.

The new code says that in cases where a patient has advanced dementia, “it is not necessary for the doctor to agree with the patient the time or manner in which euthanasia will be given”.

Kohnstamm said: “Doctors now have less to worry about putting their necks in a noose with euthanasia. They need less fear of justice. Or for the review committee.”

The decision has not been unanimously welcomed. When the 2018 case was first made public, 220 doctors put their name to an advert in which they condemned any medical practitioner who “secretly” sedated patients being helped to die.

Bert Keizer, a nursing home manager, told the Volkskrant newspaper that he opposed the changes but the clarity was welcome. He said: “This isn’t going to take off. There are very few doctors who want to do this, but it is good for those who do do this to have this clearly written down on paper.”

Since 2002, doctors have been able to euthanise adults in the Netherlands in cases where it is regarded as a voluntary and well-considered request in the context of unbearable suffering from which there is no prospect of improvement or alternative remedy.

Last year there were 6,361 cases of euthanasia in the Netherlands – just over 4% of the country’s total deaths. Of these, 91% were in cases of terminal medical conditions. The remainder of the cases involved severe psychiatric illness, including dementia.

This month the Dutch government said it would change the regulations to permit doctors to euthanise terminally ill children aged between one and 12, after months of debate within the ruling coalition government.

The health minister, Hugo de Jonge, said a change in regulations was necessary to help “a small group of terminally ill children who agonise with no hope and unbearable suffering”.