Euthanasia dilemma: Dutch doctor forced patient to follow through with death wish

[True Dough]

I am an advocate of euthanasia, but this case is a tough one. I mean, if someone of sound mind declares that they are most certainly prepared to die but then that person later, while possibly suffering from dementia, resists the act of euthanasia, what should be done?

This is what happened in Holland recently...

A Dutch woman doctor who asked an elderly patient's family to hold her down while she administered a fatal drug dose has been cleared under Holland's euthanasia laws.

Mailonline reported that the patient fought desperately in an attempt not to be killed.

Jacob Kohnstamm, chairman of the Regional Review Committee, which considered the case, said: "I am convinced that the doctor acted in good faith, and we would like to see more clarity on how such cases are handled in the future."

As a result, the case will be considered by Dutch courts to clarify the law over whether doctors who carry out euthanasia on patients with dementia should face prosecution if they acted in good faith. In this case, the woman, who was suffering from dementia, had earlier expressed a desire to have her life ended when she felt the "time was right".

http://www.telegraph.co.uk/news/2017/01/28/panel-clears-dutch-doctor-asked-family-hold-patient-carried/

[Mosby]

1. They murdered her, plain and simple.

[LisaL]

2. I'd say. If the woman is fighting then she changed her mind and is making it clear.

[HassleCat]

3. We would not allow the same thing here.

We would view a last minute struggle as a revocation of permission. Not sure why the Dutch see it differently, but they do obviously.

[Kashkakat v.2.0]

4. What's "tough" about it OP? If there is no mechanism for the person, demented or not, to change

their mind then it is a faulty, ill-conceived process that has to be changed. NOt only for the patient but how would you like to be one of those family members, haunted forever by your last memory of mom being you holding her down for a lethal injection. Yikes.

I cried for a month after my 22 yr old cat with congestive heart failure was euthanized and she had some moments of resisting - I dont know how ori f Id ever come back from it if it was my Mom.

[True Dough]

9. Well, my own feeling

is that it's abhorrent to force a person to their death.

All of the details in this case aren't presented here but let's consider these possibilities:

1) While she had all her faculties, the woman made a declaration that she wanted to die.

2) The woman began to suffer from dementia and when the time came to assist her in her death, she no longer recalled her resolute wish to avoid a deteriorating quality of life as a result of cognitive impairment.

3) The family members present knew of her insistence, while still lucid and rational, that she did not have any desire to live as a shell of the person she once was, so they respected those wishes despite her reluctance in the moment.


Now, all that said, you can counter #2 with "she has a right to change her mind." Valid point. But it's a question of making decisions while sane/insane.

You can counter #3 with "the family's motive might have truly been to cash in on her estate, not to respect her wishes regarding quality of life." Maybe.

It's not clear cut. In such a situation myself, I would be unwilling to proceed with the euthanasia, but I can see why points 2 and 3 could be debated in some circumstances.

[Kashkakat v.2.0]

12. There are no objective scientific tests for "sanity" vs. "insanity"- at best its a culturally biased

subjective determination that changes over time. That being the case the law needs to err on the side of caution. Certainly you can see holes in the brain worsening over time but still... in this case she obviously still had enough cognition to perceive what was going on

Jeez louise, whats the big rush - if its alzheimers that would've killed her soon enough.

[True Dough]

13. Not everyone with Alzheimer's goes quickly

Read post #8 from politicat. Some people suffer for years and years, becoming aggressive or violent along the way. It's a very troubling existence.

[Crunchy Frog]

5. No dilemma for me.

The doctor was absolutely in the wrong here.

[Phoenix61]

6. My maternal grandmother had dementia

All of her daughters, including my Mom, had/have dementia. When my Dad died a little over a year ago I moved my Mom in with me. I tried working full-time and caring for her but... I quit my job so I could care for her. She can't eat solid food and has been on a liquid diet for over a year. She can drink through a straw but can not hold the cup. She is wheel chair bound and requires significant assistance to transfer into/ out of it. There is no doubt in my mind this is not what she wanted.

[Buzz cook]

7. Not that simple.

"

In this case, the woman, who was suffering from dementia, had earlier expressed a desire to have her life ended when she felt the "time was right".

According to case notes, the woman, who lived in a nursing home, showed signs of fear and anger. She would also wander around the premises at night.

The end came when a doctor put a soporific into her coffee before administering a lethal injection.

But as the doctor tried to administer the injection, she began to struggle and the doctor had to seek the family's help to complete the procedure.

Details of the case emerged as the Dutch consider changes in the law which would give anyone over 75 the right to assisted suicide.

"

If I have Alzheimer's disease and I decide on euthanasia while I am still competent, does my later refusal when I am not competent supersede the earlier decision?

Would the family have helped hold mom down if they did not believe they were following her wishes?

Did this story only become an issue because the doctor didn't put enough soporific in the lady's coffee?

[True Dough]

10. That's true

There are some variables here, and in other cases, that raise many ethical questions.

[politicat]

8. Erm. Having recently been on the other side...

My grandmother had the most restrictive living will she could write when and where she wrote it. She had a suicide kit in her house. She was a geriatrics nurse, and the last thing she wanted was to spend her last years at work. If she'd had an option for assisted suicide, she would have signed up on the first day. She absolutely did not under any circumstances want to be kept alive, and did not want to live out her final years dealing with dementia.

She had her first stroke in public, and the hospital where she was taken (despite having her advance directive on file) did not follow her directions. They also failed to competently evaluate her after the first stroke, and eventually released her to her own care, despite the destruction of her executive function, ability to plan, and significant damage to her short-term memory and emotional regulation. She became an emotional 13 year old, with the planning and executive skills of a 4 year old overnight. But she could manage a social conversation and walk down a hallway, so they let her return to her rural farmhouse (alone) and resume driving for herself.

Over the next year she: started an affair with a married man who stole several thousand dollars from her, accidentally started four kitchen fires, got scammed three times over the phone and once by a traveling repair crew (in addition to the asshole) and wrecked two cars. Then she had another event, and ended up in a nursing home against her will. And again, the hospital failed her.

I didn't know she made me responsible for her until a distant cousin called and asked me what to do. (I live 1000 miles from her farmhouse.) I got her into care where I could be there and I have spent the last few years complying with both my grandmother's current wishes and the wishes she made when she was in full possession of her mind and faculties, while her body failed and mind withered under hypoxia because her arteries were blocked. By the time we found it, it was too late. (If she'd had a neck ultrasound after the first stroke and gotten the stents, she'd be fine today.) There was no way she could live with me; she outweighed me by more than a hundred pounds, she fell, and she got combative with family. Nor could I live with her.

She was miserable for all three years. She hated being in care. She couldn't care for herself, and wouldn't let family members care for her. She never stopped wanting her car, her own stove. She lost her speech, what was left of her motivation, her volition, her movement, her continence. She never wanted this -- she had a kit and she planned to use it, but never could. And as she failed, she got more combative, more resistant, more scared, because she'd lost control of her own mind. That's the dementia. The person she was died slowly as her brain starved, until she was only a brainstem.

She suddenly declined at Christmas. When hospice asked me what she wanted, I said Ativan for anxiety and morphine for pain. It's what was in her kit.

That doctor and that family and that lady have my sympathy. I wouldn't wish dementia on my worst enemy. It steals souls.

[True Dough]

11. Thanks for sharing this, politicat

I don't envy the situation you found yourself in. Must have been agonizing.