Readers’ questions about euthanasia

I experience my life as completed – what can I do?

Since I am already 87 and have a wonderful life behind me and am in a wheelchair after a fall and very dependent on others, I would very much like to stop living. My 4 children are aware and understand. My doctor is also aware. But what can I do. No more eating and drinking is all I know. Would love your advice.

Eric van Wijlick, euthanasia expert at the KNMG:

“I gather from your letter that you consider life ‘complete’. No one but the person can judge whether his or her life is complete, assuming that a life can be completed. Doctors see no role or task in judging whether a life is complete. What a doctor can and will do is take your death wish seriously by talking to you to explore underlying questions, fears and concerns. Together with you he can see what is possible and what is not allowed.

Euthanasia is only possible in the Netherlands if people suffer unbearably and hopelessly due to a disease or condition. Many people with a ‘completed life’ wish also suffer from multiple age-related complaints, which together result in unbearable and hopeless suffering. They fall within the criteria of the Euthanasia Act.

If euthanasia is not allowed and possible, or if you do not want to, then it is wise to view reliable information, such as the book Uitweg by Chabot en Braam, and to discuss with your doctor, for example, the possibility of not eating and drinking.

It Treatment ban is an advance directive in which you write that you no longer want to be treated with antibiotics for pneumonia or, for example, no longer want to be resuscitated in the event of a cardiac arrest, for example when you consider your life to be complete. It is important that you discuss this with your loved ones and also with your doctor, so that they are aware of your wishes.”

I have a euthanasia statement. But will it also happen if I become demented?

If I have a euthanasia certificate with my GP and my children also have one, can I be sure that it will also happen if I become demented?

Eric van Wijlick, euthanasia expert at the KNMG:

“A written request for euthanasia is important if you become so seriously ill that you are no longer able to discuss your request for euthanasia with the doctor. Conversations with you are very helpful for your doctor. This gives the written euthanasia request more value and a clear meaning. However, a written request for euthanasia is not a guarantee.

A written request for euthanasia is important and replaces an oral request for euthanasia. Such a situation, in which you can no longer make a verbal request, can gradually arise, for example in the case of dementia. In principle, the written request for euthanasia also includes conversations with your doctor. This contributes to a careful consideration of your request by the doctor. It is often not enough for the doctors if you only write down a request for euthanasia. It is very important that your doctor knows exactly what you mean and that he can explain to you when and when not to perform euthanasia.

It must be clear that a written request for euthanasia is certainly no guarantee of euthanasia, but that it is an important document in any case. It gives you and your children guidance and direction when choosing care if you are no longer able to communicate about this yourself. Even if no euthanasia takes place, your doctor may deduce from the written euthanasia request that you no longer want life-prolonging treatments in the circumstances described.

I have early dementia and I am always in pain, but our GP is not cooperating. What now?

My husband and I sometimes talk about euthanasia. Our doctor is not behind it. My husband has canal stenosis in several places in his spine. Nerves are pinched. He has a lot of pain. It’s not operable. Pain relief via the pain clinic does not help. He takes a lot of medication. He is also a heart patient and has had several strokes. He has thereby lost 40% capacity of the heart. He also has Sjögren’s disease and wear and tear in the knee. The whole day consists of pain. He indicates to me that he does not want to be resuscitated if he ever goes into cardiac arrest. He is now almost 70.

He indicates that if he starts to suffer from dementia, he wants to take his own life. He also does not want to put me through all the misery of care, the more so because care for the elderly is so poorly arranged these days. I myself have been a caregiver for my father for many years, and I have helped friends of ours with arranging the Social Support Act. It was all dull misery. I almost went under myself. Fortunately my father was clear of mind until the last moment of his life and could decide for himself what he wanted when he became ill. He has chosen mortification.

My husband and I wonder what to do if my husband doesn’t want to go any further, but he is, for example, mentally unable to express his wish. How can we record that euthanasia is a choice that we would like? My husband’s quality of life is already low, but if it gets even lower, we don’t want to get stuck.

Eric van Wijlick, euthanasia expert at the KNMG:

“In general, having dementia in itself is not a reason for a doctor to perform euthanasia. However, in addition to suffering from the consequences of the dementia that he is already experiencing, a person can suffer severely from the further mental decline, loss of independence or the fear of this. If the patient experiences this suffering as unbearable, a doctor can grant a request for euthanasia in certain circumstances. When this happens, it is usually in the early stages of dementia. In this phase, the doctor can still communicate with the patient himself about the intolerance of the suffering and whether the patient still wants euthanasia. If communication with the patient becomes more difficult and it becomes more difficult for the doctor to understand that the patient is now suffering unbearably and wants to die, then it is ‘five to twelve’. If a doctor can no longer check with a patient whether the wish for euthanasia still exists at that time, there is a good chance that the doctor will not perform the euthanasia.”

The doctor thinks it is still too early?

We, my wife and I have had a living will drawn up at the Notary. My GP, the Notary and I have a copy of this in our possession. My husband was told in September that he has the onset of Alzheimer’s. Does he always have to go to his doctor to tell him that he doesn’t want to go to extremes? And must the GP comply with his wish as long as my husband can still indicate that he does not want to live anymore? Everything is written in black and white, but we are afraid that the doctor will say that it is not so bad for my husband even though my husband thinks it is.

Eric van Wijlick, euthanasia expert at the KNMG:

“A doctor must comply with the Euthanasia Act. If a doctor wants to perform euthanasia, he must first check whether your request meets the due care requirements of the Euthanasia Act. He follows the professional standards and guidelines. At the time of euthanasia, your doctor must be convinced that you are suffering unbearably and hopelessly. So it may happen that a doctor says it is too early, because there are other ways to make the suffering bearable.”

Euthanasia as soon as I am too demented to eat myself – how do I arrange that?

If I am demented, I would consider the time for euthanasia to be the time to switch to tube feeding. How do I do that?

Eric van Wijlick, euthanasia expert at the KNMG:

“A written request for euthanasia provides guidance and direction in the choice of care if you are no longer able to communicate about this yourself. If you can no longer eat and drink yourself, your doctor will no longer start administering food and drink artificially. It may be deduced from the written request for euthanasia that you no longer want life-prolonging treatments in the circumstances described. To avoid any misunderstanding, you can also Treatment ban write down which treatments you no longer want if you become seriously and incurably ill. Think of no longer wanting to be resuscitated with a cardiac arrest, no longer administering antibiotics for pneumonia or no administration of fluids and food. Doctors have to follow that.”

I have incurable cancer but my doctor is strongly against it. What now?

I have incurable cancer. But my GP is vehemently against euthanasia. What are my options now.

Eric van Wijlick, euthanasia expert at the KNMG:

,,There is no right for patients to euthanasia. Your doctor is not obliged to carry out the euthanasia request. Your doctor can ensure that you can see another doctor. Sometimes you have to look for another doctor yourself, for example the doctor in the hospital.”

Is one euthanasia declaration enough for different situations? And where do I keep it?

Do you have to have a euthanasia declaration made in case you become terminally ill? And also a separate euthanasia statement for when you become demented, such that when your own family and friends are no longer recognized, you declare that you no longer want to live. Or can this be done in one statement? Who should keep copies with? Hopefully there will be a law that allows you to decide for yourself when you think you’ve had a completed life and no longer want to live.

Eric van Wijlick, euthanasia expert at the KNMG:

“If you decide that you would like euthanasia in certain and different situations, it is best to describe these circumstances as concretely as possible in one statement. It is wise to write down in your own words when suffering is so unbearable and hopeless for you that you want to make a request for euthanasia for different situations. It is sensible if your next of kin also have a copy of your statement.

Your doctor must clearly state in the medical file that you are requesting euthanasia, why and for what circumstances. Your doctor must add your written request for euthanasia to your medical file. Are you going to see another doctor, for example because you are moving house, or are you also being treated by another doctor or specialist? Please provide them with a copy of your written request for euthanasia and discuss this with them. He will ensure that your request is included in your medical file.”

Is euthanasia allowed in a coma? Also in France?

We were confronted with the facts when our 84-year-old neighbor suffered a number of strokes and fell into a coma. He was in a coma for 4 years before passing away. We live in France and here euthanasia is in no way negotiable! Is it possible, if something similar happens to one of us, to be transported to the Netherlands to make use of a euthanasia scheme?

Eric van Wijlick, euthanasia expert at the KNMG:

“Performing euthanasia on a patient in a coma is punishable by law in the Netherlands. Doctors are therefore not allowed to perform euthanasia on comatose patients, even if this is stated in a euthanasia request. The doctors in the Netherlands are of the opinion that if a patient is in a coma and there is no longer a reasonable chance of recovery, further treatment is pointless. Doctors then decide, in close consultation with the next of kin, that the treatment is discontinued and the patient dies.”

Read more:

Eric van Wijlick is a policy advisor for medical matters related to the end of life at the KNMG doctors’ federation. More information from him about euthanasia:

Euthanasia in dementia: what is possible and what is not

Everything you need to know about euthanasia