Assisted Suicide for the Demented?
July 12, 1999
A rare case history in a Dutch medical journal recently reported the assisted suicide of an elderly patient with vascular dementia, says the British Medical Journal. The psychiatric patient was considered competent to request assisted suicide and the procedure was judged to be medically and legally sound.
The case involved a 71 year old man who for four years had had cerebral atrophy and multiple brain infarction. Magnetic resonance imaging confirmed that his condition was deteriorating. He asked his doctor to help him to die because he did not want to have to cope with further decline.
Dutch law states that doctors can avoid prosecution for assisted suicide only if their patient has persistently made an informed and voluntary request and is suffering unbearably and hopelessly. The patient in this case was considered "ill enough not to want to go on anymore, but... not so demented that he could not decide."
The hospital involved, the Twents Psychiatric Hospital, set up a complex protocol -- the first of its kind in the Netherlands -- to consider the patient's request. Four months after assessment the patient died at home after drinking a high dose solution of barbiturate given to him by his doctor. The public prosecutor approved the procedure after consultation with the national forum of procurators general.
The case has raised fears that it brings euthanasia for demented elderly patients a step closer. The Alzheimer's Foundation in the Netherlands warned: "Dementia itself could never be a reason for assisted suicide because the patient is incapable of making an informed request."
Medical director of the Royal Dutch Medical Association, Rob Dillmann, said that if a patient was in the early stages of dementia but still clearly competent and with an untreatable progressive neurological disease then there was the possibility of appropriate physician assisted suicide.
Source: Tony Sheldon, "Euthanasia endorsed in Dutch patient with dementia," British Medical Journal, July 10, 1999.
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