The trial is the first of its kind in The Netherlands, where euthanasia has been legal since 2002.
CNN  — 

A doctor from a Dutch nursing home is on trial in a landmark case after performing euthanasia on a woman with dementia who prosecutors say may have had second thoughts about wanting to die.

The 74-year-old had earlier written a directive asking for euthanasia in the event that she needed to be admitted to a home due to dementia and that she thought “the time was right.” But, once in the home, she then gave “mixed signals” about wanting to die, according to a statement from the prosecutor’s office.

In the Netherlands, euthanasia is strictly defined as “the active termination of life at a patient’s voluntary and well-informed request,” according to the Royal Dutch Medical Association. It was legalized in 2002, making the country the first in the world to authorize the practice.

The trial, which is the first of its kind in The Netherlands, started Monday at The Hague district court.

Prosecutors are not seeking a punishment for the unnamed 68-year-old doctor, who is now retired, saying they were taking into account that she had good intentions, had fully cooperated, and had already been affected by the prosecution and previous disciplinary proceedings.

But they asked the court to declare her guilty in a case which they say “raises an important question that must be submitted to the court.”

The case hinges on the debate over how doctors should deal with euthanasia in the case of a patient who is incapacitated but can still communicate a desire to live, contrary to an earlier statement.

“As long as the woman was able to communicate, the nursing home doctor should have kept talking to her about her desire to live or to die,” reads the statement from the prosecutor’s office.

“And as long as that conversation gave cause for doubt, the nursing home doctor should have refrained from euthanasia.”

However the doctor performed euthanasia “in close consultation” with the family of the patient on April 22 2016, according to prosecutors.

“In this case, the public prosecutor concluded that the nursing home doctor had not met all due care requirements for euthanasia and had not been sufficiently careful,” according to the prosecutor’s office.

Two committees – the Regional Review Committee on Euthanasia and the Central Disciplinary Board for Healthcare – had come to the same conclusion, prosecutors said.

The trial will continue Wednesday and a verdict is expected in two weeks.

Alistair Thompson, spokesman for anti-euthanasia group Care Not Killing, told CNN that fear of becoming a burden to family members is driving increasing numbers of euthanasia cases.

“Once you say you have the right to die, that right quickly becomes a duty,” said Thompson. “You have people who are feeling pressured into ending their lives.”

Doctors are also affected by euthanasia policy, Thompson added.

“There’s no real help for the doctors out there either,” he said. “We should be thinking about the medical staff, who are under considerable pressure.”

But Dignity in Dying, a group campaigning to legalize assisted dying for terminally ill, mentally competent adults in the UK, said the trial demonstrated that Dutch authorities were operating within clear safeguards, with decisions carefully examined.

“What is clear from this case is that under the Dutch law decisions are being scrutinized in an open, transparent way,” Thomas Davies, the group’s campaigns and communications director, told CNN.

This was preferable to situations in which dying people were “forced to make decisions behind closed doors, suffer against their wishes or spend huge amounts of money to have an assisted death overseas,” he added.