Dutch court allows euthanasia in advanced dementia cases

The Netherlands' highest court ruled Tuesday that doctors can carry out euthanasia in patients with advanced dementia if the patient has earlier made a written directive.

(CNN)Doctors in the Netherlands may legally euthanize patients with severe dementia who previously provided a written request for the procedure, the country's highest court ruled Tuesday.

In the landmark decision, the court said that a physician may respond to a written request for euthanasia made before someone develops advanced dementia, provided certain legal requirements are met -- even if the patient's condition means they become unable to confirm that request.
Euthanasia is legal in the Netherlands if the relevant criteria are met, which include a voluntary and well-considered request from the patient, "unbearable suffering without any prospect of improvement," and the lack of a "reasonable alternative," according to the Royal Dutch Medical Association.
If those conditions are not met, the practice is still a punishable offense.
    In 2002, the Netherlands became the first country in the world to legalize euthanasia.
    Tuesday's ruling follows the criminal and disciplinary case against a nursing home doctor who in 2016 ended the life of a 74-year-old woman suffering from dementia.
    The woman had written a directive asking for euthanasia in the event she was admitted to a nursing home with dementia and she thought the time was right.
    Prosecutors had argued that the doctor did not do enough to confirm consent in ending the woman's life, saying that once she was admitted to the home, she gave "mixed signals."
    At the time, the court concluded that the unidentified doctor, who has since retired, carried out euthanasia in accordance with the law and had not been negligent.
    In its judgment Tuesday, the Supreme Court sought "to give direction to euthanasia lawmaking."
    "A doctor may respond to a written request for granting euthanasia to people with advanced dementia. In such a situation, all legal requirements for euthanasia must be met, including the requirement that there is hopeless and unbearable suffering. The doctor is then not punishable," the Supreme Court said in a statement Tuesday.
    The ruling also noted that doctors can legally follow through with the procedure if the patient can no longer agree to it, due to their illness.
    "Even if it is clear that the request is intended for the situation of advanced dementia, and that situation is reached so that the patient is no longer is able to form and express a will, there can be circumstances where no follow-up on the request is possible," it said.
    René Héman, president of the Royal Dutch Medical Association welcomed the ruling, but warned that the situation remained complicated for doctors.
      "It is good that there is now a ruling from the Supreme Court. But even with more legal clarity, not all complicated dilemmas around euthanasia in the case of dementia are gone. With every request to end a life, a doctor must still make an individual assessment if euthanasia is appropriate and if all due care criteria are met," Héman said in a statement.
      "Doctors act according to professional standards and also on their moral compass. The doctor's own consideration is and remains very important," he added.