Requests for euthanasia as a couple increase in the Netherlands

Dries and his wife, Eugènie, a 93-year-old Dutch couple who had been together for more than seven decades, died on Monday, February 5, holding hands.

Both very ill, they did not want to be separated and requested the so-called joint euthanasia, a type that has been increasing in recent years and was authorized by the doctors who treated them.

They were not an anonymous couple in the Netherlands.

He was Dries van Agt, Catholic and former Christian Democrat Prime Minister of the Netherlands between 1977 and 1982. With his wife, Eugènie Krekelberg, they had three children and seven grandchildren to whom they said goodbye in peace.

The news was announced four days later, when they had already been buried.

Dries van Agt called his wife “my girl.”

She was the pillar of his life and they did not contemplate leaving the other behind at the end of their lives.

A lover of cycling and with a use of the Dutch language so cultivated that it had a reputation for being archaic, they met when they were students.

They never separated again.

In his case, euthanasia does not seem like a choice of a Catholic believer.

However, Van Agt, who ended up voting for the environmentalists and criticized official Dutch policy on the conflict between Israel and Palestine, returned his Christian democracy card.

In 2019, he admitted that euthanasia “would be an option if life and suffering become unbearable.”

That year he had a brain hemorrhage whose consequences worsened over time, and his wife's health also deteriorated.

The doctors accepted her double request because they considered that they met the requirements of the Euthanasia Law, in force since 2002.

In recent years, the number requested as a duet has experienced an increase.

In 2022, 29 couples were performed: 58 people, according to the annual report published by the Regional Euthanasia Review Committees (RTE, in its Dutch acronym), which review all those carried out in the country.

In 2021, it was applied to 16 couples.

In 2020, there were 13, and in 2019, there were 17. In total, in 2022, doctors carried out 8,720 euthanasias and assisted suicides, the two cases contemplated in the standard.

They account for 5.1% of all deaths recorded in the country, and represents an increase of 13.7% compared to 2021. The majority of patients – almost 60% – had cancer.

When the sufferings are physical and unbearable due to an illness with no possibility of improvement, the situation may be clearer.

The moral evil of not wanting to stay alone in very close couples is a fact, but it is not decisive.

And something else.

Euthanasia must be requested freely and without external pressure.

But how to evaluate if two people who have been together their entire lives have influenced each other to request it at the same time.

“Future suffering, if it is concluded that only one of the two meets the conditions for euthanasia, is not considered a criterion.

What is evaluated is the situation on the ground and how the condition is experienced in the present moment,” says Sander de Hosson, lung specialist and author of two books on palliative care, by telephone.

“Not everyone asks for or receives euthanasia in the Netherlands, that must be clear.

Although it is true that it is considered a private matter, and we know that it has the support of about 87% of the population,” he emphasizes.

The RTE dedicated a passage to couples practice in their 2018 annual report. There you can read that, in this case, the doctor who takes care of the patients must consult two different advisors to evaluate each of the members by separate.

In 2022, euthanasia consultant Dominique Rijnja shared on her LinkedIn page a photo of the clasped hands of a married couple in these conditions on her deathbed.

The image generated numerous reactions and also requests for this kind of help, but the law has not been relaxed because of this.

In euthanasia for a single person, one doctor treats the patient and another checks that the request complies with the law.

In joint euthanasia, there are two supervisors.

“Only when these doctors, who talk in depth with the patients, have done their job and the situation is clear, do we move forward,” says De Hosson.

And he recalls: “Dutch legislation always requires insurmountable suffering with no prospect of improvement, and a lucid and repeated request on the part of the patient.”

A member of Carend, an association specialized in promoting palliative care, indicates that the Van Agts were very sick and had insurmountable suffering.

“You cannot pressure a person to choose this option.

All requests are studied in accordance with current regulations.”

The reviewing physicians cannot influence each other either, so they only exchange patient data if necessary.

With couples, it can be administered by a single doctor or two at the same time.

The Carend website contains the case of a couple who had celebrated 48 years of marriage.

Both were very ill, they lived in a nursing home and wanted to die together at the same time as their wedding: 3:15 p.m.

The doctors of the so-called Euthanasia Expert Center (Expertise Centrum Euthanasie) considered that they met the legal demands and it was carried out in 2022, with the two children of this couple being present at the farewell.

This organization accepts requests, within the law, that some doctors cannot or prefer not to attend to.

In 2022, it was in charge of 14.2% of all euthanasias carried out in the Netherlands, according to RTE data.

The figures for 2023 will be ready in spring and, according to the Regional Committees, only then will it be seen whether there has been a general increase.

What is already known is that last year 282 people with dementia requested it.

There were also 115 cases of people suffering from one or more serious psychological disorders.

On 13 occasions—0.1% of the total—there was carelessness, that is, the doctors did not pay close attention to all the details of the standards they must comply with, but no bad intentions were evident on their part.

According to the most recent official report evaluating the law (2017 and 2022), 20% of the 131 doctors surveyed considered the euthanasia procedure to be a burden.

For 69% it was neutral.

Prepared by researchers from Erasmus University in Rotterdam and the university hospital in the same city, as well as those in Utrecht and Amsterdam, it indicates that 25% felt pressured at some point by a patient.

This last group was headed by geriatricians, followed by general practitioners and specialists.

The study, published in 2023, recommends being vigilant, since the patient's perception of their own condition and suffering gains weight.

Emphasis is also placed on the need to better advise doctors in cases of mental illness or dementia.

They are the ones who usually end up in the Center of Experts in Euthanasia, which can thus face waiting lists.

The Dutch Euthanasia Law was the first of its kind in the world and was passed in 2001. In force since 2002, it is still considered an exceptional practice, and not a patient's right, and can lead to up to 12 years in prison if violated. legal requirements.

It includes both euthanasia, which is performed by the doctor - generally a family doctor - and assisted suicide.

In the second case, the person himself administers the product prepared by the doctor.

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