A disturbing story appeared on my news feed this week,

Elderly Woman Forcibly Euthanized

The article says that in the Netherlands an elderly woman with dementia was euthanized against her will.

But this article has come from the DailyWire, a partisan news outlet. And with no name given it's difficult to verify from a trustworthy news source.

Is any part of this article accurate?

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    Please don't use comments to post partial answers or anecdotes, if you want to participate in this question please post a full answer that can be voted on and that must fulfill our citation requirements. – Mad Scientist Aug 9 at 7:43

A physician in the Netherlands was recently reprimanded by an "Inspectorate" for the "Disciplinary Offices for Healthcare" (Tuchtcolleges voor de gezondheidszorg) over this case.

The women suffered dementia, and had earlier written a declaration of her desire to be euthanized. However, the Inspectorate concluded that the written declaration was not clear enough, and the patient did not give unambiguous and consistent statements about wanting to be euthanized - sometimes she wanted to die, sometimes she wanted to wait - so the physician should not have proceeded.

The main point that made the Inspectorate conclude ambiguity is given in point 5.9 of the detailed report:

Original: "[..] Het probleem met deze euthanasieverklaringen is echter dat deze verklaringen tegenstrijdigheden bevatten ten aanzien van het moment waarop patiënte de levensbeëindiging uitgevoerd zou willen zien. [..]"

My translation: The problem with these declaration of euthanasia, however, is that they contain contradictions regarding the point when the patient wants the euthanasia to be conducted.

"[..] Enerzijds lijkt het moment duidelijk ‘wanneer patiënte in een verpleegtehuis voor demente bejaarden moet worden opgenomen’, maar daar staat tegenover dat patiënte het moment waarop zij (in de terminologie van de eerste dementieverklaring) ‘nog enigszins wilsbekwaam was’ voorbij heeft laten gaan en toen geen ‘vrijwillig’ verzoek heeft gedaan. [..]"

On the one hand, the moment seems clearly defined "when the patient has to be admitted to a nursing home for people with dementia", but this is placed against the fact that she let the moment where (using the terminology of her first declaration) she was still 'somewhat lucid' slide and did not make the voluntary request to die at that point.

"[..] Hier komt bij dat de (van toepassing zijnde) tweede dementieverklaring inhoudt ‘wanneer ik daar zelf de tijd rijp voor acht’ en ‘op mijn verzoek’. Hierin wordt dus nog een tijdselement en een persoonlijke keuze ingebouwd. Niet dus het moment van opname in een verpleeghuis is bepalend, maar het eigen (nog te uiten) verzoek van patiënte. De schriftelijke euthanasieverklaring, met dementieclausule, is dus niet eenduidig en bevat onduidelijkheden. [..]"

Added on top is the (applicable) second declaration of euthanasia which states 'when I myself consider the time ripe' and 'at my request'. This builds in a time element and personal choice. Thus the moment of admission to nursing home is not the defining moment, but the (yet to be articulated) personal request. The written declaration of euthanasia contains ambiguities.

The second main issue the Inspectorate has, is the fact that the physician had not communicated to the patient that the procedure would be initiated. From paragraph 5.13 in the detailed report:

"[..] Het College onderkent dat communicatie met patiënte op cognitief niveau niet meer tot de mogelijkheden behoorde. Dit betekent echter niet dat verweerster was ontslagen van de verplichting om ten minste te proberen om met patiënte te praten over het concrete voornemen om haar leven te beëindigen en daarbij een slaapmiddel in haar koffie te doen. [..]"

The Inspectorate confirms that cognitive communication with the patient was no longer possible. However, this does not mean that the defendant no longer had an obligation to at least attempt to talk to the patient regarding the concrete intention to end her life and thereby putting a sedative into her coffee.

The case was anonymised, which explains why the newspaper reports did not include the patient's name.

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    This is the one where they had to hold her down, no? – Orangesandlemons Aug 6 at 8:02
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    @Orangesandlemons you have to do that sometimes with patients with dementia. – mathreadler Aug 6 at 9:02
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    The short of it is that when there's reason to suspect someone's severely violated their healer's oath, they get sent in. Medical equivalent of the Bar Association, although they can also recommend (in extreme cases) criminal charges to be filed. – Shadur Aug 6 at 11:57
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    I'm not sure... this answer misses quite a bit of the nuance given in the detailed decision. The declaration was 'clear enough', but based on the patient's own prediction regarding her final behaviour, which didn't match her eventual symptoms since the prediction was based on what she had seen her own mother evolve. And the main point of concern was that the physician hadn't told the patient that the drug sequence would be started with a drug mixed into her coffee. – DonFusili Aug 6 at 12:40
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    @DonFusili: I am going by a poor translation of the press release; would really appreciate any edits you can make to clear this up (or post a competing answer if you want the rep). – Oddthinking Aug 6 at 13:16

Oddthinking's answer is quite complete, but it does not quite address the allegation by the Daily Wire that

She was given coffee with a sedative in it, but she refused to drink it — and then struggled as the doctor tried to kill her. She fought so fiercely that the doctor ordered her own family to physically hold her down, and she was forcibly euthanized.

The Decision gives a detailed description under point 2.24, parts of which I will translate. Warning: Below are detailed descriptions of medical interventions with fatal result. Reading and translating this I found distressing, but if we're going to discuss this (I mean 'we' as in 'humankind') we should know the facts.

Present at the euthanasia were the husband, sister, daughter and son-in-law of the patient. Also present were a physician ("arts") and the defendant ("verweerster") who is a physician specializing in elderly care ("specialist ouderengeneeskunde").

To start with, the physician added 15 mg midazolam to the patient's coffee, as discussed with the family, but not with the patient herself.

"Toen na ongeveer 3⁄4 uur na de inname van 15 mg midazolam patiënte nog wakker was, heeft verweerster haar 10 mg midazolam subcutaan toegediend. Nadat patiënte in een toestand van verlaagd bewustzijn was geraakt, heeft een ambulancebroeder een infuus bij patiënte ingebracht, hetgeen ongeveer 15 minuten heeft geduurd omdat patiënte moeilijk te prikken was. Patiënte heeft hierbij nauwelijks gereageerd op deze pijnprikkels, maar heeft op enig moment wel een terugtrekkende beweging gemaakt."

My translation:

When, after about three quarters of an hour after taking the 15 mg midazolam, the patient was still awake, the defendant administered 10 mg of midazolam subcutaneously. After the patient entered a state of lowered consciousness, and ambulance medic started an IV, which took about 15 minutes because it was hard to find a vein. The patient hardly reacted to these painful stimuli, although she did at one point move away from them.

Then:

"Verweerster heeft, gelet op het ontbreken van pijnprikkels bij de inbrenging van het infuus, geen noodzaak gezien om (nog) de pijnstiller lidocaïne te geven. Vervolgens heeft verweerster 2000 mg thiopental intraveneus toegediend. Tijdens het inspuiten van de thiopental is patiënte omhoog gekomen en vervolgens door haar familie teruggelegd. Verweerster heeft toen de rest van de thiopental toegediend. Nadat verweerster had vastgesteld dat patiënte niet meer reageerde op aanspreken, niet ademde en geen wimperreflex had, heeft verweerster 150 mg Rocuronium intraveneus toegediend. Zeven minuten later heeft verweerster de dood vastgesteld door middel van pupilcontrole."

Translation:

Taking into account the lack of pain stimuli, the defendant did not think it necessary to administer lidocaine. Next, the defendant injected 2000 mg thiopental intravenously. While the thiopental was being injected, the patient rose up and was laid down by her family. The defendant then administered the rest of the thiopental. After the defendant established that the patient no longer responded to speech, did not breathe and had no eye-lash-reflex, the defendant administered 150 mg Rocuronium intravenously. Seven minutes later, the defendant pronounced death by way of the pupil control.

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    The critical line here is "While the thiopental was being injected, the patient rose up and was laid down by her family." – Axeman Aug 7 at 8:57
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    @Axeman indicating muscle spasm as she died, not unheard of AFAIK. – jwenting Aug 7 at 10:43
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    @jwenting, indicating something, that sentence is vague and LiveAction reports "She fought so fiercely that the doctor ordered her own family to physically hold her down". So it could be that they royally over-interpret the sentence in the decision, or it could be that the description is a very understated representation of reality. (I would suspect the first, but I'm not sure how we could discern the two.) – Axeman Aug 7 at 11:01
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    @Axeman the sentence (at least the Dutch version) is pretty clear about there not being any kind of struggle or resistance. None of these are the words you use for someone resisting, or being forced to do anything. – Erik Aug 7 at 18:09
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    I agree with @Axeman that that sentence is vague, in Dutch and in English, and leaves room, a bit too much room IMO, for interpretation. At the same time, "terugleggen" (to lay back down) has no connotation to violence: the same verb would be used for a toddler who got up in the night and is returned to bed by his parents. – Elise van Looij Aug 8 at 12:43

Something that isn't discussed in both answers here is that in her demented state, she did express herself.

From the decision, point 2.13, most recent 3 quotes, translated:

Dutch:

“2 april 2016 (…) mw. heeft lange tijd voor de camera gepraat, geklaagd en nu en dan gehuild en minimaal 2x gezegd dat zij dood wilde. (…)

“9 april 2016 (…) Gesprek in de hal (…)Mw. vertelt dat zij alles heel naar vindt en dat ze haar beter op kunnen knopen aan de deur (stelt vast dat die te laag is)”

”9 april 2016 (…) F [College: verzorgende] zegt mij het volgende: (…) Mw. was aan het huilen. (…) “ik denk dat ik binnenkort dood ga. Ik kan niet meer. Ik kan dit gewoon niet meer aan. (…)”

Translation:

2nd of april 2016. (…) Ms. has talked in front of the camera for a long time, complained, cried now and then and said at least twice she wanted to die. (…)

9th of april 2016 (…) Conversation in the hall(…) Ms. tells that everything's really unpleasant and that they could better hang her on the door (notes that the door is too low).

9th of april 2016 [Caregiver] tells me the following: (...) Ms. was crying. (...) "I think I'm dying soon. I can't anymore. I just can't handle it anymore (...).

There are many more quotes like this.

In the end, determining the will of a patient suffering from dementia is not always possible. But considering these statements, and the previous written declaration, I certainly wouldn't call this forcibly.

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    A major factor was also, as described in section 2.4-7 is that already in 2012 the patient signed a euthanasia intent, with a dementia clausule. Her mother and three brothers (one younger than her) had dementia and she feared the same prospect. When dementia was diagnosed in 2015, she signed another intent with the same content. – Elise van Looij Aug 6 at 15:00
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    @Elise very true. I hadn't repeated that since the answer by OddThinking also brought that point. The point I'm trying to add is that the patient, in her current state, was likely suffering and did desire to die. – Erik von Asmuth Aug 6 at 15:04
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    @ErikvonAsmuth yes, though the question for the lawyers is whether that suffering was grave enough under the legal definition of "great and interminable suffering" which if usually in decisions not thought to include mental anguish, only physical pain. – jwenting Aug 7 at 4:53
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    'I certainly wouldn't call this forcibly.' I think some of the question may be about the different meanings of 'forcibly'. Although the euthanasia may not have been 'against her will', the manner in which it was conducted seems by some accounts to have involved the use of physical force (restraint). – Mark Beadles Aug 7 at 13:34
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    @Mark The answer by Elise goes into the different steps leading up to that occurrence. Restraining in this case, was putting her back down in the bed after she got up, which happened after a substantial amount of Midazolam had been administered, and after she lost pain perception. This is also already discussed under that answer, but this should be considered an involuntary muscle spasm. These occur relatively frequently, and one of the reasons Rocuronium (a muscle relaxant) is used is to prevent these from occurring after death, which could be traumatic for the family. – Erik von Asmuth Aug 7 at 13:45

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