A Dutch physician who had family members restrain a struggling woman so she could administer a lethal injection has been cleared of wrongdoing by a review board.

Without consulting the patient, the doctor put a sleep-inducing drug into the woman’s coffee in order to give her the injection, but then the woman woke up and reportedly “fought desperately” to free herself. At this point, family members were summoned to hold the woman down so that the procedure could be completed.

The woman, who was in her 80s and suffered from dementia, had signed an advance directive to be killed “at the right time” though she had not ratified the request recently. According to case documents, she occasionally exhibited “fear and anger” and several times had been found wandering around the nursing home where she was living.

Medical records revealed that the patient had said “I don’t want to die” several times in the days leading up to her death, yet the doctor chose not to speak with her about her earlier request to receive euthanasia.

The slippery slope leading from voluntary euthanasia to involuntary euthanasia was articulated years ago by University of Cambridge professor of law and medical ethics John Keown: “Once a doctor is prepared to make such a judgment in the case of [a] patient capable of requesting death, the judgment can, logically, equally be made in the case of a patient incapable of requesting death,” he wrote.

“If a doctor thinks death would benefit the patient, why should the doctor deny the patient that benefit merely because the patient is incapable of asking for it?” he said.

The Regional Review Committee determined that that while the present case involved some irregularities that merited a reprimand, the doctor had been “acting in good faith” and therefore was not guilty of a criminal offense according to Dutch euthanasia laws.

The panel added a recommendation that the case come to court in order for judges to confirm that any other doctor who acts “in good faith” when euthanizing people with dementia in the future cannot be prosecuted.

“I am convinced that the doctor acted in good faith, and we would like to see more clarity on how such cases are handled in the future,” said Jacob Kohnstamm, chairman of the Review Committee.

The Netherlands was the first country to decriminalize euthanasia and assisted suicide in 2002, and in the intervening 15 years as many as 1 in 33 Dutch people are thought to have died this way, including 650 babies with disabilities a year.

Though originally proposed as a method of last resort for the terminally ill, assisted dying is fast becoming a “lifestyle choice” in the Netherlands. People now request euthanasia for a variety of causes, such as a 47-year-old divorced mother of two who was suffering from tinnitus, a loud ringing in the ears. When she was killed, she left behind a 13-year-old son and a 15-year-old daughter.

According to reports, the Netherlands is expected to enact a law later this year that would allow for elderly people to request euthanasia if they “have a well-considered opinion that their life is complete.”

Although the bill limits the disposition to “the elderly,” the briefing did not specify an age requirement.

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