An Intolerable Price

Ms. Mekel is not in any hurry: she quite likes her life, in a trim, airy house in Castricum, a Dutch village by the sea. She has flowers growing in her back garden, and there is a street market nearby where vendors greet villagers by name. But if her life is going to end the way she wants, she will have to pick a date, sooner than she might like.

“It’s a tragedy,” she said.

Ms. Mekel, 82, has Alzheimer’s disease. It was diagnosed a year ago. She knows her cognitive function is slowly declining, and she knows what is coming. She spent years working as a nurse, and she cared for her sister, who had vascular dementia. For now, she is managing, with help from her three children and a big screen in the corner of the living room that they update remotely to remind her of the date and any appointments.

In the not-so-distant future, it will no longer be safe for her to stay at home alone. She had a bad fall and broke her elbow in August. She does not feel she can live with her children, who are busy with careers and children of their own. She is determined that she will never move to a nursing home, which she considers an intolerable loss of dignity. As a Dutch citizen, she is entitled by law to request that a doctor help her end her life when she reaches a point of unbearable suffering. And so she has applied for a medically assisted death.

The Netherlands is one of just four countries (plus the Canadian province of Quebec) that permit medically assisted death by advance request for people with dementia. But the idea is gaining support in other countries, as populations age and medical interventions mean more people live long enough to experience cognitive decline.

Ms. Mekel’s doctor referred her to the Euthanasia Expertise Center, in The Hague, an organization that trains doctors and nurses to provide euthanasia within the parameters of Dutch law and connects patients with a medical team that will investigate a request and provide assisted death to eligible patients in cases where their own doctors won’t. But even these doctors are reluctant to act after a person has lost mental capacity.

For five to 12 to work, doctors should know their patients well and have time to track changes in their cognition. As the public health system in the Netherlands is increasingly strained, and short of family practitioners, that model of care is becoming less common.

Ms. Mekel is haunted by what happened to her best friend, Jean, who, she said, “missed the moment” for an assisted death. Although Jean was determined to avoid moving to a nursing home, she lived in one for eight years. Ms. Mekel visited her there until Jean became unable to carry on a conversation. Ms. Mekel continued to call her and sent emails that Jean’s children read to her. Jean died in the nursing home in July, at 87.

Jean is the reason Ms. Mekel is willing to plan her death for sooner than she might like.

Conclusion

Ms. Mekel’s story highlights the complex ethical dilemmas surrounding assisted dying and end-of-life care. The Netherlands’ unique approach, which allows for advance requests for euthanasia, is controversial, but it has been supported by a significant majority of the Dutch population. The country’s public health system is under strain, and the availability of family practitioners is decreasing, making it challenging for doctors to provide the necessary care and support to patients like Ms. Mekel.

The introduction of medically assisted death has raised concerns about the potential for abuse and the need for clear guidelines and safeguards. The debate surrounding assisted dying is ongoing, with some arguing that it is a necessary option for people who are suffering and others who believe it is morally wrong.

FAQs

* What is medically assisted death?
Medically assisted death, also known as euthanasia, is a medical procedure in which a doctor intentionally ends the life of a patient who is suffering from a terminal illness or incurable condition.
* Is medically assisted death legal in the Netherlands?
Yes, medically assisted death is legal in the Netherlands, and it is permitted for patients with dementia who have made an advance request for euthanasia.
* How does the process work?
Patients who wish to request medically assisted death must make an advance request, which is then reviewed by a doctor and a medical team. The patient must be deemed to be suffering from a terminal or incurable condition, and the request must be made with “voluntary and informed consent.”
* Is medically assisted death available in other countries?
Yes, medically assisted death is available in a few countries, including Canada, Belgium, and Luxembourg. The legality of assisted dying varies by country and is subject to ongoing debate and controversy.