Professor Penney Lewis:

There are two different ways by which a patient might access euthanasia in the Netherlands. By far the most common is where a patient in relatively early stages of dementia makes a contemporaneous request, and I distinguish that from someone who makes a request in advance of losing capacity. This is someone who would be assessed by the doctor performing euthanasia and the independent consulting doctor who, in the vast majority of cases, will be a doctor who has been specifically trained to perform that consulting function in euthanasia cases as having capacity to make decisions. It would be at a relatively early stage in the disease progression. The vast majority of cases involving dementia patients involve those kinds of patients. They also have to meet the other criteria, of which the most important to flag is unbearable and hopeless suffering with no prospect of improvement. They would have to convince the doctor that they were suffering unbearably as a result of their condition. The Dutch statute does permit advanced requests for euthanasia, that is, a request made in advance of the loss of capacity. The evidence appears to be that Dutch doctors do not like to perform euthanasia in those circumstances and the number of advance requests is tiny. The vast majority of dementia cases where the patient has received euthanasia have been contemporaneous requests. In theory, it is possible to make an advanced request. There are two reasons those cases are vanishingly small. One reason is that doctors like to be able to speak to the patient about his or her request at the end and be sure that it is what the patient still wants. The medical association advises that one must still be able to do that so if one cannot then, one should not perform euthanasia. The other is that the unbearable suffering criterion still exists so the doctor would still have to be convinced at the time of the euthanasia that the patient was suffering unbearably and it can be quite difficult to be convinced of that if the patient no longer has capacity to express to the doctor his or her suffering.