Writer Henk Blanken sees the possibilities for a death as he wishes approaching (‘A death with which I can live is in sight’, 8/1 Opinion). Now that the Supreme Court and the Royal Dutch Society for the Promotion of Medicine (KNMG) have said that the doctor no longer needs to ask for confirmation of your advance directive if you have become mentally incapacitated, and that you can even put a sleeping aid in your coffee unsolicited to ‘contrast’ For him, that is a step in the right direction. After all, the doctor can no longer hide behind your incompetent opinion that it is not yet time for death. That makes life a lot more pleasant, or perhaps only possible if, like Whites, you are afraid of becoming demented.
But a problem remains. In addition to the advance directive, there is another requirement that must be met. Namely the presence of an actual unbearable suffering. This is understood to mean observable suffering experienced by the person in question at the time the euthanasia request is current. However, that suffering is often no longer there when the dementia has progressed so far that there is also incapacity. You simply no longer know who you are and where you are going. So under what suffering? Blanken calls this a cruel paradox: that the dementia you fear robs you of the only necessary condition to be able to receive euthanasia when the time comes.
Reflection
For me, the Blanken paradox is rather the mirror image. The advance directive, which was intended to give you a grip on your uncertain fate, takes away from you the fear that could lead you to take a hold (to request euthanasia) if you still can: in a capable state. A fear that can be regarded as an anticipatory intolerable suffering, and can therefore be a basis for euthanasia. It’s the horse behind the cart.
With this comes the consideration of the value of the advance directive. On the one hand, the few who have both an advance directive and a current unbearable suffering and are given euthanasia on the basis of that (according to Blanken seven cases in a year and a half). On the other hand, the many who write an advance directive that will usually prove to be of no value because the suffering, once arrived in the nursing home, is imperceptible. But it gave the false reassurance that it is ‘arranged’. Which is not so.
The verdict has already been handed down: the advance directive must be seen as a failed experiment.
Simon Green is a clinical geriatrician np, scen doctor and employee of the Euthanasia Expertise Center.