Table 2 Case Vignette

Mr. Smit is 70 years old and is indisputably diagnosed with dementia by a geriatrician. He does not recognize his wife and children anymore, refuses to eat, and increasingly isolates himself. Discussing his treatment is not possible anymore. Ten months ago, still being competent, he composed an advance euthanasia directive (AED), in which he declared that he would opt for euthanasia when suffering from dementia.

His family is now asking for performing this, given the patient’s AED and his unbearable suffering with no prospect of improvement. The general practitioner considers the patient incompetent, can imagine that the patient is unbearably suffering and is convinced that the patient’s AED can replace an oral request. The consulted SCEN physician^a and elderly care physician confirmed this and approved euthanasia. A sedative was orally administered to prevent possible unpredictable behavior, agitation and startle reactions at which the patient might walk away, after which the GP performed the euthanasia. After having received the written report of the euthanasia procedure from the GP, the regional review committee invites him to give an explanation of his actions.