The Dutch doctor who euthanized a 74-year old dementia patient against her will and was exonerated of all charges gave a televised interview recently, in which she defended her actions as “for the best.”
The 2016 incident caused an uproar, in no small part because the doctor began the euthanization process by secretly drugging her patient’s coffee. The horror didn’t end there. When the patient woke up and resisted the lethal injection, now-retired geriatric specialist Marinou Arends asked a relative to hold her down so she could administer the fatal dose.
The patient had two previous directives stating she wanted to be euthanized “when the time was ripe,” but had explicitly declined to be euthanized three times leading up to her death. To Arends, however, ending the patient’s suffering was more important than doing what the patient said she wanted.
“Asking if she wanted to die [a fourth time] would only cause additional suffering,” Arends said, having judged the patient incapacitated enough that nothing she said could be taken seriously. As a doctor, she claimed also had “the authority to omit the question.”
Arends contends her patient was “sad,” “rebellious,” and “unhappy all day long. And that is another word for suffering.” “If I, as a doctor, have the opportunity to stop suffering, then I cannot abandon her,” she explained.
The appallingly permissive Dutch euthanasia law ensured Arends would be free from any legal consequences. The doctor’s most disconcerting justification for killing her patient, however, is not in the letter of the law so much as the attitude guiding euthanasia laws further and further into openly state-sanctioned murder: unhappiness can be a kind of “unbearable suffering,” and doctors not only have the right, but the responsibility, to end it.
Arend’s decision to euthanize her patient against her will is entirely consistent with the belief on which modern legal euthanasia is based: evading suffering as the highest moral good, easily outweighing any qualms about the sanctity of human life. Euthanasia at the level of permissibility we see in The Netherlands is merely pursuit of the goal of limiting human suffering.
Autonomy, often perceived as the point of legal assisted suicide, is in fact a secondary consideration. Case in point: That this dementia-stricken woman wasn’t at least “somewhat capable,” as Arends alleges, of giving an “coherent” answer either way was all the more reason to kill her, not to let her live out of respect for her autonomy.
Arends’ patient was unhappy, by all reports. As Arends tells it, “When we drank tea she usually started to complain immediately how terrible it all was. That she couldn’t do it all anymore. And that she was so tired. She was always sad, sad, rebellious, restless.” Considering her complaints to other employees as well, Arends was convinced of this woman’s “very serious suffering.”
To most people, simply being unhappy is not a sufficient moral justification to kill oneself, and premeditatively killing someone else because she is unhappy is almost universally considered to be murder. Yet Arends can sit across from a reporter, fully exonerated, and explain her choice as a medical decision, not a murderous one.
The level of subjectivity involved in the decision is likely breath-taking to most Americans, but doctors in The Netherlands have broad discretion in determining whether patients are eligible to be euthanized. According to Nieuwsuur, Arends says it’s “essential” to take into account how the words are said, not just the words themselves.” “All three times [she declined euthanasia] it was hesitant, with an erring look of ‘yes, that is difficult’. That is the point of willpower. Someone must have a coherent, coherent opinion. And that patient was completely lacking.”
That supposedly incoherent opinion was, on three occasions, some iteration of “No, I don’t want that right now.” Yet Arends’ vast discretionary power allowed her to prioritize reducing suffering over bodily autonomy or the sanctity of life.
It’s not hard to see how her patient’s persistent unhappiness, or “suffering,” colored Arends’ perception of her refusals. She must be conflicted, of course. How could you say no and really believe it, if you are so unhappy, and if you had said long ago that you eventually want to be euthanized?
Arends’s defense of refusing to ask for consent right before euthanizing her patient clues us into her hierarchy of concerns: “Ask someone who is incapacitated and you will get an answer that comes from the emotion that exists at the time.” In other words, doctors can’t let a patient’s fear of death or “panic” outweigh what their unhappiness should otherwise push them to accept.
The Dutch Supreme Court ruled on this case that patients with advanced dementia, who are legally incompetent, can be euthanized according to advanced directives. Whether this cautions people against giving advanced consent ahead of dementia, knowing they are the mercy of their physician, remains to be seen.
But if being unhappy is “unbearable suffering,” then the expectation for people who’ve written advance directives, particularly the elderly and sick, is clear: Smile and don’t complain, or risk lethal injection.