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It is common for Dutch patients with dementia to seek euthanasia, but may not be able to confirm their consent to the procedure in the later stages of the disease, a doctor is prosecuted such a case. The fear of having her claim rejected in such situations makes some people ask to die sooner than they would like.
Annie Zwijnenberg never doubted what she wanted. "The neurologist said:" I'm sorry, but there is no doubt that it's Alzheimer's disease, "said his daughter, Anneke Soute-Zwijnenberg, describing the moment when his mother was diagnosed. And she said, "OK, so I know what I want."
Anneke's brother, Frank, adds: "She may have hesitated for five seconds and said," Now I know what to do. "" They both knew that Annie was referring to euthanasia.
In the case of Annie, the consent was clear and consistent. But there are cases in the Netherlands where the patient's consent is less consistent and, in the last moments, less clear.
A documentary depicts the euthanasia of Annie Zwijnenberg
The story of Annie is narrated by the film Before it it was too late Dutch director Gerald van Bronkhorst. The documentary shows Annie's journey into the twists and turns of Alzheimer's disease, which resulted in her death by euthanasia at the age of 81.
The film shows a woman proud of having raised three children herself, loving climbing mountains and was a person who had a lot of religion – shaken by the madness
"I had the # It's a habit to climb, ski or do something else, "says Annie in the movie. "In my city, they said:" Annie is still moving. "I would put my backpack on my back and go out for a walk, I would walk all day, now I can not do anything anymore, am confused all the time. "
Euthanasia is the act of putting an end to a person's life to alleviate his suffering. It differs from badisted suicide (also called badisted death), which occurs when the person goes away
– Euthanasia is legalized in Belgium, Canada in Colombia, Luxembourg and the Netherlands, while badisted suicide is allowed in Switzerland.
– Both are illegal in Brazil.
– In England and Wales, a person may decide in advance to refuse a specific type of treatment in the future in the event of loss of the ability to make decisions on his or her own behalf
Annie wanted people to understand
We see her sitting on the couch, apparently good and calm. Her three children are with her and play alternately with the two doctors who come to practice euthanasia after a special family meal the night before.
"We went to a three-star restaurant," says Frank.
"I asked him," What do you want to do before you die? "We had a good meal, we laughed and cried, there was no tomorrow that special night." But we went home and it was very difficult to sleep. "
Anneke describes the letter her mother wrote that night." She asked God to take care of her children. She knew that if there was a God, she would be kind and caring. "
Frank adds," She said, "It's a pity I can not send e-mail. mail to my children say what it is. ""
The film shows the doctor to make sure that Annie is fully aware that she chooses euthanasia. many times if she knows what she's doing.
"Are you sure you want to drink the mixture I'm going to give you?" says the doctor. Annie says, "I thought about it many times last night, that's what I want, it's the best for me. "
She does not hesitate when she says," You know it's okay "to fall asleep and you will not wake up?"
receives a glbad of clear liquid containing a lethal dose of sedative.He drinks and complains only of bitter taste.
We see his family by train to kiss Annie while she sleeps for the "She drank," Frank recalls later. "But it took a while."
"Sleep has become deeper and deeper," adds Anneke. "It was very calm."
But a few hours pbaded and Annie was still asleep. This led to a surreal scene portrayed by filmmaker Gerald van Bronkhorst
"She slept on the couch and started to snore." And the family started saying, "Are we hungry, have a sandwich?" So we all remained to nibble this sleeping and dying lady, but this shows how normality gets the upper hand, even in such a situation. "
Worried that Annie could actually wake up, the doctors finally gave her a lethal injection." After 20 seconds, she left, "says Frank.
He and Anneke badert that they have always supported their mother's decision, despite their reservations about it. "It's hard to see your mother die, but it was not our decision. It was his, "says Anneke.
" There is no good or bad decision, it is difficult to choose to die, but it is also difficult, I think , that to decide to continue (19659002) Frank adds: "A friend said:" You are so brave to make this decision. "She said that choosing to live with a dementia is just as courageous as [You have to stop your loved one when you need to stop her]" Helps: "Nonjeneferaipascelajevoussoutiendrai" Samèrem "adit:" You'reyourhourforthyourcontinuewiththe ""
Euthanasia is in increase since the law was amended in the Netherlands
Such conflicts are frequent between family and friends and reflect the wider debate that began in the Netherlands in the 1970s, when doctors began to openly apply the "death by mercy". . The debate continued in the period before the legalization of euthanasia in 2002. It never stopped.
The number of people who opt for euthanasia has increased steadily, especially over the past decade. In 2002, 1,882 cases were reported to the Dutch authorities. The law on euthanasia stipulates that patients must convince the doctor that their decision is entirely voluntary and that their life has become or will become "unbearable suffering with no prospect of improvement" and that "it will not happen again. there is no reasonable alternative. "
The first recorded case of a patient with dementia and subjected to euthanasia appeared in 2004, two years after the change of the law.
But cases of euthanasia involving patients with dementia are almost always occurring in the early stages of the disease because it is difficult to convince a doctor that the patient will be able to confirm his decision in the final stages.
Despite this, medical ethics Berna van Baarsen believes that a change is occurring and that there will be more and more cases in which euthanasia will be applied to more advanced stages of dementia.
Member of a committee charged with examining cases of euthanasia in a region of the Netherlands, but resigned, claiming that the problematic cases were approved with much ease.
"I've seen this change happen, but the problem is that it's very hard to detect.But that's what's happening."
Bern van Baarsen thinks that & # 39; There is undue reliance on written statements or living wills that patients wishing to euthanize often give their doctor an early onset of illness.
can report what are your fears. So, you do not want to go there. But it's just a wish. And, as we all know, people are changing their minds. "
" At first, they say, "I do not want to live in an asylum". Or "I do not want to live in a wheelchair," and these things happen then. People always find ways to deal with the situation. It's a beautiful thing for a human being. "
She argues that, before helping anyone to die, doctors should always make sure that this is always the wish of the patient and that, in cases of advanced dementia, that It's not always the case. "If you can not talk to a patient, you do not know what he wants," he says.
If Berna van Baarsen is right and the pendulum turns to euthanasia of patients with dementia at the stage The case involved a 74-year-old woman who had signed a written statement in which she claimed to want to euthanize, but only when? she stated that
The doctor, who was working in an asylum, put a sedative in the patient's coffee without warning and she woke up while the doctor was trying to apply it. fatal and had to be controlled by relatives during the course of the proceedings, although the degree of intensity of this confinement was challenged.
Jacob Kohnstamm, chairman of the regional euthanasia review committees of the Netherlands, it is clear that the doctor has exceeded a limit.
"The board felt that the written statement was not sufficient and that the doctor should have interrupted the procedure by the time the patient had risen," he says. determined that the doctor did not act with due diligence and referred the matter to the prosecution. This can help clarify the circumstances under which patients with dementia can die from euthanasia.
While this is welcome for many physicians, it is a concern to those who are willing to practice euthanasia, even in people with advanced dementia. – as a doctor of Annie Zwijnenberg, Constance de Vries
She is ready to end the life of patients who have trouble expressing their wishes, provided that they have always expressed what they wanted clearly be able to do it.
It is important to have a long-term relationship with patients and their families, she says, so that they can talk to them about the written statement and observe for a long time whether the desire euthanasia remained unshakable.
She tells one of these cases. "When you do not recognize my grandchildren, I want to die."
"I do not know what to do.] When that moment arrived, Constance de Vries continued euthanasia with the support of the family." I gave her a glbad of fruit juice and I had says: "When you take it, you will sleep forever." She looked at her daughter and she said to her, "Okay, Mom." And she agreed. "[19659002] I ask if the first indictment of a doctor for terminating a patient 's life by euthanasia left him worried at the thought of be involved in cases like this. . "I'm worried, yes," he says. "I'm a little scared of the judgment that will be made later, so I'm trying to be very very sure of what I'm doing."
But do you intend to stop? "No", Constance de Vries admits however that in this case it may be more difficult for patients with late dementia to obtain euthanasia in the future. And if this happens, it can have an impact on people with dementia at an early stage who wish to euthanasia at a later time.
Many of them are already afraid that if they wait too long, their desire will be refused.
Fear has become so common that a sentence has been adopted to indicate the ideal time for euthanasia – "from five to midnight". Like the Cinderella character, everyone wants to wait until the last possible moment before leaving the party – until midnight minus five – but many find that it's risky to wait so long.
This is the only regret that Anneke and Frank express about "
" She was very afraid that even if she had the law and the doctors on her side, there would come a time where some would say: "OK, but you can not stand it anymore. "
" Yesterday I spoke on the phone to a former neighbor. "
Annie talks about it in the film, which evokes that fear in her title," Annie says in the documentary. She said, "I do not understand, you can always do whatever you want, do not you?" I said, "Well, the fact is that I can not, and if you wait, it will be too late." "
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