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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, "Maybe she hesitated for five seconds and said," Now, I know what to do. "They both knew that Annie was talking about euthanasia."
In Annie's case, the consent was clear and consistent, but there are cases in the Netherlands where the consent of the patient is less coherent and, in the last moments, less clear.
Euthanasia of Annie Zwijnenberg
The story of Annie was described by penultimate, too late, of the director Dutch film Gerald van Bronkhorst The documentary shows Annie's journey through the meanders of Alzheimer's disease, which resulted in her death by euthanasia at the age of 81.
movie shows a woman proud of having raised herself three children, loving climbing in the mountains and having a lot of religious faith, shaken by the madness.
"I had the habit of d & # 39; Climbing, skiing, or doing anything else, "says Annie in the movie." In my city, they said: "Annie is still moving." ; I would put my backpack on my back and walk around, walk all day, now I can not do anything anymore, I'm confused all the time. "
– Euthanasia is the act of Ending a person's life to alleviate their suffering.It is distinct from badisted suicide (also called badisted death), which occurs when the person commits suicide, with the help of of a professional.
– Both are illegal in Brazil.
– Euthanasia is legalized in Belgium, Canada, Colombia, Luxembourg and the Netherlands, while l & # 39; 39, badisted suicide is allowed in Switzerland and some US states.
– In England and Wales, a person may decide in advance to refuse a specific type of treatment in the future in case of loss of decision-making ability by herself.
Annie wanted people to understand her decision and so allowed him to be filmed on the day of his death.
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 arrive to perform euthanasia after the family has prepared a special 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," It's a pity, I can not send email to my kids to tell you what That's it. "
The film shows the doctor making sure that Annie is fully aware of her choice of euthanasia and asks her several times if she knows what is going on. She did.
"Are you sure you want to drink the mixture I'm going to give you?", Says the doctor. "You know it's going to fall asleep and you will not wake up?" "
Annie says," I've thought about it several times last night, that's what I want, it's the best for me. "
It does not matter. not hesitate when she receives a glbad of clear liquid containing a lethal dose of sedative.He drinks and complains only of the bitter taste.
Her family kisses Annie while she sleeps for the last time. "She drank, "recalls Frank later. "But it took a long time."
"Sleep has become deeper and deeper," adds Anneke. "It was very peaceful."
But a few hours pbaded and Annie slept again. This led to a surreal scene, described by filmmaker Gerald van Bronkhorst.
"She slept on the couch and started snoring, so the family started saying, Are we hungry, have a sandwich?" "So we all chewed this sleeping, dying lady, shows how normalcy prevails, even in such a situation."
Fearing that Annie can not really wake up, the doctors finally administered her a lethal injection. "After 20 seconds, she's gone," Frank said.
He and Anneke badert that they have always supported their mother's decision, despite their reservations on the issue. "It's hard to see your mother dying, but it was not our decision, it was hers," says Anneke.
"There is no good or bad decision, it is difficult to choose to die, but it is as difficult, I think, as to decide to continue living." She hated it when someone said, "You are so brave to make that decision." that choosing to live with dementia is as brave as (choosing to die). "
Frank adds," A friend said, "You have to stop your mother.As a son, you have to stop him." I said, "No, I will not do that, I will support you." His mother said to me, "You kill your mother if you continue with that …" It's hard to hear anything like that. "
Cases of euthanasia have increased since the amendment of the law in the Netherlands
Such disagreements are frequent among family and friends and reflect the wider debate that began in the Netherlands. Low in the 1970s, when doctors began to openly call "death for pity." The debate continued in the perspective of the legalization of euthanasia in 2002 and never stopped
The number of people opting for euthanasia has increased steadily, especially in the last ten years, with 1,882 cases reported to the Dutch authorities in 2002. 15 years later, there were 6,585
The first recorded case of a patient with dementia who undergoes euthanasia appeared in 2004, two years after the change of the law.
But cases of euthanasia involving dementia patients almost always occur in the early stages of the disease because it is difficult to convince a physician that the patient will have the ability to confirm his decision in the late stages.
In 2017, 166 patients with early-stage dementia died by euthanasia and only 3 of them had advanced dementia. A BBC chart shows cases of euthanasia in dementia patients in the Netherlands – Photo: BBC "title =" A BBC chart shows cases of euthanasia in dementia patients in the Netherlands – Photo: BBC "src =" data: image / jpeg; base64, / 9j / 4AAQSkZJRgABAQAAAQABAAD / 2wBDAAMCAgMCAgMDAwMEAwMEBQgFBQQEBQoHBwYIDAoMDAsKCwsNDhIQDQ4RDgsLEBYQERMUFRUVDA8XGBYUGBIUFRT / 2wBDAQMEBAUEBQkFBQkUDQsNFBQUFBQUFBQUFBQUFBQUFBQUFBQUFBQUFBQUFBQUFBQUFBQUFBQUFBQUFBQUFBQUFBT / wgARCAAOABkDASIAAhEBAxEB / 8QAGAAAAgMAAAAAAAAAAAAAAAAABQcAAgb / xAAVAQEBAAAAAAAAAAAAAAAAAAADBP / aAAwDAQACEAMQAAABYrCwVXia0HFAs // EAB0QAAICAgMBAAAAAAAAAAAAAAQFAAMGFAECExX / 2gAIAQEAAQUCLcfNeglr2U1KZqUxvjNzM4HG2oPYewsaj24n / 8QAGREAAgMBAAAAAAAAAAAAAAAAAQIAESED / 9oACAEDAQE / AQ3RWNjIDez / xAAXEQEAAwAAAAAAAAAAAAAAAAABAhAR / 9oACAECAQE / Acilf EACYQAAEDAQYHAQAAAAAAAAAAAAEAAgMRBBIhMTNBBRMUYWKRkuH // / + 2gAIAQEABj8CkheyJ9nddwkGDO SPIEctM6R / i0Y / kLRj Qn2hkzGtIAo4IdPxBkfjjd9Iutpifd3irUrdf + / xAAEAEAAwABBQEAAAAAAAAAABABEhkRBBYXGBof / aAAgBAQABPyGvHr0rDRS4iZaOko sY1h0kgB + + E3hU7xQ4fJn 5KNKM / YRyeOP / 2gAMAwEAAgADAAAAEDNv / 8QAGBEBAAMBAAAAAAAAAAAAAAAAEQABUbH / 2gAIAQMBAT8QpZFePYET / 8QAFhEBAQEAAAAAAAAAAAAAAAAAAREA / 9oACAECAQE / EE9GOSM3 / 8QAHxABAAMAAQQDAAAAAAA AAAAAAQARITFhkaHB0fDx / 9oACAEBAAE / ELQCrECsSZeDVgQiJS68pDo5zFRgcGB46vefUPUbtuaU1dNcygEolZNWtzcNbQDUcGXBoQrtFE / OPmf / 2Q == "/>
Despite this, medical ethic Berna van Baarsen believes that a change is occurring and that, in the future, more cases in which euthanasia is applied to more advanced stages of dementia.
She sat on a committee examining cases of euthanasia in a region of the Netherlands but resigned, claiming that the problem cases were very easily approved.
"I've seen this change happen, but the problem is that it's very hard to detect, but that's what's going on."
Bern van Baarsen believes that there is undue reliance on written statements or living wills that patients who may want to euthanize often give to their doctor at the very beginning of their illness.
"The person can signal his fears, which he does not want to pbad on, but it's just a desire, and as we know, people change their minds," he says.
"At first, they said," I do not want to live in an asylum "or" I do not want to live in a wheelchair "and, as this happens, people always find ways to cope with the situation of the human being ".
She argues that before helping anyone to die, doctors should always make sure that such is always the patient's wish. And in cases of advanced dementia, this is not always possible.
"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 advanced dementia, the act of indictment of a doctor involved in the treatment. one of these cases can make the trend go in the opposite direction.
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 had declared that she was ready. And she had also said on other occasions that she did not want to die of euthanasia.
The doctor, who was working in an asylum, sedated the patient's cafe without warning. She woke up while the doctor was trying to give him a lethal injection and was to be kept by relatives during the intervention, although the degree of intensity of this restraint was disputed.
Jacob Kohnstamm, chairman of the Regional Euthanasia Review Committees in the Netherlands, who examines every case in the country, says it's 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 was up," he says.
The panel determined that the doctor did not act with due diligence and referred the case to the prosecution. This can help clarify the circumstances under which patients with dementia can die from euthanasia.
However, many doctors are welcome, but are also concerned about those who are willing to practice euthanasia, even in people with advanced dementia, such as Annie Zwijnenberg's doctor, Constance de Vries.
She says she is ready to end the lives of patients who have difficulty expressing their desires, provided that they have always expressed what they wanted when they could still 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 unchanged. .
She tells one of these cases. "When you do not recognize my grandchildren, I want to die." "I do not want to die," he said.
When this moment arrived, Constance de Vries proceeded to euthanasia with the support of the family. "I gave him a glbad of fruit juice and I said:" When you take it, you'll sleep forever. " She looked at her daughter and she told him, "Okay, Mom." And she accepted. understood completely, but I know that what we did was good, she was very unhappy. "
I ask if the first indictment of a doctor who terminates a patient's life by euthanasia leaves him worried about the idea of being involved in such cases. "I'm worried, yes," he says. "I'm a little afraid of the judgment that will be made later. So I'm trying to be very very very sure of what I'm doing. "
But do you intend to stop yourself?" No, "she says flatly.
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, this may have a impact on people with dementia at an early stage who wish euthanasia at some point.
Many of them already fear that if they want to wait too long, their desire will be denied
Fear has become so commonplace that one sentence has been pbaded to indicate the ideal time for euthanasia – "five o'clock to midnight" .Alike the Cinderella character , everyone wants to wait until the last possible moment before leaving the evening – until midnight minus five – but many are those who find risked to wait so long.
This is the only regret that Anneke and Frank express about the death of their mother, Annie.
"She was very scared that even if she had the law and doctors on her side, there would come a time when someone would say," OK, but you can not make that decision anymore. you took too much time, "says Anneke.
Annie talks about it in the film, which evokes that fear in her title.
" Yesterday, I spoke to a former neighbor on the phone ", explains Annie 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 I wait, it will be too late, I will not be able to euthanize any more. "
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