Advance request in euthanasia and assisted suicide of patients with severe dementia.

Background - To permit euthanasia or assisted suicide (EAS( the medical ‘due care criteria’ of the Termination of Life on Request and Assisted Suicide Act (TLRASA) should be met, i.e., the request should be (1) voluntary and well considered and (2) expressed after informed consent about diagnosis and prognosis. (3) Suffering should be unbearable, with no prospect of improvement and (4) no reasonable alternatives should be available. Aim - To explore key elements influencing the RTE’s judgement on whether the due care criteria have been met of EAS cases in severe dementia based on written advance euthanasia requests. Methods - Qualitative study of reports of the RTE published online (n=21) in which a written euthanasia directive was mentioned and considered incompetent to make a decision regarding EAS. Two independent researchers (AvdB, GM) extracted factual data independently of one another (see appendix) and judged the due care criterion 'competence to make a decision regarding EAS'. Results & conclusion - Examination of the RTE’s judgment underlines the need for a clear euthanasia directive in advance request cases, as in 2 cases the criteria voluntary and well considered were not met because of this. Additionally, it becomes apparent that it is essential that the patient confirms their request after writing the directive. The RTE did not consider consulting an independent expert to establish the patient’s decision-making capacity essential for the due care criteria to be met. However, this solely applied when physicians acted diligently. Recommendations – We would recommend updating a written directive at least every year