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Advance euthanasia directives: a controversial case and its ethical implications
  1. David Gibbes Miller1,
  2. Rebecca Dresser1,2,
  3. Scott Y H Kim1
  1. 1Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
  2. 2School of Law, Washington University, Saint Louis, Missouri, USA
  1. Correspondence to Dr Scott Y H Kim, Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda MD 20892, USA;{at}


Authorising euthanasia and assisted suicide with advance euthanasia directives (AEDs) is permitted, yet debated, in the Netherlands. We focus on a recent controversial case in which a Dutch woman with Alzheimer’s disease was euthanised based on her AED. A Dutch euthanasia review committee found that the physician performing the euthanasia failed to follow due care requirements for euthanasia and assisted suicide. This case is notable because it is the first case to trigger a criminal investigation since the 2002 Dutch euthanasia law was enacted. Thus far, only brief descriptions of the case have been reported in English language journals and media. We provide a detailed description of the case, review the main challenges of preparing and applying AEDs for persons with dementia and briefly assess the adequacy of the current oversight system governing AEDs.

  • capacity
  • dementia
  • euthanasia
  • living wills/advance directives

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  • Contributors All three authors have contributed to qualify for authorship: substantial contributions to the conception of the work; or the acquisition, analysis or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding Supported in part by the Intramural Research Program of the NIH Clinical Center. RD was a Visiting Scholar in the Department of Bioethics during the period of writing this paper.

  • Disclaimer The opinions expressed in this article are the authors’ and do not represent the views or policies of the NIH, Department of Health and Human Services or any other part of the USA Government.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All of the data used in this study are publicly available.

  • Author note All authors meet the ICMJE 2013 criteria for authorship.

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