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For the fifth year in a row, deaths by euthanasia and assisted suicide have risen sharply in the Netherlands. There were 4,829 reported cases in 2013, according to official statistics released yesterday by the five regional control commissions in charge of checking the procedures’ compliance with the law.

This amounts to a 15 percent increase in one year. That number has nearly doubled since 2009 when 2,636 cases were registered. The overwhelming majority of cases was deemed lawful; only five were criticized either because the second doctor consulted before performing the act was not “independent” in these cases, or because the substance used to provoke a coma before administering a muscle relaxant was not the one prescribed by official euthanasia guidelines.

Not a single case will give rise to an official complaint or investigation by the judiciary authorities.

This means that 99.9 percent of all cases of such cases in the nation – 4,501 cases of euthanasia, 286 assisted suicides and 42 combinations of the two – met the conditions of the Dutch law.

But how stringent are they? A closer look at the statistics and their rapid increase shows that killing the elderly, the ill and the mentally fragile is becoming socially and medically more acceptable, on ever-widening grounds.

While most voluntary ending of lives involved cancer patients complaining of “unbearable suffering” – 3,588 of the total – the most spectacular progression is that of euthanasia on patients with dementia and psychiatric illnesses. In all, 97 persons with incipient or fully developed dementia were killed in 2013; 42 with mental illness, as opposed to 14 in 2012 and 13 the year before that. The statistics indicate that doctors are increasingly accepting loss of autonomy, fear of suffering or humiliation, and despair – sometimes linked to psychological trauma – as acceptable causes for euthanasia.

In 251 cases, multiple complaints associated with growing old were accepted as a valid reason for euthanasia.

Euthanasia for the demented is one of the main priorities of the “chosen end of life” lobby in the Netherlands. In 2010, the 21 cases approved by the control commissions all concerned people who were becoming demented but still capable of expressing their own will. In fact they chose to be killed at that stage because the overwhelming majority of doctors was not prepared to carry out euthanasia on a person who was no longer able to state and repeat the request while in possession of his free will.

Since then the “Association for voluntary end of life” (NVVE) has lobbied intensely in political circles but also in the field, organizing conferences and meetings to raise public awareness as to this “problem” and to encourage people over 70 to make living wills requesting euthanasia in case dementia would leave them helpless and dependent.

In 2013, several cases of euthanasia were performed in such cases and deemed lawful when the patient’s living will had been clearly set out and updated, and reestablished by unequivocal conversations between the patient and the family doctor. In those cases, judged the commission, doctors should help their patients to formulate their wishes as clearly as possible and personally constitute files to put these conversations on record.

The 2013 report describes several dementia cases that led to euthanasia, such as that of a woman in her eighties who suffered from “hallucinations” and “stiffness” and the fear of becoming even more demented. She obtained euthanasia through the “End of Life clinic.”

Another woman in her eighties was afraid of the suffering Alzheimer's Disease would bring; her death wish was accepted and the euthanasia deemed compliant with the law on the grounds of two video recordings made two years before her death, in which she explained that she would want to be euthanized at such time when moving to a specialized institution would become inevitable.

Under the heading of “unbearable and hopeless suffering” the report classifies the case of a married couple in their eighties with “severe illnesses.” The woman could not walk long distances and could not take part in activities organized in the home for the elderly where they lived. The husband was diagnosed with an incipient case of Alzheimer's. He was unwilling to move to a nursing home without his wife and was the first to request euthanasia.

The woman decided she also wanted to die, five days before the couple were put to death, because she could no longer look after herself, had shortness of breath and difficulty with communicating. They were euthanized on the same day at the same time by two different doctors.

The commission also accepted the euthanasia of persons who judged themselves to be “finished with living,” a recent justification for euthanasia which echoes the NVVE’s suggestion that all people over 70 should be allowed to receive euthanasia when multiple complaints or the sheer sadness of being alone, with many near ones dead, makes life seem pointless.

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The report quotes the case of a man in his nineties, almost blind and deaf, who had lost his social life. Among other things he suffered from “traumatic memories of the war” and insomnia. A psychiatrist confirmed that his suffering was “unbearable” because he could no longer have meaningful relationships with others.

An especially sad case is that of a woman in her thirties who had psychiatric and post-traumatic problems due to having been sexually abused in her youth. She tried to commit suicide several times and mutilated herself on multiple occasions. There was “continual war in her head”; she had nightmares and eating disorders. Her condition did not improve with medical treatment. Several psychiatrists decided she did not suffer from depression and that in the absence of other medical options she could have her death wish fulfilled.

Another woman in her thirties was euthanized because she had “borderline personality disorder” and severe eating disorders.