Euthanasia and Assisted Suicide of Persons With Dementia in the Netherlands

•Primary Questions: What are the characteristics of persons with dementia who receive euthanasia and assisted suicide (EAS); how do their physicians evaluate/implement their requests; and how do euthanasia review committees assess the cases?•Main Finding: Patients who make advance requests (AR) and concurrent requests (CR) for EAS differ in age, duration of illness, and past experiences. AR-EAS cases were complicated by ambiguous directives, patients being unaware of the EAS procedure, and physicians having difficulty assessing “unbearable suffering.” Both the physicians and the review committees deemed some quite impaired CR-EAS patients as competent by appealing to patients’ previous statements.•Meaning: Problems discussed in the literature about AR-EAS are indeed present in practice and the competence assessment model used in EAS for dementia does not seem be a functional capacity model; both findings will likely engender further ethical discussion about EAS in persons with dementia. To describe the characteristics of persons with dementia receiving euthanasia/assisted suicide (EAS) and how the practice is regulated in the Netherlands. Qualitative directed content analysis of dementia EAS reports published by the Dutch euthanasia review committees between 2011 and October 5, 2018. Seventy-five cases were reviewed: 59 concurrent requests and 16 advance requests. Fifty-three percent (40/75) were women, and 48% (36/75) had Alzheimer disease. Advance request EAS patients were younger, had dementia longer, and more frequently had personal experience with dementia. Some concurrent request EAS patients were quite impaired: 15% (9/59) were deemed incompetent by at least one physician; in 24% (14/59), patients’ previous statements or current body language were used to assess competence. In 39% (29/75), patients’ own physicians declined to perform EAS; in 43% (32/75), the physician performing EAS was new to them. Physicians disagreed about patients’ eligibility in 21% (16/75). All advance request and 14 (25%) concurrent request patients had an advance euthanasia directive but the conditions of applicability often lacked specificity. In 5 of 16 advance request EAS and 2 of 56 concurrent request EAS cases, EAS procedure was modified (e.g., premedication). Twenty-five percent (4/16) of advance request cases did not meet legal due care criteria, in particular the “unbearable suffering” criterion. Advance and concurrent request EAS cases differ in age, duration of ill