Wijsbek Henri
Universiteit van Amsterdam, afd. Wijsbegeerte, Amsterdam, the Netherlands.
Ned Tijdschr Geneeskd. 2013;157(25):A6440.
The Dutch Euthanasia Act states that an advance directive can replace an actual request for euthanasia in cases in which a patient has become unable to make autonomous decisions. In Euthanasia and the Severely Demented, I agree with Keizer that the severely demented can suffer unbearably, but contrary to Keizer I do not believe that it is impossible to state in advance the conditions under which one would not wish to go on living any longer. Consequently, euthanasia can be permissible even in patients with late-stage dementia, provided that the other due-care criteria are met. Permissibility by itself, however, will not settle disputes about borderline cases. Due to the erratic course of the disease, the right moment for euthanasia may very well be impossible to determine.
荷兰《安乐死法案》规定，在患者已无法做出自主决定的情况下，预先指示可替代实际的安乐死请求。在《安乐死与重度痴呆患者》一文中，我同意凯泽的观点，即重度痴呆患者可能会遭受无法忍受的痛苦，但与凯泽不同的是，我认为预先说明在哪些情况下人们不希望继续活下去并非不可能。因此，只要符合其他适当护理标准，即使是晚期痴呆患者的安乐死也可以是允许的。然而，仅仅允许并不能解决关于临界情况的争议。由于该疾病病程不稳定，很可能无法确定安乐死的合适时机。
