In the Netherlands, where euthanasia is legal, it is not usual for patients with dementia to seek help. But in the latter stages of this disease, many do not use their own faculties and can not give their consent. In such cases, the doctor is faced with a judicial process.
Therefore, the fear that prohibits access to this practice is encouraging some patients, they liked euthanasia earlier.
Annie Zwijnenberg did not hesitate.
"The neurologist said:" I am sorry, but there is no mistake, it's Alzheimer's, "Soute-Anneke Zwijnenberg said, the day was diagnosed with the disease.
"Then he said:" Badly, then I know what I want. ""
Frank, brother of Anneke, participates: "Maybe after five seconds he said:" Now I know what I will do. "
They both knew that her mother mentioned euthanasia.
It can be said that the story of Annie Zwijnenberg is a good example of how euthanasia works in the Netherlands: clear and precise with the consent of the patient.
But there are other cases where there is less authorization and, in the end, less light.
Zwijnenberg's story is a documentary by Dutch director Gerald van Bronkhorst's "Too Late" ("It's too late").
In the film, the public can see the evolution of Zwijnenberg's disease, which has spent eighty years of euthanasia dead.
She shows a strong woman, who only raised three children, climbing mountains and deep religious beliefs, followed by senile dementia.
"Climbing, skiing, I used everything," says the star of the film.
"But now I can not do that, I've been confused all the time."
Zwijnenberg wanted to understand his decision, so that a camera could shoot his last moments, the day of his death.
The video shows up on the couch, quiet and optimistic.
The three children are surrounded by euthanasia with the two doctors who arrive at the special dinner on the night before.
"We went to a three or four star restaurant, we cried, we did a lovely dinner, maybe it was not there tonight, it was very special," said the star.
For her part, Anneke's daughter said she had found a letter she had written on her mother's night.
"He wrote a letter to God to look after his children, knowing he was God, that God would be disdainful," he said.
The doctor shows that Zwijnenberg was determined to kill euthanasia. He asks several times what he was doing.
"Are you sure you want to mix the drink I want?" The doctor asked.
"Do you know that you will connect and not wake up again?" He added.
"I thought several times, I reviewed it from the beginning to the end and that's what I want, it's best for me," he replied.
Then, when it is clear that the liquor is stopped, it has a lethal dose of calming.
She only complains that she has a bitter taste.
She approaches her family for the last time to sleep.
"It took the content of the glass, but it took some time," Frank recalled later. "Gradually, he slept, deeper, more soft."
But two hours passed and the woman slept. This led to the surreal scene, according to the director of the film.
"She slept in her dress and rumors began, and her relatives said to each other:" I am hungry for a sandwich? "So it was to chew on the couch around the woman who was sleeping on the floor," he said.
As worried that Annie may wake up, the doctors gave him a deadly injection.
"Twenty seconds later, he died," said his son.
Both children said they always accepted their mother's decisions, because they did not feel it.
"It's hard to see your mom die so, but it was not our decision, it was," said Annek.
While Frank had received complaints about his mother.
"A good friend told me," You should stop your mother, "and that's why I replied that I did not need to do it, when I gave her help, then she said:" You're dying to kill your mother, if you still kill your mother. It was difficult to hear that, "he said.
Instructions for this are common among friends and family who choose euthanasia, and they reflect a wider debate in the 1970s on the part of the Netherlands, when doctors called "homicides for mercy".
Debates continued in discussions in euthanasia in 2002. They were constantly on hold.
In order to comply with the law on euthanasia, patients should convince the doctor that the decision is totally voluntary, whether it has become a "unpredictable condition for non-improvement" and that there is no "fair alternative".
A doctor must make an independent assessment to confirm.
The first case of Euthanasia with dementia patients occurred in 2004, two years later, the law changed.
But in cases of euthanasia with dementia patients are in the early stages of the patients, it is difficult to persuade the doctor because the person has the ability to understand the decision to kill the disease. an advanced situation.
In 2017, 166 patients with dementia died of euthanasia and only in the following three stages of illness.
Thereafter, Berna van Baarar's ethics doctor believes that a change will occur in the future.
Each expert in the Euthanasia case reviewed in the Netherlands region, but resigned, in most cases difficult cases were easily accepted.
"I have seen the change, understanding that this is a very difficult problem with this change, understanding, but happening, that it is taking place under our noses, and finally we will know that it was a change, not the process," he said.
For Van Baa, it is based too much on written affirmations or living wills, and patients want euthanasia and give them the first symptoms of depression.
"You can indicate what your fears are, what you do not want, but your desires, it's a fear statement, and we know it's changing people," he said.
For this reason, he argues that before someone dwells, the doctors must always confirm that the patient is willing. And with senile dementia patients with advanced, this is impossible.
"If you can not talk to a patient, it's impossible to know what he wants," he said.
Van Baarsen, on the other hand, the pendulum now facilitates access to euthanasia for patients with advanced dementia, which could be swollen in the direction of a doctor's judgment.
In that case, he was a 74-year-old woman who had signed an euthanasia, but only when he was ready.
At the same time, the patient said that he did not want to kill euthanasia.
When the doctor worked at the geriatric house, he relaxed the woman's coffee, without saying it. Afterwards, the woman woke up at a specific time that the doctor was trying to make a lethal injection.
And it was worse: when euthanasia was over, relatives needed to do it, although the level of control used is not clear.
Jacob Kohnstamm, one of the heads of the euthanasia review committee in the Netherlands, is clear that the doctor has overcome many limits in this case.
"The Commission said the written statement was not enough and the doctor had to stop the procedure when the patient woke up," he said.
The Commission stated that the professional did not prioritize his patient and referred to the case of the Dutch Court.
In this case, the peaks will be examined in the trial, especially for patients with dementia to have access to euthanasia.
But in the case of many doctors who will clearly explain, it will also be people with advanced despair, such as Dr. Constance de Vries, the person who participated in Annie Zwijnenberg.
De Vries argues that they do not end the life of the patients who want to create conflicts, who have difficulties in expressing what they want, as long as they clearly expressed their desires.
For them, it is essential to have long-term relationships with patients and their families, to talk with their written assertions and to euthanasia unwanted desire.
Remember a special case:
"She was not happy, cried out, screamed, did not eat and was aggressive to others, and when she saw him, she was unhappy, and always had something clear:" I do not know day to my grandchildren, that day died I want. "
And when the moment came when he did not recognize them, De Vries continued with euthanasia, with the help of the relatives of the woman.
"In the first case of doctors in Euthanasia, I worry, of course, I am worried about the judgments of later value, so I am very sure what I am doing," he said.
However, it will not be taken into account.
It is a bit, he says, that this judicial case may facilitate access to euthanasia of patients following the disease in the future.
If this happens, euthanasia may sometimes cause a rebound.
In fact, some are worried, if they expect too much, they could deny the procedure.
Fear has become more common in order to describe the perfect time to apply euthanasia: "Five minutes before midnight".
As in Cinderella's story, everyone wants to wait until the last day "five minutes before the midnight," but not too late.
That's the fact that Anneke and Frank's repression on the death of Annie's mother.
"I was afraid, even though the law was on its own side or that it was accepted by doctors, it would have come to a point where someone could say:" Yes, but because it's too late, you can not make a decision. To yourself, "said Anneke.
Zwijnenberg talks about the subject in Gerald van Bronkhorst's movie, and he mentions his fear in his name, It's too late.
"I spoke yesterday to ex-patients on the phone," said Annie. "He told me:" But I do not understand, you can still do everything, right? "I said:" Well, that's the point, first of all, I can not. Secondly, if I had waited until I stopped, it would be too late. They will not have more euthanasia.