After a lifetime together, Jan and Els decided to undergo joint euthanasia in the Netherlands: why?

Three days before they voluntarily took their last breath, Jan and Els’ caravan was parked at a sunlit marina in Friesland in the northern Netherlands.

They were a couple who loved to move around and had lived most of their marriage in a mobile home or on boats.

“Sometimes we try [vivir] in a house,” Jan joked when I visited, “but it didn’t work.”

At 70, he sat on one leg in the swivel driver’s seat of the van – the only position that relieved his constant back pain. His wife, Els, was 71 and suffered from dementia. By the time I visited them, she was struggling to form sentences.

“This,” he said, rising easily from his seat and pointing at his body, “is fine.” “But this,” he said, pointing to his head, “is terrible.”

Forever

Jan and Els met in kindergarten and their relationship lasted a lifetime..

As a youngster, Jan played hockey for the Netherlands national youth team and later became a sports coach. Els trained as a primary school teacher. But it was their shared love of water, boats and sailing that defined their years together.

As a young couple they lived on a houseboat. Later they bought a cargo ship and built a business transporting goods on the inland waterways of the Netherlands.

Meanwhile, Els gave birth to her only child (who asked not to be named). She did her schooling at a boarding school where she lived during the week but spent the weekends with her parents. During school holidays, when her son was also on board, Jan and Els were looking for work trips that would take them to interesting places, along the Rhine River or to the islands of the Netherlands.

By 1999, the trucking business had become very competitive. Jan was suffering from severe back pain due to the heavy lifting he had been doing for over a decade.

He and Els moved to the mainland, but after a few years they returned to living on a boat. When that became too much to handle, they bought their spacious camper van.

Jan had back surgery in 2003, but his condition did not improve. He stopped taking a heavy regimen of painkillers and was no longer able to work, but Els remained busy teaching. They sometimes discussed euthanasia: Jan explained to his family that he did not want to live too long with his physical limitations. It was around this time that the couple joined NVVE, the Dutch “right to die” organisation.

“If you take too many medications, you live like a zombie,” Jan told me. “So with the pain I’m in and Els’s illness, I think we have to stop this.”

When Jan says “stop this” he means “stop living.”

In 2018, Els retired from teaching. He was beginning to show early signs of dementia but was reluctant to see a doctor, perhaps because he had witnessed his father’s deterioration from Alzheimer’s and his subsequent death. But there came a point when his symptoms could no longer be ignored.

In November 2022, after being diagnosed with dementia, Els stormed out of the doctor’s office, leaving her husband and son behind.

“I was furious, like a bull,” Jan recalls.

It was after Els learned that her condition would not improve that she, Jan and her son began talking about euthanasia as a couple: the two would die together.

A difficult decision

In the Netherlands, euthanasia and assisted suicide are legal if someone requests it voluntarily, and doctors must diagnose their suffering. –physical or psychological– as “unbearable”, with no prospects of improvement.

Each person who requests assisted death is evaluated by two doctors, the second checking the evaluation made by the first.

In 2023, 9,068 people died by euthanasia in the Netherlands, around 5% of the total number of deaths. There were 33 cases of euthanasia in couples, i.e. 66 people. These are complex cases that are further complicated if one of the partners has dementia, opening the door to uncertainty about their ability to give consent..

“Many doctors do not even want to think about euthanizing a patient with dementia,” says Dr. Rosemarijn van Bruchem, a geriatrician and ethicist at the Erasmus Medical Center in Rotterdam.

This was the position of Jan and Els’ GP. And this reluctance among doctors is reflected in the euthanasia figures. Of the thousands who died in 2023, only 336 had dementia. So how do doctors assess the legal requirement of “unbearable suffering” in dementia patients?

For many people with early-stage dementia, is the uncertainty about how things might progress which can lead them to think about ending their lives, explains Dr. Van Bruchem.

“Will I not be able to do the things I consider important? Will I no longer recognize my family? If this can be expressed well enough, if it is perceptible both to the doctor who is willing to perform euthanasia and to the patient, then I will not be able to do the things I consider important. [segundo] “a doctor specializing in mental competence, existential fear of what is to come may be the reason for considering euthanasia.”

Looking for death

Since their family doctor was unwilling to cooperate, Jan and Els turned to a mobile euthanasia clinic: The Euthanasia Expertise Centre. This revolutionary model oversaw around 15% of assisted deaths last year in the Netherlands and, on average, grants around a third of the requests it receives.

In the case of a couple who wish to end their lives, doctors must ensure that one of the partners has not had an influence on the other.

Dr. Bert Keizer has seen two cases of couples’ euthanasia. He also recalls meeting another couple where he suspected the man was coercing his wife. On another visit, Keizer spoke to the woman alone.

“He said he had so many plans…!” says Keiser, explaining that the woman clearly realized her husband was seriously ill, but I had no plans to die with him.

The euthanasia process was stopped and the man died of natural causes. His wife is still alive.

Dr Theo Boer, a professor of health care ethics at the Protestant Theological University, is one of the few outspoken critics of euthanasia in the Netherlands and believes that advances in palliative care often mitigate the need for its use.

“I would say that murder at the hands of a doctor could be justified. However, that should be an exception.”

What worries Dr Boer is the impact of couples’ euthanasia cases, especially after a former Dutch prime minister and his wife decided to die together earlier this year. and made headlines around the world.

“Last year we saw dozens of cases of euthanasia in couples and there is a general tendency to ‘heroise’ dying together,” says Dr Boer. “But the taboo on intentional killing is eroding, especially when it comes to dual euthanasia.”

The end

The day before their appointment with the doctors in charge of euthanasia, Els, Jan, their son and their grandchildren were together. Jan, always practical, wanted to explain to them the particularities of the motorhome so that it would be ready to be sold.

“Then I went for a walk on the beach with my mom,” says her son. “The kids were playing, there was some joking… It was a very strange day.”

“I remember we were having dinner at night and I got tears in my eyes just watching us eat together.”

On Monday morning, everyone gathered at the local hospice. There were the couple’s best friends, brothers Jan and Els, and their daughter-in-law with her son.

“We spent two hours together before the doctors came,” he says. “We talked about our memories… And we listened to music.”

Idlewild from Travis to Els, and Now and Then from the Beatles to Jan.

“The last half hour was difficult,” says his son.“The doctors arrived and everything happened quickly: they followed their routine and then it was just a matter of minutes.”

Doctors administered lethal drugs to Els van Leeningen and Jan Faber and they died together on Monday, June 3, 2024.

Their motorhome has not yet been put up for sale. Els and Jan’s son has decided to keep it for a while and go on holiday with his wife and children.

“I will eventually sell it,” he says. “I want to create some memories for the family first.”

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