Dying together happens more often, but 'less romantic than it seems'

Assessing the euthanasia wishes of life partners is sometimes “quite difficult” for Pieter Stigter. Then, for example, the geriatric medicine specialist hears from an eighty-year-old that he or she met their life partner at the age of fourteen. Dying together is their last wish. “Then I understand: they don't want to be without each other. But I can't promise anything.”

Last week, former Prime Minister Dries van Agt died hand in hand with his wife Eugenie Krekelberg. They opted for so-called duo euthanasia. It is a form of ending life that is more common in the Netherlands. According to the latest annual report of the Regional Euthanasia Review Committees (RTE), this involved 29 couples in 2022, or 58 people. In previous years there were fewer than 20 couples each time. According to the Dutch Association for a Voluntary End of Life, this increase is partly because more and more is known publicly about the conditions under which euthanasia can be granted.

Yet the number of cases of duo euthanasia is less than 1 percent of all people who opted for a soft end. This relatively low number is because euthanasia requests from partners are assessed individually, says doctor Stigter, affiliated with the Euthanasia Expertise Center. According to the law, the situation of someone who wants euthanasia must be “unbearable and hopeless”, without a reasonable other solution. There should also be no “undue pressure” from someone else to obtain euthanasia. One partner may therefore not force the other to end their life at the same time.

Both must suffer

An assessment usually takes place by two different doctors, after which a second independent doctor also looks at the euthanasia request. Duo euthanasia can only take place if both partners have an incurable disease or disability and suffer unbearably from it.

Unbearable suffering is a relative concept, Stigter acknowledges. “The point is not whether I would make the same choices in the same situation as the applicant, but whether I can understand that the situation is intolerable.” According to him, this is easier to understand in the case of pain or shortness of breath: “It becomes more complicated when people are unable to give meaning to life. Or if they fear decline, or struggle with increasing dependence on their environment.” For this reason, the doctor always looks at the past of the person who wants euthanasia. “What was important to the person, what did he lose.”

But what if someone says: life will no longer have any meaning without my life partner? “You cannot deny that someone has that thought. However, when assessing a euthanasia request, you must look at the rest of the story. It may be a side effect, but not the medical basis for euthanasia,” says Stigter.

The dependence can be not only emotional but also practical in nature. Stigter recalls a situation in which one partner fulfilled an informal care role for the other. The caring partner would die, meaning that the other would no longer be able to live at home and would have to go to a nursing home. “Such a joint request not only concerns emotional dependence, but also practical dependence related to the person's disability. That could be a reason for a doctor to approve euthanasia.”

'Tangle of feelings'

Until now, it has mainly been older people who opted for duo euthanasia. But there is no age limit, other than the minimum euthanasia age of twelve years. “I can imagine that two partners have a similar illness or condition. In principle, they could also opt for euthanasia together,” says Stigter. According to him, there is “every reason to assume that the number of euthanasia, and therefore also duo-euthanasia, will increase.” Many people live longer with multiple conditions that would previously have killed you, he says, due to increasing medical options: “For example, they have diabetes, lung disease and once had something wrong with the heart.”

When you think of duo euthanasia, you picture two old people, with their hands folded on a bed. Is that image correct? “Yes,” says Stigter, “but you have to be careful not to romanticize that picture too much. By definition, they are two people who suffer unbearably and for whom there is no other option. We shouldn't make it more beautiful than it is.”

As a doctor, he is always in a “tangle of feelings” around the moment of granting euthanasia, especially when it comes to duo euthanasia: “Children then lose two parents at once. On the one hand you have the feeling: this is what they wanted, how wonderful that this is possible. And on the other side there is double sadness. That sometimes makes it difficult,” says Stigter. “But if the first feeling prevails, then I have the feeling that I have done something important for people.”

MMV Lineke Nieber

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