Euthanasia in a duo: why a happy couple decided to die together

Jan and Els were married for almost five decades. In early June, they died together after being given lethal drugs by two doctors. In the Netherlands this is called duo euthanasia. It’s legal and it’s rare, but every year more and more Dutch couples choose to end their lives this way.

Some people might find this article disturbing.

Three days before voluntarily taking their last breath, Jan and Els’ campervan is parked at a sunny marina in Friesland, in the north of the Netherlands. They are a couple who like to be mobile and have lived most of their marriage in an RV or on boats.

“We have sometimes tried (living) in a pile of stones – a house,” Jan jokes when I visit them, “but it doesn’t work.”

He is 70 years old and sits in the swivel driver’s seat of the van, one leg bent beneath him in the only position that relieves his constant back pain. His wife, Els, is 71 years old and suffers from dementia. Today, she has difficulty formulating her sentences.

“That’s very good,” she said, standing up easily and gesturing to his body. “But it’s terrible,” she said, pointing to her head.

Jan and Els met in kindergarten – their partnership lasted their entire lives. As a youngster, Jan played hockey for the Dutch junior national 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 started a business transporting goods on the inland waterways of the Netherlands.

During this time, Els gave birth to their only son (who asked not to be named). He becomes a weekly boarder at the school and spends weekends with his parents. During school holidays, when their child was also on board, Jan and Els looked for work trips that would take them to interesting places – along the Rhine or to the islands of the Netherlands.

In 1999, the land freight transportation sector became very competitive. Jan suffered from severe back pain due to the heavy work he had done for over a decade. He and Els moved to land, but after a few years they lived on a boat again. When that became too much to handle, they purchased their spacious camper van.

Jan had back surgery in 2003, but the situation did not improve. He had stopped an intensive regimen of painkillers and could no longer work, but Els was still busy teaching. Sometimes they talked about 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” organization.

“If you take too much medication, you live like a zombie,” Jan told me. “So with the pain I have and Els’ illness, I think we need to stop this.”

When Jan says “stop it,” he means: stop living.

In 2018, Els retired from teaching. She was showing early signs of dementia but was reluctant to see a doctor – perhaps because she had witnessed her father’s decline and death from Alzheimer’s disease. But there came a time 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.

“She was furious – like a smoking bull,” Jan recalls.

It was after Els learned that her condition would not improve that she and Jan, along with their son, began discussing a joint euthanasia – the two dying together.

In the Netherlands, euthanasia and assisted suicide are legal if the person requests it voluntarily and their suffering – physical or psychological – is deemed “unbearable” by doctors, with no prospect of improvement. Anyone who requests assistance in dying is assessed by two doctors, the second verifying the assessment made by the first.

In 2023, 9,068 people died by euthanasia in the Netherlands, about 5% of the total number of deaths. There were 33 cases of duo euthanasia, or 66 people. These are complex cases, especially if one of the partners has dementia, where there may be uncertainty about their capacity to give consent.

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

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

For many people with early-stage dementia, it’s the uncertainty about how things will turn out that can lead them to consider ending their lives, says Dr van Bruchem.

“Am I not going to be able to do the things that I find important? Will I no longer recognize my family? If this can be expressed well enough, if it is perceptible both to the doctor prepared to perform euthanasia and to the (second) doctor specialized in mental competence, the existential fear of what is going to happen can be the reason. consider euthanasia.

Since their GP was unwilling to intervene, Jan and Els contacted a mobile euthanasia clinic – the Euthanasia Expertise Centre. Last year, the centre oversaw about 15% of assisted homicides in the Netherlands and, on average, grants about a third of the requests it receives.

In the case of a couple wishing to end their life together, doctors must ensure that one partner does not influence the other.

Dr. Bert Keizer attended two duo euthanasia cases. But he also remembers meeting another couple, when he suspected the man of coercing his wife. During another visit, Dr. Keizer spoke to the woman alone.

“She said she had so many plans…!” “, says Dr. Keizer, explaining that the woman clearly knew that her husband was seriously ill, but that she had no intention of dying with him.

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

Dr. Theo Boer, professor of health care ethics at the Protestant Theological University, is one of the few vocal critics of euthanasia in the Netherlands and believes that advances in palliative care often alleviate the need of his appeal.

“I would say that murder by doctor could be justified. However, this must remain an exception.

What worries Dr Boer is the impact of the cases of duo euthanasia – particularly after one of the former prime ministers of the Netherlands and his wife chose to die together earlier this year and made global headlines.

“Over the past year, we have seen dozens of cases of two-person euthanasia, and there is a general tendency to ‘heroize’ simultaneous death,” says Dr. Boer. “But the taboo on voluntary manslaughter is eroding, especially when it comes to two-person euthanasia.”

Jan and Els could probably continue living in their campervan indefinitely. Don’t they think they might die too soon?

“No, no, no, I can’t see it,” Els said.

“I have lived my life, I don’t want to suffer anymore,” said her husband. “The life we ​​have lived, we are growing old (because of it). We think it needs to be stopped. »

And there’s something else. Els has been examined by doctors who say she still has the capacity to decide for herself whether she wants to die – but that could change if her dementia becomes more advanced.

None of this was easy for Jan and Els’ son.

“You don’t want to let your parents die,” Jan says. “So there were tears – our son said, ‘Better times will come, better times’ – but not for me.”

They feel the same way.

“There is no other solution.”

The day before their meeting with the doctors responsible for euthanasia, Els, Jan, their son and their grandchildren were gathered. Always pragmatic, Jan wanted to explain the particularities of the motorhome, so that it was ready to be sold.

“Then I went for a walk on the beach with my mother,” their son says. “The children were playing, there were jokes… It was a very strange day.”

“I remember we were having dinner that night and I had tears in my eyes just watching us all eat dinner together for the last time. »

Monday morning everyone gathered at the local hospice. The couple’s best friends were present, Jan and Els’ brothers, as well as their daughter-in-law and son.

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

Idlewild by Travis for Els, Now and Then by the Beatles for Jan.

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

Els van Leeningen and Jan Faber were given lethal drugs by doctors and died together on Monday June 3, 2024.

Their campervan is still not 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’ll eventually sell it,” he said. “I want to create memories for the family first.”