Euthanasia for two: Why happily married couple decided to die together – BBC News

Jan and Els were married for nearly 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 rare, but every year more and more Dutch couples choose to end their lives this way.

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Three days before they voluntarily take their last breath, Jan and Els’ campervan is on 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 a campervan or on boats.

“We have sometimes tried (to live) 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 van’s swivel driver’s seat, one leg bent beneath him in the only position that relieves his ongoing back pain. His wife, Els, is 71 years old and suffers from dementia. Now she has difficulty formulating her sentences.

“That’s fine,” she said, standing up easily and pointing to her body. “But that’s terrible,” she said, pointing to her head.

Jan and Els met in nursery school – their partnership lasted their entire lives. When he was young, Jan played hockey for the Netherlands junior national team and later became a sports coach. Els trained as a 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. They later bought a cargo ship and established a business transporting goods on the inland waterways of the Netherlands.

In the meantime, Els gave birth to their only son (who asked to remain anonymous). He became a weekly boarder at the school and spent weekends with his parents. During the school holidays, when their child was also on board, Jan and Els looked for business trips that would take them to interesting places, along the Rhine or to the islands of the Netherlands.

In 1999, the overland freight transport sector became very competitive. Jan suffered from severe back pain due to the hard work he had been doing for over a decade. He and Els moved to land, but after a few years they were living on a boat again. When this became too much to handle, they bought their spacious camper van.

Jan had a back operation in 2003, but his condition did not improve. He had stopped taking heavy pain medication 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 organisation for the ‘right to die’.

“If you take a lot of medication, you live like a zombie,” Jan told me. “So with the pain I’m experiencing 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 euthanasia as a duo – they were both dying together.

In the Netherlands, euthanasia and assisted suicide are legal if a person voluntarily requests it and their suffering – physical or psychological – is assessed by doctors as “unbearable”, with no prospect of improvement. Everyone who requests assisted 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’s GP. And this reluctance of doctors is reflected in the euthanasia figures. Of the thousands of people who died in 2023, 336 suffered from dementia. So how do doctors assess the legal requirement of “unbearable suffering” in patients with dementia?

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

“She said she had so many plans…!” Dr. Keizer said, explaining that the woman clearly realized her husband was seriously ill, but 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.