by Craig Klugman, Ph.D.

O true apothecary!
Thy drugs are quick. Thus with a kiss I die. – Romeo & Juliet, Act 5, Scene 3

In a scene reminiscent of Romeo and Juliet, a Dutch couple were voluntarily euthanized together after sharing their final kiss. Nic Elderhorst, 91, had a stroke 5 years ago that left him with limited mobility and chronic pain. Trees, 91, his wife and primary caregiver, had declining physical health and was diagnosed with vascular dementia. She feared that she could no longer care for him. Both feared living without the other and had stated for a long time that they had hoped to die together.

Headlines around the world focused on the romance of their euthanasia. “Dying Together was their deepest wish” declared one British paper. Another said “Loving couple, 91, pass away in rare double euthanasia” not only showing the romance, but changing the active process of killing to the metaphor of “passing away.” “Elderly couple got ‘deepest wish’ declared the Washington Post. “Elderly couple kiss, hold hands before double-euthanasia” was published in New Zealand.

The Netherlands is one of the few countries in the world that permits voluntary euthanasia, where a physician administers a drug to fulfill a person’s request to end his/her life. To qualify, a patient must make a considered request, have unbearable and hopeless suffering, be informed about the situation and future possibilities, and have no reasonable alternatives. Thus, a person does need to have a “terminal illness” or “irreversible condition” in order to request and receive life-ending procedures. People can request euthanasia for reasons of mental illness such as PTSD as long as the condition is viewed as permanent and irreversible. In the Netherlands, 4.5% of all deaths are from requested-euthanasia compared to physician-assisted suicide that accounted for 8.3% of deaths.

Euthanasia is more controversial than assisted suicide because the former requires a physician to administer the life ending agent. In assisted suicide, the patient performs the action that ends his/her life. The lack of control, the question of whether one has autonomy to make such a choice, whether anyone should be able to make such a choice, and the potential for a slippery slope (voluntary today, forced tomorrow) are arguments made against euthanasia.

For this couple, the decision came out of their 65-year relationship. Soon after Tree’s diagnosis they signed an advance euthanasia directive. Studies have shown that such directives are rarely carried out for people with dementia. Given this fact, one might ask whether Tree’s wishes would have been followed if she were not ending her life alongside her husband? Is her “broken heart” hopeless and unbearable suffering? Time was of the essence as the family feared Tree might not be mentally competent for much longer.

What if the couple had been younger? What if one spouse was 55-years-old and dying of cancer? What if the second spouse was the same age but decided that living without the partner of 30-years was unbearable? Would their double euthanasia have been permitted? Would it have been reported as a romantic moment in the worldwide press? My guess is that the story would not have been presented in a positive and romantic light but rather with more alarm and concern.

The couple’s age is a big factor in how this story has been portrayed and accepted by many.

Double euthanasia is rare in the Netherlands because it is not often that both partners meet the criteria. The advanced age of this couple is also a factor in how their deaths are portrayed. Life expectancy in the Netherlands is 81.71 years (compared to 78.74 in the US) so living until 91 means this husband and wife both had a long life. Dying in old age fits the social script that we have been taught. If they were younger, however, that script would be violated and reaction would likely have been more negative.

This is not to say that everyone is seeing the romance and fulfillment of autonomy in this case. LIfesitenews declared, “Fear, rather than health, drive married couple to be euthanized together.” Opponents to euthanasia believe that legality inappropriately gives doctors the right to kill (i.e. murder) their patients. Since doctors are supposed to be professionals who save and better lives, taking life is viewed as incompatible with their work. Perhaps even where euthanasia is legal, doctors should not be the people to perform it. Many supporters of assisted suicide often draw the line at euthanasia, distinguishing between the causative actor in each procedure.

For this couple, they chose euthanasia while both of them were competent to make the choice, had qualifying health problems, and they lived in a country where their wishes could legally be carried out. The physician’s act was a respect for their autonomy in line with their long-held views and wishes.