Duo euthanasia: why a happily married 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 two-person 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 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 (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 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 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 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.

They lived in a houseboat when they were young. They later purchased a cargo ship and established a freight transport business on the inland waterways of the Netherlands.

In the meantime, Els gave birth to their only son (who wished to remain anonymous). He became a weekly boarder at the school and spent weekends with his parents. During school holidays, when their child was also on board, Jan and Els were looking for work 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 motorhome.

Jan had back surgery in 2003, but his condition did not improve. He had stopped 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 didn’t 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 a lot of medication, you live like a zombie,” Jan told me. “So with the pain I’m in and Els’ illness, I think we need to stop that.”

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 seek medical attention – perhaps because she had witnessed her father decline and die from Alzheimer’s. But there came a point when her 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 raging bull,” Jan remembers.

It was after Els learned his 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 the person voluntarily requests it 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, with 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 don’t even want to consider performing euthanasia on 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 of doctors is reflected in the figures for euthanasia. Among 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 is the uncertainty about how the condition will develop that can lead them to consider ending their life, 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.

When their GP refused to commit, Jan and Els turned to a mobile euthanasia clinic: the Euthanasia Expertise Centre. Last year, it oversaw about 15% of assisted deaths 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 process was halted and the man died of natural causes. His wife is still alive.