Why a happily married couple decided to die together

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.

Some people may find this article disturbing.

Three days before they voluntarily breathe their last, Jan and Els’ camper van sits 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 (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 constant back pain. His wife, Els, is 71 and has dementia. Today, she has trouble forming 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 at nursery school and formed a lifelong couple. When he was young, Jan played hockey for the Netherlands youth 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.

Meanwhile, Els gave birth to their only son (who asked not to be named). 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 work trips that would take them to interesting places – along the Rhine or to the islands of the Netherlands.

By 1999, the domestic freight industry had become 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 were living 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 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 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 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 a person requests it voluntarily and their suffering – physical or psychological – is assessed by doctors as “unbearable” with no prospect of improvement. Anyone who requests assistance in dying is assessed by two doctors – the second checking the assessment made by the first.

In 2023, 9,068 people died by euthanasia in the Netherlands, approximately 5% of the total number of deaths. There were 33 cases of duo euthanasia, or 66 people. These are complex cases, even more so if one partner has dementia, where there may be uncertainty about their ability 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 things will turn out that can lead them to consider ending their life, says Dr van Bruchem.

“Will I no longer be able to do the things that I find important? Will I no longer recognize my family? If one can express this well enough, if it is perceptible both to the doctor who is prepared to perform euthanasia and to the (second) doctor specializing in mental capacities, the existential fear of what is going to happen can be the reason for considering euthanasia.”

With their GP unwilling to intervene, Jan and Els contacted a mobile euthanasia clinic – the Euthanasia Expertise Centre. Last year, this center supervised around 15% of assisted homicides in the Netherlands and, on average, it grants around 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…!” 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.

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 a doctor could be justified. However, it must remain an exception.

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

“Over the past year, we have seen dozens of cases of duo euthanasia, and there is a general tendency to ‘heroize’ death together,” says Dr. Boer. “But the taboo on intentional homicide is eroding, especially when it comes to duo 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 is something else. Els has been evaluated 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 worsens.

None of this has been easy for Jan and Els’ son.

“You don’t want to let your parents die,” Jan says. “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 having dinner together for the last time.”

On Monday morning, everyone gathered at the local hospice. The couple’s best friends were there, 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.”

Travis’ Idlewild for Els, The Beatles’ Now and Then for January.

“The last half hour was difficult,” their son says. “The doctors arrived and everything happened quickly: they follow their routine, and it’s 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 motorhome is still not on sale. Els and Jan’s son decided to keep him for a while and go on vacation with his wife and children.

“I’ll eventually sell it,” he said. “I want to create memories for the family first.”