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It is a poignantly romantic image: after a lifetime together, an older couple knocks together at the gate of heaven. It is what the Catholic Dutch former Prime Minister Dries van Agt and his wife Eugenie Krekelberg did last Monday. The couple, both 93 years old, held hands and exchanged the temporary for the eternal.

In the Netherlands, such a joint euthanasia is called duo-euthanasia. It also occurs in our country. In October last year, a couple of 87 and 90 in Ypres were euthanized on the same day. Two years earlier, the De Crée-Roex couple, a doctor and an artist, made the same decision.

“It is very moving,” says Luc Proot, an oncological surgeon who specializes in euthanasia and is a member of the Euthanasia Committee. He himself has already supervised duo euthanasia three times. “It is usually very emotional because the couple is very closely connected until the last moment. They also symbolically join hands and want to die at the same time. It is not obvious for a doctor, and it also keeps you busy afterwards. That is why we always do this with two doctors.”

1 When can a couple receive euthanasia together?

The two partners must each separately qualify for euthanasia and therefore meet the conditions set out in the law. This means that they must be mentally competent, they must suffer from a serious and incurable condition and the suffering must be ‘unbearable and unbearable’. “Both files are examined separately,” says Proot. The doctors must of course agree to have the euthanasia take place at the same time.

2 Does the unbearable prospect of living without a partner count as an argument?

Euthanasia is possible in our country not only because of physical suffering, but also because of psychological suffering. Can the prospect of having to continue living without your partner serve as an argument for this? “We sometimes receive requests where one person in the couple is seriously ill, and the other person states that he or she cannot continue living without his or her partner,” says Proot. “If that second person does not meet the conditions of the law, we cannot go there. Then we will propose to perform euthanasia on the first partner first, and then wait at least 3 or 6 months to judge whether the remaining partner can get over the loss.”

3 Does it often happen that a couple is euthanized together?

In 2022, 2,966 people in our country died due to euthanasia. But no records are kept of whether people receive euthanasia together. “The registration is done anonymously. There are no names on the documents and therefore no relationships. So we only know if the doctor indicates that it happened together,” says Proot. “But it is exceptional. I don’t think it happens more than once or twice a year.”

In the Netherlands, statistics are kept on duo euthanasia. In 2022, 29 couples were simultaneously granted euthanasia.

4 Is it also possible in other countries?

“In other countries it is often more complicated, or the euthanasia legislation stipulates that only terminal patients are eligible,” says Proot. “That doesn’t mean they are dying, but it does mean they are expected to die in the coming weeks or months. In Belgium it is also permitted for non-terminal patients, who could therefore live longer, but do meet the conditions.”

5 Do the partners really die together?

Partners who choose euthanasia together often really want to die at the same time. But can the doctors guarantee that? “It requires experience,” says Proot. “First, a sleeping pill is administered so that they sleep well. Then two doctors simultaneously administer the medication that causes the patient to die. That happens quickly: the patient dies within two to three minutes.”

6 Is it as romantic as it seems?

“Is it romantic? I’ve never thought about it that way,” says Proot. “You only do that if you like each other and can no longer live without each other. After all, sometimes one of the two could hold out a little longer, and yet they decide that the time has come to end it.”

But accompanying doctors must be extra vigilant when requesting joint euthanasia. “I am aware of a case of a man with severe lung disease and a woman with dementia,” says Proot. “During the investigation, the impression arose that the woman was being put under pressure by the man. It was then decided not to have the euthanasia take place together. The woman ultimately did not have it carried out.”

Duo euthanasia does not only happen to couples. “There is also a case of two brothers who suffered from Huntington’s disease, a dementia-like disease. They both chose euthanasia, and they got it together.”