[Euthanasia in advanced dementia: directive is useful]

The Dutch Euthanasia Act states that an advance directive can replace an actual request for euthanasia in cases in which a patient has become unable to make autonomous decisions. In Euthanasia and the Severely Demented, I agree with Keizer that the severely demented can suffer unbearably, but contrary to Keizer I do not believe that it is impossible to state in advance the conditions under which one would not wish to go on living any longer. Consequently, euthanasia can be permissible even in patients with late-stage dementia, provided that the other due-care criteria are met. Permissibility by itself, however, will not settle disputes about borderline cases. Due to the erratic course of the disease, the right moment for euthanasia may very well be impossible to determine.