Duo Euthanasia: Why a Happily Married Couple Chose to Die Together

Dying Together: Why a Happily Married Couple Chose to End Their Lives

10 hours ago By Linda Pressly, BBC News

Jan (70) and Els (71) photographed two days before they died

Jan and Els were married for nearly 50 years. In early June, they chose to die together with the help of two doctors who gave them lethal medication. This practice, known as duo-euthanasia, is legal but rare in the Netherlands. However, more Dutch couples are opting for this way to end their lives each year.

Some readers may find this story upsetting.

Three days before their planned death, Jan and Els’ campervan was parked at a sunny marina in Friesland, in northern Netherlands. They loved being on the move and spent most of their marriage living in a motorhome or on boats. “We tried living in a house,” jokes Jan, “but it didn’t work.” Jan, 70, sat in the driver’s seat of the van, one leg bent to ease his constant back pain. Els, 71, had dementia and struggled to speak clearly. “This is very good,” she said, pointing to her body. “But this is terrible,” she added, pointing to her head. Jan and Els met in kindergarten and shared a lifelong bond. Jan once played hockey for the Netherlands’ national youth team and later became a sports coach. Els trained as a primary school teacher. Their love for water and sailing defined their life together. They lived on a houseboat as a young couple and later bought a cargo boat to transport goods around the Netherlands. They had one son, who preferred to remain unnamed. He boarded at school during the week and spent weekends with his parents. During school holidays, the family took work trips to interesting places like the river Rhine or the Netherlands’ islands. By 1999, the cargo business became very competitive, and Jan’s back pain worsened. They moved to land but soon returned to living on a boat. When that became too difficult, they bought a spacious campervan. Jan had back surgery in 2003, but it didn’t help. He stopped taking heavy painkillers and couldn’t work anymore, while Els continued teaching. They often discussed euthanasia, and Jan told his family he didn’t want to live too long with his physical limitations. Around this time, they joined NVVE, the Netherlands’ “right to die” organization. “If you take a lot of medicine, you live like a zombie,” Jan said. “So, with my pain and Els’ illness, I think we have to stop this.” By “stop this,” Jan meant ending their lives.

Jan pictured with his son in 1982

In 2018, Els retired from teaching. She showed early signs of dementia but avoided seeing a doctor, possibly because she had seen her father suffer from Alzheimer’s. Eventually, her symptoms couldn’t 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 steaming bull,” Jan recalled. After learning her condition wouldn’t improve, Els and Jan, along with their son, began discussing duo-euthanasia. In the Netherlands, euthanasia and assisted suicide are legal if someone makes a voluntary request and their suffering is deemed “unbearable” by doctors, with no chance of improvement. Each request is assessed by two doctors.

Where to get help

In 2023, 9,068 people died by euthanasia in the Netherlands, about 5% of all deaths. There were 33 cases of duo-euthanasia, involving 66 people. These cases are complex, especially if one partner has dementia, raising questions about their ability to consent. “Many doctors don’t want to consider euthanasia for a patient with dementia,” says Dr. Rosemarijn van Bruchem, a geriatrician and ethicist at Erasmus Medical Centre in Rotterdam. This was the stance of Jan and Els’ GP. Of the thousands who died by euthanasia in 2023, 336 had dementia. How do doctors assess “unbearable suffering” in dementia patients? For many with early-stage dementia, the uncertainty about the future can lead them to consider ending their life, explains Dr. van Bruchem. “Am I going to lose the ability to do important things? Will I not recognize my family anymore? If these fears are clearly expressed and understood by both the doctor willing to perform euthanasia and the second doctor specialized in mental competency, the existential fear of what’s to come can be a reason to consider euthanasia.”

Els van Leeningen, photographed in 1968, was diagnosed with dementia later in life

With their GP unwilling to help, Jan and Els contacted a mobile euthanasia clinic, the Centre of Expertise on Euthanasia. This clinic supervised about 15% of assisted deaths in the Netherlands last year and approved about a third of the requests it received. In cases where a couple wants to die together, doctors must ensure one partner isn’t influencing the other. Dr. Bert Keizer has attended two duo-euthanasia cases. He also recalled meeting another couple where he suspected the man was coercing his wife. After talking to the woman alone, she revealed she had many plans and didn’t want to die with her husband. The euthanasia process was stopped, and the man died naturally. His wife is still alive.

Dr. Theo Boer, a professor of healthcare ethics at the Protestant Theological University, is one of the few critics of euthanasia in the Netherlands. He believes advancements in palliative care often reduce the need for euthanasia. “Killing by a doctor could be justified, but it should be an exception,” he says. Dr. Boer is concerned about the impact of duo-euthanasia cases, especially after a former Dutch prime minister and his wife chose to die together earlier this year, making global headlines. “In the past year, we’ve seen dozens of duo-euthanasia cases, and there’s a tendency to ‘hero-ify’ dying together,” says Dr. Boer. “But the taboo on intentional killing is eroding, especially with duo-euthanasia.”

Jan and Els could probably continue living in their campervan indefinitely. Do they feel they might be dying too soon? “No, no, no – I cannot see it,” says Els. “I’ve lived my life, I don’t want pain anymore,” says Jan. “The life we’ve lived, we’re getting old for it. We think it has to be stopped.” There’s another reason. Els has been assessed by doctors who say she still has the capacity to decide she wants to die, but this could change if her dementia worsens. This decision hasn’t been easy for their son. “You don’t want to let your parents die,” Jan explains. “There have been tears – our son said, ‘Better times will come, better weather’ – but not for me.” Els feels the same. “There is no other solution.”

Els and Jan on their wedding day, 1975

The day before their appointment with the euthanasia doctors, Els, Jan, their son, and grandchildren were together. Ever practical, Jan wanted to explain the campervan’s quirks so it would be ready to sell. “Then I went for a walk on the beach with my mum,” their son says. “The kids were playing, there were some jokes… It was a very strange day. I remember we were having dinner in the evening, and I got tears in my eyes just watching us all having that final dinner together.” On Monday morning, everyone gathered at the local hospice. The couple’s best friends were there, along with brothers of both Jan and Els, and their daughter-in-law with their son. “We had two hours together before the doctors came,” he says. “We spoke about our memories… And we listened to music.” Idlewild by Travis for Els, the Beatles’ Now and Then for Jan. “The final half hour was difficult,” their son says. “The doctors arrived, and everything happened quickly – they follow their routine, and then it’s just a matter of minutes.” Els van Leeningen and Jan Faber were given lethal medication by doctors and died together on Mon 3 Jun 2024. Their campervan hasn’t been sold yet. Their son has decided to keep it for a while and go on holiday with his wife and children. “I’ll sell it eventually,” he says. “First, I want to make some memories for the family.”