Victor was 76. He had run an international company and flown around the world for it, and when the dementia diagnosis came he wrote a euthanasia directive straight away. In the interview he gave researchers, he said he wanted to choose the moment himself, while he was still fully conscious. He also said this: "I don't want my wife to witness me becoming someone else."
Victor received euthanasia four years after his diagnosis.
His two sentences sit side by side in a short paper published online on 8 May 2026 in Palliative Care and Social Practice, by Trijntje Scheeres-Feitsma, Jenny van der Steen and the philosopher Petruschka Schaafsma. Their claim is simple and awkward. The wish to die with dementia is frequently aimed at someone else. People want to spare a partner, a daughter, a son the years of watching.
That matters because Dutch euthanasia law is built on the opposite picture: a request that is voluntary, well considered and persistent, made by one person, with the doctor obliged to rule out pressure from the family. The authors argue that keeping family influence out of the decision is an illusion, and they call instead for a relational account of autonomy, one that puts loved ones inside the conversation where they already are.
If you have ever sat at a kitchen table while a parent said, quietly, that they do not want to be a burden to you, you know the grammar of this. The sentence is about love and about fear, and it is almost never only about pain.
The evidence underneath the argument is small and should be described exactly. It is a philosophical letter, with no trial, no cohort, no outcome. It reasons from the team's own qualitative interview study, published in Death Studies (volume 49, pages 1012 to 1022), in which seven people with dementia and a euthanasia wish in the Netherlands were interviewed at home in late 2019, and two of them plus five family members were interviewed again three years later: fourteen conversations in total. One of its four themes was protecting the relationship from the impact of dementia. Another was the implicit expectation that family would agree.
Seven people cannot tell you how common Victor's motive is. They can tell you it exists, in detail, in a man's own words.
The authors then press on the part most people skip. A wish to spare others is understandable at the kitchen table. Written into a medical decision and weighed by a doctor, it becomes something else: a society agreeing that it can be right to want to die in order to spare other people suffering. They do not argue that this settles the question either way. They argue that it should be said out loud, and that people trained in existential questions, including spiritual counsellors, belong in the room when it is.
The practice they are writing about is growing. The Dutch Regional Euthanasia Review Committees reported on 26 March 2026 that they received 10,341 notifications of euthanasia in 2025, 6 percent of all deaths in the country. In 499 of those cases the person had a form of dementia, up from 427 in 2024. In 492 of the 499, the person was still competent to make the request. Eleven notifications across all conditions concerned people who no longer were. NL Times, reporting the committees' figures in April 2026, put the 2020 dementia total at 170.
Those numbers carry the whole dilemma. Almost everyone who gets euthanasia with dementia in the Netherlands asks for it early, while they can still argue their own case. The Dutch End-of-Life Association, a campaigning body, describes the timing as being just before the clock strikes, and told NL Times that "ahead-of-time euthanasia requires courage", because it means giving up good months to avoid the years that are feared. Families, they said, are often the ones who notice capacity slipping.
So the person is choosing alone, by law, at a moment that the people around them helped define.
For a family living with this in a country where euthanasia is unavailable, the finding still lands. The wish to protect the people you love shapes advance directives, care home decisions, the refusal of a treatment, the insistence on one. It is worth hearing as a statement about a relationship, and worth asking about directly, because the fear underneath it is usually specific and sometimes addressable: a particular scene, a particular person, a particular day someone cannot bear to imagine.