Doctors still do not dare to perform euthanasia on people with severe dementia who have made living wills expressing their wish to die, the Volkskrant said on Friday.

A year ago, the justice and health ministries said the guidelines for performing euthanasia on people with severe dementia had been relaxed a little so that patients can be helped to die even if they incapable of making their current feelings known.

However, they do have to have signed a euthanasia declaration with their family doctor before they became seriously ill to be considered for help in dying.

‘In such cases, a doctor may carry out euthanasia, even if the patient cannot make this clear by word or gesture. But there must be a written euthanasia request which the patient completed earlier,’ the new guidelines state.

Jacob Kohnstamm, chairman of the euthanasia monitoring body, told the paper in the past year there had been just three such cases. ‘There is no talk of growth,’ Kohnstamm said.

Euthanasia is legal in the Netherlands under strict conditions. For example, the patient must be suffering unbearable pain and the doctor must be convinced the patient is making an informed choice. The opinion of a second doctor is also required.