Doxit Podcast No 3: Happy Hypoxia in the Age of COVID & Dementia & Advance Directives in the Netherlands

Exit Podcast - The Good Death

This week we take the lead from the plethora of news reports on 'happy hypoxia' vis a vis COVID-19 and a good death.

The term ‘happy hypoxia’ first gained attention in early 2020 during the COVID-19 pandemic. Some people whose lungs were severely affected by the virus (so that oxygen could not readily cross into the blood), were found to be hypoxic. However, these patients were not particularly distressed.

Happy hypoxia has also been associated with deaths resulting from lung infections and pneumonia.

When William Osler (one of the founders of the Johns Hopkins Hospital) described in 1892, a death from pneumonia as ‘the old person’s friend’, it was happy hypoxia that he was referring to.

Happy hypoxia depends on cerebral oxygen levels dropping to lethal levels, while avoiding any increase in carbon dioxide (with the associated distressing symptoms).

The second topic of this Podcast is the recent Dutch Supreme Court decision that confirmed that doctors should act upon an advance directive that contains a person's wish for euthanasia in the context of advanced dementia.

Euthanasia in the context of dementia or is a controversial subject. In the vast majority of jurisdictions that have some form of voluntary assisted dying laws, a person who has dementia will be expressly excluded from being able to seek help.

This is not the case in the Netherlands or Belgium.