It’s a tough case, but an even tougher way to go. In order to perform euthanasia on this patient, the doctor only had to sedate the patient and then have her family forcibly restrain her to deliver the fatal dose. Totally cool, right? A Dutch court certainly thought so:

A Dutch court on Wednesday acquitted a doctor over euthanising a woman with severe dementia in a landmark case for the Netherlands, the first country in the world to legalise euthanasia.

Prosecutors had accused the unnamed doctor of failing to properly consult the 74-year-old Alzheimer’s patient in the case in 2016, saying that the woman may have changed her mind before about dying.

The case attracted media attention due to details of how the patient was given a sedative in her coffee but nevertheless had to be restrained by her family as the now-retired doctor injected the euthanasia drug.

But applause broke out in the courtroom after judges ruled that the doctor was right to abide by the woman’s wish, expressed four years earlier, to be euthanised instead of being placed in a care home.

It’s a heartbreaking case, as Alzheimer’s cases usually are, and prosecutors understood that. Even though they tried the doctor in a criminal court, they had already declared that they were not seeking prison time. “We do not doubt the doctor’s honest intentions,” they told the court. Rather, prosecutors wanted to set a precedent that would require doctors to get more informed consent than a conversation that took place four years earlier.

The defense pointed to a “living will” the woman made four years earlier, which swayed the court:

The patient had a certified living will stating her wish for euthanasia if her condition were to worsen significantly. The doctor carried out the mercy killing with the consent and support of the woman’s family.

Prosecutors brought the criminal case, arguing that the doctor should also have checked with the patient herself, even though she was no longer mentally competent, saying the law was unclear on that point.

But judges ruled the doctor was right to rely solely on the living will to carry out the mercy killing.

It’s a fair point in an otherwise horrendous case, but apparently no one thought twice about checking with the woman on her descent into dementia after that. Had it been a month, or six months, since her living will was signed, then perhaps that might be understandable. Four years later, though, seems like a significant amount of time — especially if the catalyst was that she would “get worse.” Presumably, that must have happened relatively recently, or the family would have asked for euthanasia earlier. Why did no one check with the patient at that point to make sure she hadn’t changed her mind?

Instead, the court set a precedent that one can only call a slippery slope:

“The court concludes that the doctor did not need to verify the current desire for euthanasia (of the patient),” presiding judge Mariette Renckens said.

That’s what prosecutors clearly hoped to prevent. Merely expressing a desire for euthanasia at any point will eventually obviate any responsibility for getting informed consent later. It opens the door wider on potentially non-voluntary euthanasia, which might end up producing the forced-dose scenario seen in this case, and perhaps even worse down the road.