A doctor in the Netherlands who euthanized a woman with advanced Alzheimer's, despite the woman saying she did not want to be killed, maintains that she made the right decision.

"I believed that her suffering was truly awful and I knew that it could last for a long time," retired geriatric doctor Marinou Arends told Nieuwsuur television program in a new interview.

Arends – whose identity is only being made public – was cleared of murder in a case involving the 2016 death of a 74-year-old patient with serious dementia.

Euthanasia was legalized in the Netherlands in 2002. The procedure is available for terminally ill patients who experience unbearable suffering and face no foreseeable improvement. Under the Termination of Life on Request and Assisted Suicide Act, patients are required to give consent in writing and persistently over time.

The patient in question suffered from Alzheimer's disease. When she was diagnosed in 2012, she requested the procedure occur at a time she deemed appropriate and before she was placed in a nursing home.

"I want to be able to decide (when to die) while still in my senses and when I think the time is right," she told the public broadcaster NOS, according to Courthouse News.

Four years later, the woman was admitted to a care home in The Hague, where she was placed under Arends' care.

A second specialist agreed that she was suffering unbearably. However, when Arends asked her directly if she wanted to die, the patient repeatedly responded, "Not yet."

"If you asked her: 'What would you think if I were to help you to die?', she looked bewildered and said: 'That's going a bit far!'" Arends told Nieuwsuur.

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However, she contended, "I saw in her eyes that she didn't understand it any more."

Despite asking the patient three times, and receiving a negative reply each time, Arends went through with the euthanasia on April 22, 2016. She secretly put a sleeping drug in the patient's coffee. However, the patient woke up and appeared to recoil from the lethal infusion, and her daughter and husband had to restrain her while the procedure was completed.

In the public outcry that followed, Arends was charged with murder. Prosecutors argued that the patient may have changed her mind about the euthanasia, and said Arends should have done more to ensure her consent.

However, a district court in The Hague ruled in September 2019 that it would have been impossible to further identify the patient's consent, saying she no longer understood the definition of "euthanasia." The court ruled that a decision made during a time of sound judgment is valid even after the patient loses their mental capacities.

The decision was upheld by the Dutch Supreme Court in April 2020.

In her interview with Nieuwsuur, Arends defended her use of the secret sedative, as well as euthanizing the patient without final consent and against her last vocal wishes.

"It is good to get the confirmation," she said. "But I couldn't get this confirmation, and without it I had to take this step. It was tremendously difficult, but for the best."

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She maintained that she believed her actions were legal, because government regulations allowed a previous living will to serve as adequate consent to euthanasia if a patient later becomes unable to express their desires.

Religious freedom and pro-life advocates decried the court's decision in 2019 and emphasized that legal euthanasia has dangerous consequences for society, the National Catholic Register reported.

"With regulators and euthanasia campaigners closely intermingled, this case shines a spotlight on the weakness of safeguards and review procedures, as well as, frighteningly, on the whole culture around attitudes to end-of-life care in the Netherlands," said Gordon Macdonald, CEO of Care Not Killing.

"The case in the Netherlands exposes the threat that legalizing euthanasia poses to individuals and the society as a whole," said Andreas Thonhauser, spokesman for Alliance Defending Freedom International. "Once a country allows euthanasia, as in the Netherlands, there is no logical stopping point."