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They later bought a cargo boat and built a business transporting goods around the Netherlands’ inland waterways.Meanwhile, Els gave birth to their only son (who asked not to be named).

During school holidays when their child was onboard too, Jan and Els looked for work trips that would take them to interesting places – along the river Rhine, or to the Netherlands’ islands.By 1999, the inland cargo business had become very competitive.

But there came a point when her symptoms couldn’t be ignored.In November 2022, after being diagnosed with dementia, Els stormed out of the doctor’s consulting room, leaving her husband and son behind.“She was furious – like a steaming bull,” remembers Jan.It was after Els learned her condition wouldn’t improve that she and Jan, with their son, began to discuss duo-euthanasia – the two of them dying together.In the Netherlands, euthanasia and assisted suicide are legal if someone makes a voluntary request, and their suffering – physical or psychological – is assessed by doctors as “unbearable”, with no prospect of improvement.

These are complex cases made even more so if one of the partners has dementia, where there can be uncertainty about their capacity to give consent.“A lot of doctors don’t even want to think about performing euthanasia on a patient with dementia,” says Dr Rosemarijn van Bruchem, a geriatrician and ethicist at the Erasmus Medical Centre, in Rotterdam.This was the position of Jan and Els’ GP.

Dr Theo Boer, professor of healthcare ethics at the Protestant Theological University, is one of the Netherlands’ few outspoken critics of euthanasia, and believes progress in palliative care often mitigates the need for its use.“I would say that killing by a doctor could be justified.

Listen to Linda Pressly’s documentary Loving, Living and Dying Together on Assignment from Tue 2 Jul on BBC World Service.

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