Euthanasia in the Netherlands
Encyclopedia
Euthanasia in the Netherlands is regulated by the "Termination of Life on Request and Assisted Suicide (Review Procedures) Act" from 2002. It states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient's request, the patient's suffering (unbearable and hopeless), the information provided to the patient, the presence of reasonable alternatives, consultation of another physician and the applied method of ending life. To demonstrate their compliance, the Act requires physicians to report euthanasia to a review committee.
Termination of Life on Request and Assisted Suicide (Review Procedures) Act took effect on April 1, 2002. It legalizes euthanasia and physician assisted suicide in very specific cases, under very specific circumstances. The law was proposed by Els Borst
, the D66 minister of Health
. The procedures codified in the law had been a convention of the Dutch medical community for over twenty years.
The law allows medical review board to suspend prosecution of doctors who performed euthanasia when each of the following conditions is fulfilled:
The doctor must also report the cause of death to the municipal coroner
in accordance with the relevant provisions of the Burial and Cremation Act. A regional review committee assesses whether a case of termination of life on request or assisted suicide complies with the due care criteria. Depending on its findings, the case will either be closed or, if the conditions are not met brought to the attention of the Public Prosecutor. Finally, the legislation offers an explicit recognition of the validity of a written declaration of will
of the patient regarding euthanasia (a "euthanasia directive"). Such declarations can be used when a patient is in a coma
or otherwise unable to state if they wish to be euthanized.
Euthanasia remains a criminal offense in cases not meeting the law's specific conditions, with the exception of several situations that are not subject to the restrictions of the law at all, because they are considered normal medical practice:
Euthanasia of children under the age of 12 remains technically illegal; however, Dr. Eduard Verhagen
has documented several cases and, together with colleagues and prosecutors, has developed a protocol to be followed in those cases. Prosecutors will refrain from pressing charges if this Groningen Protocol
is followed.
sodium thiopental
is intravenously administered to induce a coma
. Once it is certain that the patient is in a deep coma, typically after some minutes, Pancuronium
is administered to stop the breathing and cause death.
Officially reported were also 148 cases of physician assisted dying (0.14% of all deaths), usually by drinking a strong (10g) barbiturate
potion
. The doctor is required to be present for two reasons:
In two cases the doctor was reprimanded for not being present while the patient drank the potion. They said they had not realized that this was required.
Forty-one cases were reported to combine the two procedures: usually in these cases the patient drinks the potion, but this does not cause death. After a few hours, or earlier in the case of vomiting
, the muscle relaxant is administered to cause death.
By far, most reported cases concerned cancer
patients. Also, in most cases the procedure was applied at home.
A study in 2000 found that Dutch physicians who intend to provide assistance with suicide sometimes end up administering a lethal medication themselves because of the patient's inability to take the medication or because of problems with the completion of physician-assisted suicide.
In 2010 there were 3136 cases reported of a physician assisting the death of a patient. Split out it were 2910 cases of "end of life on request", 182 cases of assisted suicide and in 44 cases it was a combination. The evaluation commissions decided that in 9 cases the procedures were not according to protocol and referred the cases to the Public Prosecution Service and the Health Care Inspectorate. It was the fifth year in a row that the number of reported cases was rising. The reason for this rise is not clear.
Legal framework
The legal debate concerning euthanasia in the Netherlands took off with the "Postma case" in 1973, concerning a physician who had facilitated the death of her mother following repeated explicit requests for euthanasia. While the physician was convicted, the court's judgment set out criteria when a doctor would not be required to keep a patient alive contrary to their will. This set of criteria was formalized in the course of a number of court cases during the 1980s.Termination of Life on Request and Assisted Suicide (Review Procedures) Act took effect on April 1, 2002. It legalizes euthanasia and physician assisted suicide in very specific cases, under very specific circumstances. The law was proposed by Els Borst
Els Borst
Else Borst-Eilers is a former Dutch Politician, she led D66 in the 1998 election campaign and served as Minister of Health, Welfare and Sport for eight years, and the last four as Deputy Prime Minister. Before entering politics she had a career in medicine.-Education and Academic Career:Borst...
, the D66 minister of Health
Ministry of Public Health (Netherlands)
The Ministry of Health, Welfare and Sport is the public health authority of the Netherlands. The current minister is Edith Schippers...
. The procedures codified in the law had been a convention of the Dutch medical community for over twenty years.
The law allows medical review board to suspend prosecution of doctors who performed euthanasia when each of the following conditions is fulfilled:
- the patient's suffering is unbearable with no prospect of improvement
- the patient's request for euthanasia must be voluntary and persist over time (the request cannot be granted when under the influence of others, psychological illness or drugs)
- the patient must be fully aware of his/her condition, prospects and options
- there must be consultation with at least one other independent doctor who needs to confirm the conditions mentioned above
- the death must be carried out in a medically appropriate fashion by the doctor or patient, in which case the doctor must be present
- the patient is at least 12 years old (patients between 12 and 16 years of age require the consent of their parents)
The doctor must also report the cause of death to the municipal coroner
Coroner
A coroner is a government official who* Investigates human deaths* Determines cause of death* Issues death certificates* Maintains death records* Responds to deaths in mass disasters* Identifies unknown dead* Other functions depending on local laws...
in accordance with the relevant provisions of the Burial and Cremation Act. A regional review committee assesses whether a case of termination of life on request or assisted suicide complies with the due care criteria. Depending on its findings, the case will either be closed or, if the conditions are not met brought to the attention of the Public Prosecutor. Finally, the legislation offers an explicit recognition of the validity of a written declaration of will
Living will
An advance health care directive, also known as living will, personal directive, advance directive, or advance decision, are instructions given by individuals specifying what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or...
of the patient regarding euthanasia (a "euthanasia directive"). Such declarations can be used when a patient is in a coma
Coma
In medicine, a coma is a state of unconsciousness, lasting more than 6 hours in which a person cannot be awakened, fails to respond normally to painful stimuli, light or sound, lacks a normal sleep-wake cycle and does not initiate voluntary actions. A person in a state of coma is described as...
or otherwise unable to state if they wish to be euthanized.
Euthanasia remains a criminal offense in cases not meeting the law's specific conditions, with the exception of several situations that are not subject to the restrictions of the law at all, because they are considered normal medical practice:
- stopping or not starting a medically useless (futile) treatment
- stopping or not starting a treatment at the patient's request
- speeding up death as a side-effectAdverse effect (medicine)In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...
of treatment necessary for alleviating serious suffering
Euthanasia of children under the age of 12 remains technically illegal; however, Dr. Eduard Verhagen
Eduard Verhagen
Eduard Verhagen is an attorney and the medical director of the department of pediatrics at the University Medical Center Groningen . He is mainly known for his involvement in infant euthanasia in the Netherlands....
has documented several cases and, together with colleagues and prosecutors, has developed a protocol to be followed in those cases. Prosecutors will refrain from pressing charges if this Groningen Protocol
Groningen Protocol
The Groningen Protocol is a text created in September 2004 by Eduard Verhagen, the medical director of the department of pediatrics at the University Medical Center Groningen in Groningen, The Netherlands...
is followed.
Practice
In 2003, in the Netherlands, 1626 cases were officially reported of euthanasia in the sense of a physician assisting the death (1.2% of all deaths). Usually the sedativeSedative
A sedative or tranquilizer is a substance that induces sedation by reducing irritability or excitement....
sodium thiopental
Sodium thiopental
Sodium thiopental, better known as Sodium Pentothal , thiopental, thiopentone sodium, or Trapanal , is a rapid-onset short-acting barbiturate general anaesthetic...
is intravenously administered to induce a coma
Coma
In medicine, a coma is a state of unconsciousness, lasting more than 6 hours in which a person cannot be awakened, fails to respond normally to painful stimuli, light or sound, lacks a normal sleep-wake cycle and does not initiate voluntary actions. A person in a state of coma is described as...
. Once it is certain that the patient is in a deep coma, typically after some minutes, Pancuronium
Pancuronium
Pancuronium is a muscle relaxant with various purposes. It is the second of three drugs administered during most lethal injections in the United States.- Mode of action :...
is administered to stop the breathing and cause death.
Officially reported were also 148 cases of physician assisted dying (0.14% of all deaths), usually by drinking a strong (10g) barbiturate
Barbiturate
Barbiturates are drugs that act as central nervous system depressants, and can therefore produce a wide spectrum of effects, from mild sedation to total anesthesia. They are also effective as anxiolytics, as hypnotics, and as anticonvulsants...
potion
Potion
A potion is a consumable medicine or poison.In mythology and literature, a potion is usually made by a magician, sorcerer, dragon, fairy or witch and has magical properties. It might be used to heal, bewitch or poison people...
. The doctor is required to be present for two reasons:
- to make sure the potion is not taken by a different person, by accident (or, theoretically, for "unauthorized" suicide or perhaps even murder)
- to monitor the process and be available to apply the combined procedure mentioned below, if necessary
In two cases the doctor was reprimanded for not being present while the patient drank the potion. They said they had not realized that this was required.
Forty-one cases were reported to combine the two procedures: usually in these cases the patient drinks the potion, but this does not cause death. After a few hours, or earlier in the case of vomiting
Vomiting
Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...
, the muscle relaxant is administered to cause death.
By far, most reported cases concerned cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
patients. Also, in most cases the procedure was applied at home.
A study in 2000 found that Dutch physicians who intend to provide assistance with suicide sometimes end up administering a lethal medication themselves because of the patient's inability to take the medication or because of problems with the completion of physician-assisted suicide.
In 2010 there were 3136 cases reported of a physician assisting the death of a patient. Split out it were 2910 cases of "end of life on request", 182 cases of assisted suicide and in 44 cases it was a combination. The evaluation commissions decided that in 9 cases the procedures were not according to protocol and referred the cases to the Public Prosecution Service and the Health Care Inspectorate. It was the fifth year in a row that the number of reported cases was rising. The reason for this rise is not clear.