Under strictly specified circumstances, physicians in the Netherlands are allowed to perform euthanasia and assisted suicide at the request of a patient. Euthanasia is defined as the active termination of life at a patient’s voluntary and well-informed request. Physician-assisted suicide (PAS) also comes under this definition. Only physicians are allowed to perform euthanasia.
In most cases the request for euthanasia comes from patients in the final stages of a malignant disease. A request for euthanasia can only be granted in cases in which the patient and physician have exhausted all options and the patient’s suffering cannot be remedied or alleviated by any other means. There is no right to euthanasia for patients in the Netherlands and physicians are not under any obligation to perform euthanasia.
Euthanasia is still a punishable offence under the Dutch Penal Code, and is only permissible if the relevant due care criteria are met, as laid down in Dutch legislation. These criteria include a voluntary and well-considered request from the patient, unbearable suffering without any prospect of improvement, and the lack of a reasonable alternative. Although most patients who receive euthanasia have a terminal disease and a short life expectancy, these are not legal requirements.
The law further stipulates that physicians should consult at least one other independent physician who has seen the patient and has given a written opinion regarding the due care criteria. To ensure this is done professionally, the Royal Dutch Medical Association (KNMG) established a network of independent, expert doctors known as SCEN physicians (SCEN: Support and Consultation on Euthanasia in the Netherlands). SCEN physicians are available for support, information and formal consultation.
Physicians must report euthanasia to one of five regional review committees on euthanasia. The committee assesses whether the physician who performed euthanasia has fulfilled the due care criteria. This procedure is intended to ensure greater transparency and consistency in the way cases are reported and assessed. Physicians who fail to fulfil the due care criteria may be prosecuted.
Most patients who receive euthanasia are in the final stages of a malignant disease. However, some patients with dementia or with a mental illness also suffer unbearably from their condition and might therefore fall within the scope of the law. In these cases, the physician must take extra care to ascertain the voluntary nature of the request and the lack of a reasonable alternative.
Currently there is a debate in the Netherlands on the subject of assisted suicide in the case of elderly persons who consider their life to be ‘completed’. This would involve separate legislation for elderly individuals who believe their life has reached its natural conclusion. The KNMG has stated that such legislation, alongside the current Euthanasia Act, is undesirable. The KNMG fears such legislation would stigmatise the elderly and undermine current euthanasia practice.
The End-of-Life Clinic (ELC) was founded in 2012 by the Dutch Voluntary Termination of Life Association (NVVE). Its aim is to provide euthanasia for patients who meet all legal requirements but whose regular physicians rejected their request. In many cases, this concerns patients with a ‘complex’ request that may, for example, involve a mental illness. The ELC is not a regular clinic, but rather a network of physicians.
Euthanasia in the Netherlands: balancing autonomy and compassion (World Medical Journal, October 2017)