Euthanasia in the Netherlands

In 2001, the Netherlands decriminalized the euthanasia and assisted suicide . They remain officially still a crime for people practicing it on others, but the law codified a moratorium twenty years ago ^{[ref.Necessary]} not to prosecute physicians who had practiced euthanasia in specific circumstances and cases. The Ministry of Health, Welfare and Sports (en) says that this practice “allows any person to end his life with dignity after receiving all types of palliative care available ¹ “.

The legal framework

The Decree on End of Life on Request and Assisted Suicide came into force on 1 ^st April 2002. It decriminalized assisted suicide in very special cases and limited circumstances. The law was proposed by Els Borst , Minister of Health from the Politieke Partij Democraten 66 . The procedures codified by this law endorsed more than twenty years of tacit practices of the medical profession.

The law authorizes the Council of the Medical Corps to waive all prosecutions of physicians who have practiced euthanasia if each of the following conditions has been met:

• The suffering of the patient is unbearable and without hope of improvement;
• The request for euthanasia formulated by the patient must be of his / her own fact and recurring in time (one can not accede to his request if he is under the influence of third parties, of any psychological deficiency or of drugs);
• The patient must be fully informed of his condition, the course of his illness and possible care options;
• There must be consultation with at least one independent physician who will confirm that each of the previous steps has been completed;
• Death must be medically appropriate, by the doctor or the patient himself; In the latter case, the doctor must be present;
• The patient is at least 18 years old (parental consent is required between 12 and 16 years of age).

The physician must also report the death to the municipal coroner ( forensic pathologist) in accordance with the laws of burial and cremation laws . A Regional Ethics Committee decides whether end-of-life on request or assisted suicide meets the criteria. According to his conclusions, either the case is closed, or he is brought before the Public Prosecutor if the conditions are not fulfilled.

Finally, the law explicitly recognizes the validity of an end-of-life statement written by the patient (his “guidelines” on his euthanasia), which can be used when the patient is in a coma or in a State no longer allowing him to express his will.

Euthanasia remains a crime under the law if these conditions are not fulfilled, except in certain exceptional circumstances considered to be the normal practice of medicine:

• Suspend (or not initiate) unnecessary medical treatment;
• Suspend (or not initiate) treatment at the request of the patient;
• If death results from the administration of a treatment intended to alleviate extreme suffering.

The euthanasia of children under the age of 12 remains technically illegal; However, the D ^r Eduard Verhagen noted some individual cases and set up for them to follow a protocol defined in collaboration with colleagues and the public prosecutor. All proceedings will be suspended if the ” Groningen Protocol ” has been respected ² .

In practice

In 2003 in the Netherlands, 1,626 euthanasia cases, in the sense of medically assisted “death” (as opposed to “assisted suicide”), were officially reported (1.2% of all deaths). In 2013, there were 4,289 cases (3.4% of all deaths). In practice, a sedative , sodium thiopental , is injected intravenously to cause coma . After several minutes, when the patient is plunged into a deep coma, Pancuronium is administered to stop breathing and thus cause death.

148 cases of medically assisted deaths were also reported (1.2% of all deaths) death caused by the absorption of a potion based barbiturates high-dose ( 10 g ). The presence of the doctor is required for two reasons:

• Ensure that the potion is not taken by a third party (whether by accident, for “unauthorized” suicide or possibly murder);
• Direct the procedure and be ready to proceed with the following steps, if any, set out above.

In two cases the doctors were accused of not being present at the absorption of the potion. They replied that they had not realized this mandatory step.

There have been reported 41 cases combining the two procedures: in these cases, the patient drinks the potion but does not cause death. After a few hours, or sooner in case of vomiting , a respiratory depressant is administered to cause death.

Most cases involved patients with cancer , so the procedure was mostly used at home.

In 2000, in a previous study of 649 patients undergoing euthanasia or physician-assisted suicide, 14% of patients undergoing euthanasia experienced complications such as coma outputs, spasms or vomiting ³ . 32% of patients with medically assisted suicide experienced complications that were painful enough that in 18% of cases the physician switched to an active euthanasia procedure . In this study, physicians were absent in 28% of euthanasia cases and 48% of assisted suicide cases.

Some believe that this euthanasia authorization regime is a brake on palliative care. In an interview of 2009 ^{[ref. required]} , Els Borst Minister who had worn the law, said the law had intervened “much too early” and that palliative care had suffered.

Notes and references