Euthanasia in the Netherlands

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Euthanasia in the Netherlands is regulated by the "Termination of Life on Request and Assisted Suicide (Review Procedures) Act" which was passed in 2001 [1] and took effect in 2002. It states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. [2] These criteria concern the patient's request, the patient's suffering (unbearable and hopeless), the information provided to the patient, the absence of reasonable alternatives, consultation of another physician and the applied method of ending life. [2] To demonstrate their compliance, the Act requires physicians to consult another, independant colleague before the euthanasia (a so called "scen doctor") [3] and to send a report after the euthanasia to a review committee. [2]

Contents

The legal debate concerning euthanasia in the Netherlands began with the "Postma case" in 1973, concerning a physician who had facilitated the death of her mother following repeated explicit requests for euthanasia. [4] 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 formalised in the course of a number of court cases during the 1980s.

Termination of Life on Request and Assisted Suicide (Review Procedures) Act was passed in April 2001 [1] and took effect on 1 April 2002. It legalises euthanasia and physician-assisted suicide in very specific cases, under very specific circumstances. [5] 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 are 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 euthanised.

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 not considered euthanasia but 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.

Practice

In 2023, the number of official cases of euthanasia in the Netherlands was 9,068 which was 5.4% of total deaths in the Netherlands. [6]

In 2010, the number had been 4,050, and according to research done by the Vrije Universiteit, University Medical Center Utrecht and Statistics Netherlands, and published in The Lancet , that was not more than before the "Termination of Life on Request and Assisted Suicide (Review Procedures) Act" took effect in 2002; [7] and the study concluded that In effect, the legislation did not lead to more cases of euthanasia and assisted suicide on request. [8]

In 2003, in the Netherlands, 1,626 cases were officially reported of euthanasia in the sense of a physician assisting the death (1.2 % of all deaths). Usually the sedative sodium thiopental is intravenously administered to induce a coma. Once it is certain that the patient is in a deep coma, typically after less than a minute, pancuronium is administered to stop breathing and cause death.

Officially reported were also 148 cases of physician-assisted dying (0.14 % of all deaths), usually by drinking a strong (10 g) 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 realised that this was required. [9]

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. [10]

In 2010, there were 3,136 cases reported of a physician assisting the death of a patient. When categorised there were, 2,910 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. [11] The number of reported cases was rising by 8 % each year. In 2017, the number of reported euthanasias had increased to 6,585; 99.8 % of them being performed carefully. [12] The reason for this rise is not clear. [11]

Further developments

Under current Dutch law, euthanasia by doctors is only legal in cases of "hopeless and unbearable" suffering. In practice this means that it is limited to those suffering from serious medical conditions like severe pain, exhaustion or asphyxia. Sometimes, psychiatric patients that have proven to be untreatable, can get euthanasia. There is much discussion about people with early dementia who have previously stated in a written will that if they ever got dementia, they would want to get euthanasia. [13]

In February 2010, a citizens' initiative called Out of Free Will further demanded that all Dutch people over 70 who feel tired of life should have the right to professional help in ending it. The organisation started collecting signatures in support of this proposed change in Dutch legislation. A number of prominent Dutch citizens supported the initiative, including former ministers and artists, legal scholars and physicians. [14] [15] However, this initiative has never been legalised.

In 2016, the Dutch Health Minister of the Second Rutte cabinet announced plans to draft a law that would allow assisted suicide in cases without a terminal illness, if the person feels they have completed life. [16]

In April 2023, euthanasia was expanded to include children of all ages who are in unbearable suffering. [17]

In November 2023, the political party D66 drafted a bill to give people aged 75 and over the option to have euthanasia if they felt they had completed life. [18]

Foreign views

In 2012, United States Republican presidential candidate Rick Santorum claimed that forced euthanasia accounted for 5% of all deaths in the Netherlands and that elderly Dutch people wear a bracelet reading “Do not euthanize me.”, but these claims have been disproven. [19] [20] The lack of a formal statement by Dutch officials on the matter angered Dutch politician Frans Timmermans, who demanded minister of foreign affairs Uri Rosenthal to take a public stance against such assertions. [21] [22]

The 2019 suicide of 17-year-old Noa Pothoven led to false reports in English-language media that she had been granted an assisted death. [23]

The euthanasia of 29-year-old Zoraya ter Beek in May 2024, who had been a sufferer of chronic depression, autism, anxiety disorder and psychotraumas, and who decided that she wanted a medically-assisted death, attracted international attention. [24]

See also

Related Research Articles

Euthanasia is the practice of intentionally ending life to eliminate pain and suffering.

<span class="mw-page-title-main">Assisted suicide</span> Suicide undertaken with aid from another person

Assisted suicide describes the process by which a person, with the help of others, takes drugs to end their life. It has been referred to as physician-assisted suicide (PAS), assisted suicide, assisted dying or medical aid in dying.

The right to die is a concept based on the opinion that human beings are entitled to end their lives or undergo voluntary euthanasia. Possession of this right is often bestowed with the understanding that a person with a terminal illness, or in incurable pain has access to assisted suicide. The question of who, if anyone, may be empowered to make this decision is often the subject of debate.

In medicine, specifically in end-of-life care, palliative sedation is the palliative practice of relieving distress in a terminally ill person in the last hours or days of a dying person's life, usually by means of a continuous intravenous or subcutaneous infusion of a sedative drug, or by means of a specialized catheter designed to provide comfortable and discreet administration of ongoing medications via the rectal route.

Voluntary euthanasia is the purposeful ending of another person's life at their request, in order to relieve them of suffering. Voluntary euthanasia and physician-assisted suicide (PAS) have been the focus of intense debate in the 21st century, surrounding the idea of a right to die. Some forms of voluntary euthanasia are legal in Australia, Belgium, Canada, Colombia, Luxembourg, the Netherlands, New Zealand, and Spain.

The Groningen Protocol is a medical protocol created in September 2004 by Eduard Verhagen, the medical director of the department of pediatrics at the University Medical Center Groningen (UMCG) in Groningen, the Netherlands. It contains directives with criteria under which physicians can perform "active ending of life on infants" without fear of legal prosecution.

<span class="mw-page-title-main">Suicide legislation</span> Laws concerning suicide around the world

Suicide is a crime in some parts of the world. However, while suicide has been decriminalized in many countries, the act is almost universally stigmatized and discouraged. In some contexts, suicide could be utilized as an extreme expression of liberty, as is exemplified by its usage as an expression of devout dissent towards perceived tyranny or injustice which occurred occasionally in cultures such as ancient Rome, medieval Japan, or today's Tibet Autonomous Region.

Involuntary euthanasia is illegal in all 50 states of the United States. Assisted suicide is legal in 10 jurisdictions in the US: Washington, D.C. and the states of California, Colorado, Oregon, Vermont, New Mexico, Maine, New Jersey, Hawaii, and Washington. The status of assisted suicide is disputed in Montana, though currently authorized per the Montana Supreme Court's ruling in Baxter v. Montana that "nothing in Montana Supreme Court precedent or Montana statutes [indicates] that physician aid in dying is against public policy."

Non-voluntary euthanasia is euthanasia conducted when the explicit consent of the individual concerned is unavailable, such as when the person is in a persistent vegetative state, or in the case of young children. It contrasts with involuntary euthanasia, when euthanasia is performed against the will of the patient.

<span class="mw-page-title-main">Legality of euthanasia</span>

The legality of euthanasia varies between countries and territories. Efforts to change government policies on euthanasia of humans in the 20th and 21st centuries have met with limited success in Western countries. Human euthanasia policies have also been developed by a variety of NGOs, most advocacy organisations although medical associations express a range of perspectives, and supporters of palliative care broadly oppose euthanasia.

Child euthanasia is a form of euthanasia that is applied to children who are gravely ill or have significant birth defects. In 2005, the Netherlands became the first country since the end of Nazi Germany to decriminalize euthanasia for infants with hopeless prognosis and intractable pain. Nine years later, Belgium amended its 2002 Euthanasia Act to extend the rights of euthanasia to minors. Like adult euthanasia, there is world-wide public controversy and ethical debate over the moral, philosophical, and religious issues of child euthanasia.

Euthanasia became legal in New Zealand when the End of Life Choice Act 2019 took full effect on 7 November 2021. It is illegal to "aid and abet suicide" under Section 179 of the New Zealand Crimes Act 1961. The clauses of this act make it an offence to "incite, procure or counsel" and "aid and abet" someone else to commit suicide, regardless of whether a suicide attempt is made or not. Section 179 covers both coercion to undertake assisted suicide and true suicide, such as that caused by bullying. This will not change under the End of Life Choices Act 2019, which has provisions on coercion of terminally ill people.

<span class="mw-page-title-main">Assisted suicide in the United States</span> Medically-induced suicide with help from another person

In the United States, the term "assisted suicide" is typically used to describe what proponents refer to as "medical aid in dying", in which a terminally ill adult is prescribed, and self-administers, barbiturates if they feel that they are suffering significantly. The term is often used interchangeably with "physician-assisted suicide" (PAS), "physician-assisted dying", "physician-assisted death", "assisted death", and "medical aid in dying" (MAiD).

<span class="mw-page-title-main">Euthanasia in Canada</span> Legal history of euthanasia in Canada

Euthanasia in Canada in its legal voluntary form is called Medical Assistance in Dying and it first became legal along with assisted suicide in June 2016 for those whose death was reasonably foreseeable. Before this time, it was illegal as a form of culpable homicide. In March 2021, the law was further amended by Bill C-7 which to include those suffering from a grievous and irremediable condition whose death was not reasonably foreseeable. The planned inclusion of people with mental illnesses is controversial and has been repeatedly delayed. The legality of this postponement to 2027 is being challenged in court.

Terminal dehydration is dehydration to the point of death. Some scholars make a distinction between "terminal dehydration" and "termination by dehydration". Courts in the United States generally do not recognize prisoners as having a right to die by voluntary dehydration, since they view it as suicide.

Critics of euthanasia sometimes claim that legalizing any form of the practice will lead to a slippery slope effect, resulting eventually in non-voluntary or even involuntary euthanasia. The slippery slope argument has been present in the euthanasia debate since at least the 1930s.

Noa Pothoven was a Dutch mental health activist and author. Her death at the age of 17 sparked global controversy due to public statements she made about her wish to die, her activism concerning youth mental health care, and foreign media reports that incorrectly attributed her eventual death to active euthanasia. Many foreign news outlets wrongfully stated Pothoven was euthanised under the Dutch 2001 Termination of Life on Request and Assisted Suicide Act.

Organ donation after medical assistance in dying is the donation of organs after death that is medically assisted (MAiD). Both are expressions of human autonomy. The governments of the countries where MAiD is permitted have introduced detailed regulations for this procedure. Combining these procedures requires a combination of the separate regulations applying to each procedure. Popular demand has furthered the development of the combined procedure, known in English-speaking countries as "organ and tissue donation and transplantation after medical assistance in dying " and in Europe as "organ donation after euthanasia (ODE)". By 2020 MAiD by intravenous injection had been legalized in 8 countries and occurred more than 17,000 times including more than 220 ODE procedures.

Euthanasia for mental illness involves a physician intentionally ending the life of a patient who has requested euthanasia due to a psychiatric condition. The practice is legal in Belgium, the Netherlands, Luxembourg, Spain and Colombia. In Canada, legislation authorizing the procedure was passed, but has since been repeatedly postponed.

References

  1. 1 2 "Dutch 'mercy killing law' passed". BBC. 11 April 2001. Retrieved 3 November 2018.
  2. 1 2 3 Buiting H, van Delden J, Onwuteaka-Philpsen B, et al. (2009). "Reporting of euthanasia and physician-assisted suicide in the Netherlands: descriptive study". BMC Med Ethics. 10: 18. doi: 10.1186/1472-6939-10-18 . PMC   2781018 . PMID   19860873.
  3. ↑ Euthanasiecommissie: Wat is een SCEN-arts?
  4. ↑ Rietjens JA, van der Maas PJ, Onwuteaka-Philipsen BD, van Delden JJ, van der Heide A (September 2009). "Two Decades of Research on Euthanasia from the Netherlands. What Have We Learnt and What Questions Remain?". J Bioeth Inq. 6 (3): 271–283. doi:10.1007/s11673-009-9172-3. PMC   2733179 . PMID   19718271.
  5. ↑ Janssen, André (2002). "The New Regulation of Voluntary Euthanasia and Medically Assisted Suicide in the Netherlands". Int J Law Policy Family. 16 (2): 260–269. doi:10.1093/lawfam/16.2.260. PMID   16848072.
  6. ↑ Ferrer, Isabel (19 April 2024). "Debate ignites in the Netherlands over rise in euthanasia for mental disorders". EL PAÍS English. Retrieved 15 December 2024.
  7. ↑ Onwuteaka-Philipsen, Bregje D.; Brinkman-Stoppelenburg, Arianne; Penning, Corine; de Jong-Krul, Gwen J. F.; van Delden, Johannes J. M.; van der Heide, Agnes (8 September 2012). "Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey". Lancet. 380 (9845): 908–915. doi:10.1016/S0140-6736(12)61034-4. ISSN   1474-547X. PMID   22789501.
  8. ↑ "Euthanasiewet leidde niet tot meer euthanasie" [Euthanasia Law did not lead to more euthanasia]. nl.nl (in Dutch). 10 July 2012. Retrieved 11 March 2015.
  9. ↑ (in Dutch) Regionale toetsingscommissies euthanasie Jaarverslag 2003 (PDF)
  10. ↑ Groenewoud, JH.; van der Heide, A.; Onwuteaka-Philipsen, BD.; Willems, DL.; van der Maas, PJ.; van der Wal, G. (February 2000). "Clinical problems with the performance of euthanasia and physician-assisted suicide in The Netherlands". N Engl J Med. 342 (8): 551–6. doi:10.1056/NEJM200002243420805. hdl: 1765/9262 . PMID   10684914.
  11. 1 2 "Aantal euthanasiegevallen weer gestegen" [Number of Euthanasia cases risen again]. nu.nl (in Dutch). 2 September 2011. Retrieved 11 March 2015.
  12. ↑ NOS: Opnieuw meer meldingen van euthanasie [again more reported euthanasia cases]
  13. ↑ Medisch Contact june, 30, 2011: Artsen steunen euthanasie bij dementie
  14. ↑ "'Right to die' for elderly back at centre of Dutch debate". Radio Netherlands Worldwide. 9 February 2010. Archived from the original on 3 March 2014. Retrieved 9 February 2010.
  15. ↑ "Citizens group argues 'right to die' - A citizens action group wants to legalise assisted suicide for all people over 70". nrc handelsblad. 9 February 2010. Archived from the original on 15 April 2010. Retrieved 9 February 2010.
  16. ↑ Bilefsky, Dan; Schuetze, Christopher F. (13 October 2016). "Dutch Law Would Allow Assisted Suicide for Healthy Older People". The New York Times.
  17. ↑ "Netherlands to broaden euthanasia rules to cover children of all ages". The Guardian . 14 April 2023. Retrieved 15 November 2023.
  18. ↑ "D66 adjusts "completed life" bill for longer guidance before assisted suicide". NL Times . 7 November 2023. Retrieved 15 November 2023.
  19. ↑ Mackey, Robert (22 February 2012). "Dutch Puzzled by Santorum's False Claim of Forced Euthanasia". The New York Times .
  20. ↑ Posthumus, Niels (18 February 2012). "Rick Santorum denkt Nederland te kennen: grootschalige bejaardenmoord". NRC Handelsblad (in Dutch).
  21. ↑ Mackey, Robert (24 February 2012). "Dutch Official Is Pressed to Respond to Santorum's 'Scandalous Accusations'". The New York Times.
  22. ↑ "Timmermans wil actie Rosenthal om 'schandalige euthanasie-beschuldigingen' Santorum". de Volkskrant (in Dutch). 23 February 2012.
  23. ↑ Henley, Jon (5 June 2019). "Dutch girl was not 'legally euthanised' and died at home". The Guardian .
  24. ↑ Sherwood, Harriet (16 May 2024). "Dutch woman, 29, granted euthanasia approval on grounds of mental suffering". The Guardian. ISSN   0261-3077 . Retrieved 4 June 2024.
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