Euthanasia In The Netherlands – in practice

An explanation by Dr Rob Jonquière, GP (retired)
Executive Director, World Federation of Right to Die Societies

In the Netherlands, the law which makes euthanasia legal requires the following criteria to be met:

  • There must be a voluntary and well considered request from the person involved.
  • The patient’s suffering must be unbearable and without prospect of improvement (hopeless).
  • The patient has been fully informed and is fully aware of his/her condition, prospects, and options.
  • A second independent doctor must be called in for consultation and see the patient. This is almost always a SCEN-doctor. (SCEN = Support and Consultation in Euthanasia in the Netherlands).
  • The death must be carried out in a medically appropriate fashion by the doctor (or in case of assisted suicide by the patient, with prescription from the doctor; and the doctor must be present).
  • The euthanasia must be reported to one of the (5) Regional Review Committees.
  • The law applies to adults (18 and over); children from 12 to 16 may request, but parents have to consent; 16 and 17 year old may request, but parents have to be informed.

In practice, the whole process of euthanasia – from first mentioning the idea, until the process takes place, takes a varying amount of time. How long depends on many details: the underlying reason for a request; the relationship with the doctor; the likely course of the illness etc. Typically, the process takes between a couple of days and more than a month.

The following steps are important in any procedure.

  1. Both patient and doctor, from the first conversations, need to make clear what they mean and want. To ensure this they should use the word “euthanasia” when talking about the options for ending someone’s life. The conversation should start soon after the moment the declining health situation has set in.
  2. The first essential legal criteria is the patient’s request. The doctor will evaluate this, using his/her knowledge about the patient’s ideas and his/her family. Ideally this will be done by the family doctor. Failing that, it is done by a specialist involved in the patient’s treatment. The evaluation is done during a number of consultations. Issues covered in these conversations with the patient, (and if applicable, family), concern whether the request was made freely and voluntarily; the opinion and (non) influence of family members; the social-emotional aspects; and whatever else is necessary to get a clear picture of the character of the request. The doctor must always have communications privately with the patient, to exclude pressure-issues.
  3. The second essential criterion is the patient’s suffering. The doctor assesses the character and gravity of the suffering, and possible ways in which this can be treated. There are two sides to this: the patient’s and the doctor’s. The patient must try to convince the doctor that (s)he considers the suffering to be “unbearable”. The doctor will look for “treatment” options to offer, which are acceptable to the patient, aimed at making the suffering bearable again. If, after exploring all possibilities, no acceptable treatment options are available which could make the suffering bearable, then the suffering is considered “hopeless”. This is important because under Dutch law there has to be both unbearable and hopeless suffering.
  4. Through these conversations, the diagnosis, prognosis and treatment possibilities and alternatives will have been carefully reviewed. When both patient and doctor finally decide that euthanasia is the option of choice, the doctor must call in the consultation of a second, independent doctor. In the Netherlands, this is virtually always a specially trained SCEN doctor. (SCEN stands for Support and Consultation in Euthanasia in the Netherlands). This doctor will be called in /consulted by the euthanizing doctor using an independent telephone number, and give his report to the initial doctor, mainly stating the extent to which the request complies with the legal criteria.
  5. If the second doctor’s report agrees with the first doctor’s assessment, doctor and patient then decide on when precisely the euthanasia will take place.
  6. If there is disagreement in the second doctor’s report the euthanizing doctor can do one of three things:
    1. When in agreement with report refuse the execution of the euthanasia
    2. When disagreeing, comply with the request and convince the Review Committee (who should receive the negative consultation as well) why s/he thinks s/he has complied with the due care criteria
    3. When disagreeing, seek another independent consulting doctor.
  7. The law does NOT obligate a doctor to comply with a request. It is considered appropriate professional behavior to refer patients requesting euthanasia to another physician, who probably is willing to comply. In practice referral is sometimes not very successful, so it is better for patients with a potential wish for euthanasia to talk with their family doctor about the doctor’s policy and opinion on assistance with dying. If their doctor is unhelpful, they should consider changing doctors. A new doctor will ask for the medical records to ensure continuity of care.