Euthanasia in the Netherlands

In 2002, the Netherlands legalized euthanasia. Euthanasia is still a criminal offence but the law codified a twenty year old convention of not prosecuting doctors who have committed euthanasia in very specific cases, under very specific circumstances. The Ministry of Public Health, Wellbeing and Sports claims that this practice "allows a person to end their life in dignity after having received every available type of palliative care."

Legal framework
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 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 can not 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 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 whether they want euthanasia or not.

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-effect of treatment necessary for alleviating serious suffering

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 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 sedative 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:
 * 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, 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.

In an earlier 2000 study of 649 patients undergoing euthanasia or physician-assisted suicide, 14% of patients undergoing euthanasia had complications such as waking from the coma, spasms or vomiting. Thirty-two percent of patients undergoing physician-assisted suicide had complications which were troublesome enough in 18% to require their doctors to switch to active euthanasia. In this study physicians were absent in 28% of cases of euthanasia and 48% of cases of physician-assisted suicide.

Social debate
The legislation has wide support among the socially libertarian Dutch, who have one of the world's highest life expectancies. There is, however, persistent opposition, mainly from the orthodox protestant Political Reformed Party and the ChristianUnion, which call for more attention for palliative care and the eventual illegalization of the procedure.

In 1992, Huib Drion, a member of the Dutch high court proposed to develop and legalize a drug, which is now known as Drion's pill. This fictional drug would be a set of two pills. The first pill could be taken without any harm; the second pill would have to be taken a couple of days later (and only then would work). This would give the patient the time to think things over. The main goal of this drug would be to allow people who have unbearable psychological suffering to end their life, especially old people who feel their life is finished. The drug was never developed. The proposal, however, indirectly started up the discussion of euthanasia in Netherlands.

Carlo Giovanardi (Italian government minister for parliamentary affairs) compared the euthanasia laws in the Netherlands to the policies of Adolf Hitler. The Dutch government denied that its euthanasia law resembles these policies. The Dutch prime minister called Giovanardi's comments 'scandalous and unacceptable'.