Physician-Assisted Suicide and Euthanasia in the Netherlands: A Report to the House Judiciary Subcommittee on the Constitution

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Executive Summary

This report examines legal developments and policy arguments in the Netherlands which, in the past 23 years, have led from toleration of the practice of physician-assisted suicide for physically-suffering, terminally-ill, competent patients to the judicial and medical sanctioning of the nonconsensual termination of patients' lives.

Since 1886, the Dutch Penal Code has prohibited assisted suicide and euthanasia. However, in the 1970s the Dutch courts began to tolerate physician-assisted suicide and euthanasia for terminally-ill, competent patients. By the early 1980s, the medical profession and courts in the Netherlands had established guidelines for physicians to perform assisted suicide and euthanasia. In 1984, the Supreme Court of the Netherlands accepted physician-assisted suicide and euthanasia, not only for terminally-ill patients, but also for chronically-ill or elderly patients whose deaths were not otherwise imminent.

In 1986, the Dutch medical association in collaboration with the nurses association established official "Guidelines for Euthanasia." These official Guidelines form the basis for the current practice of physician-assisted suicide and euthanasia in the Netherlands. The Guidelines list five criteria for physicians to meet before engaging in assisted suicide or euthanasia. First, a voluntary request from the patient is required. Second, the request must have been well considered by the patient. Third, the patient must have a "persistent desire for death." Fourth, the suffering of the patient must be unacceptable. And fifth, the physician must consult with another colleague. Although the criteria are explained in the Guidelines and in a report on which the Guidelines were based, the criteria remain vague and ambiguous and leave a great deal of discretion to physicians.

Although the Guidelines specifically require that a patient voluntarily request physician-assisted suicide or euthanasia, the Remmelink Report, a study of the practice of physician-assisted suicide and euthanasia, confirmed that non-voluntary euthanasia was being widely performed in the Netherlands. The Report cited that in 1990 there were 2,300 cases of euthanasia at the patient's request, 400 cases of physician-assisted suicide, and more than 1,000 cases in which physicians terminated patients' lives without their consent. Fourteen percent of the patients who were killed without consent were fully competent, and eleven percent were partially competent. These were patients who could have made their own decisions about whether to live or die but were never given the opportunity to decide for themselves.

Based on the findings of the Remmelink Report and the 1986 "Guidelines on Euthanasia," the Dutch Government established, and both Houses of Parliament approved, a new reporting procedure which was codified and became effective on June 1, 1994. The new procedure requires physicians to fill out questionnaires and report to a coroner all cases in which they assist in suicide, perform euthanasia on request, or terminate a patient's life without the patient's consent. The failure of a physician to report one of these cases is not a crime in itself.

In 1984, the Dutch Supreme Court decided that mental suffering, as well as physical suffering, can justify a physician assisting a patient in suicide. Dr. Boudewijn Chabot, a psychiatrist, assisted a fifty-year-old healthy woman in suicide because she refused treatment for her depression and wished to die. The Court held that there are physically healthy patients whose unbearable mental suffering cannot be alleviated; and therefore, physician-assisted suicide can be an alternative for a patient who is suffering mentally.

The new reporting procedure also acknowledges the practice of physician-assisted suicide for patients who are suffering mentally. The questionnaire to be submitted to the coroner includes a specific section for such cases. …