Euthanasia in the Netherlands: a slippery slope?

By Brigit Toebes, Academic Director, Global Health Law Groningen Research Centre
b.c.a.toebes@rug.nl

The Dutch euthanasia legislation has been lauded as well as criticized by legal scholars and physicians in the Netherlands and abroad. The legal framework so established is renowned for setting a number of valuable due-care criteria for the physician to follow when performing euthanasia on a patient. However, is the Dutch approach traveling down a slippery slope now that euthanasia is increasingly performed on patients suffering from dementia and on patients with chronic psychiatric conditions?

Euthanasia in the Netherlands is regulated by the ‘Termination of Life on Request and Assisted Suicide Act’ of 2002. According to the Act, euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with a set of ‘due-care criteria’, which, among other criteria, include the unbearable and hopeless suffering of the patient and the consultation of another physician by the physician involved.

Some foreign scholars have voiced criticism about the Dutch euthanasia legislation. In their 2006 Handbook on Law and Medical Ethics, British scholars Mason and McCall Smith warn that the Dutch euthanasia legislation may lead to a slippery slope, arguing that the removal of an absolute prohibition against killing in the Dutch legislation would make the practice far more difficult to control. In this context, they refer to a Dutch psychiatrist who was found to be medically justified in assisting the suicide of a physically healthy person suffering from depression. They conclude:

The Dutch legislation could rapidly lead to an acceptance of euthanasia in the face of relatively minor discomfort or of conditions which, although distressing, are not necessarily either permanent or terminal.’ [1]

It seems important to remind ourselves of this statement in light of current developments. Several physicians have warned that the Dutch euthanasia law and practice are indeed traveling down a slippery slope. In a recent article in NRC Handelsblad, physician Boudewijn Chabot observes that there is a culture change in relation to the Dutch euthanasia practice. He expresses concern about the rising amount of approvals for euthanasia in case of dementia and persons suffering from chronic psychiatric conditions. According to Chabot, the quality of life of these patients has been affected by the dismantling of the quality of care for these patients, leading to an increase in the requests for euthanasia. In addition, an important change in the legal framework is marked by the fact that an advance directive (living will) can now replace the oral request for euthanasia, which means that persons with dementia can be more readily (without their oral consent) be subjected to euthanasia.

In this context, the role of the so-called End-of Life Clinic should be mentioned, which opened in 2012, offering services to patients whose doctors are unwilling to cooperate with the patient’s request for euthanasia or assisted suicide. According to Chabot, of the 2016 euthanasia cases, one-third of those involving persons with dementia and three-quarters of those who were chronic psychiatric patients were performed in this clinic. A point of concern is that doctors and psychiatrists working in these clinics lack the close patient-doctor relationship that general practitioners have built up with their patients once these patients reach the point where they no longer want to live and ask their doctor for euthanasia.

When Mason and McCall Smith published their Handbook in 2006 I worked in as a lecturer at the University of Aberdeen in Scotland. The topic of euthanasia was one of the key themes in my course ‘Health and Human Rights’. In the light of current developments, I think I must revisit my rather optimistic depiction of the Dutch Euthanasia law, and give credit to Mason and McCalls warning.

[1] Mason & McCall Smith, Law and Medical Ethics, Oxford: Oxford University Press, 1993, p. 607.

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