Dutch euthanasia procedures relaxed

BMJ 1997; 314 doi: (Published 01 February 1997) Cite this as: BMJ 1997;314:323
  1. Tony Sheldon
  1. Utrecht

    The Dutch cabinet has announced plans to allow doctors who take part in euthanasia and assisted suicide to have their cases reviewed by regional committees of doctors, lawyers, and ethicists. They will judge if the strict guidelines for good medical practice have been followed and report to the public prosecution department.

    In the rare cases when doctors have acted without a specific request, such as with severely handicapped newborn babies and patients who have been in a coma, a separate national committee, to be established in 1998, will first conduct a medical ethical review before passing the case to the legal authorities.


    Justice minister Winnie Sorgdrager presents the plan to Parliament


    The amendment of the notification procedure follows years of pressure from the Royal Dutch Medical Association to prevent doctors who act within the guidelines from automatically facing criminal prosecution.

    Euthanasia remains a criminal act in the Netherlands, although since 1983 courts have acquitted doctors acting within strict guidelines, which include an explicit, informed, and voluntary request from a patient who must be suffering unbearably and hopelessly. A second doctor must be consulted.

    The plans have been described as a welcome and logical step, drawing a firm line between medical care and murder. They also follow the collapse of several test cases against doctors in which the criminal courts were deemed a blunt instrument for dealing with complex medical ethics.

    At present the doctor's detailed written report is sent by the coroner to the local magistrate, who must decide whether to prosecute. Doctors theoretically face a maximum prison sentence of 12 years if they contravene the guidelines. In future the coroner will pass the report to the appropriate review committees to judge if the guidelines were followed. The plans are designed to encourage doctors to report euthanasia. Recent research showed a report rate of only 41%.

    The medical association welcomes the proposals, which, it argues, will encourage doctors to report euthanasia, but it believes that only a change in the law will adequately address doctors' fears.

    The justice minister, Winnie Sorgdrager, went further than the cabinet, saying that adjusting the law to create a separate position for doctors could be expected in the future. But first there had to be improvements in reporting and palliative care.

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