Dutch experience of monitoring euthanasia

doi:10.1136/bmj.331.7518.691

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Bregje D Onwuteaka-Philipsen, health scientist (b.philipsen@vumc.nl)1,
Agnes van der Heide, epidemiologist2,
Martien T Muller, social gerontologist1,
Mette Rurup, medical biologist1,
Judith A C Rietjens, health scientist2,
Jean-Jacques Georges, nursing scientist1,
Astrid M Vrakking, sociologist2,
Jacqueline M Cuperus-Bosma, lawyer1,
Gerrit van der Wal, professor of social medicine1,
Paul J van der Maas, professor of social medicine2

¹Department of Public and Occupational Health, Institute for Research in Extramural Medicine, VU University Medical Centre, 1081 BT Amsterdam, Netherlands
²Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, Netherlands

Correspondence to: B D Onwuteaka-Philipsen

Accepted 11 June 2005

Doctors in the United Kingdom can accompany their patients every step of the way, up until the last. The law stops them helping their patients take the final step, even if that is the patient's fervent wish. Next month's debate in the House of Lords could begin the process of changing the law. To help doctors decide where they stand we publish a range of opinions

Introduction

Physician assisted death is known to occur in several countries,1^–5 and probably takes place in others, albeit with different frequencies. Three places have enacted a notification procedure to safeguard this practice: Oregon in the United States, Belgium, and the Netherlands.6^–8 In the United Kingdom, a law on assisted dying for the terminally ill has been proposed and has stimulated much discussion.9^–11 The Netherlands has had a formal procedure for reviewing cases of euthanasia and physician assisted suicide since 1991. The procedure has been evaluated and revised twice.12 We examine how well the Dutch system has ensured best practice and reporting of physician assisted suicide. Although the Dutch experience cannot solve the question whether legal regulation of assisted dying is desirable, it gives insight into the possibilities of achieving transparency, public oversight, and legal control.

Review procedure

In the Dutch review procedure, euthanasia is defined as purposely ending the life of someone at his or her explicit request. Physician assisted suicide is defined as the prescription or supply of drugs with the explicit intention to enable the patient to end his or her own life. The review procedure aims to stimulate disclosure of cases and ensure verifiability, and adherence to the requirements for prudent practice.

The first review procedure was introduced in 1991 and was legally enacted in 1994. Doctors were required to report cases to the …