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 …