Dutch doctors complain about long wait for judgments in cases of euthanasia

BMJ 2011; 343 doi: (Published 12 September 2011) Cite this as: BMJ 2011;343:d5768
  1. Tony Sheldon
  1. 1Utrecht

Doctors in the Netherlands who carry out voluntary euthanasia must wait up to eight months before knowing whether they face a criminal investigation after an “enormous” rise in numbers of cases has swamped an already stretched reporting system.

The Dutch Medical Association describes the situation as “serious,” with “unrest” among doctors. One doctor had written complaining that his euthanasia report this summer would not be considered until April.

Under the 2002 law doctors have a legal obligation to report voluntary euthanasia (where a doctor ends a patient’s life at his or her explicit request) and assisted suicide (where the patient takes a deadly drug but the doctor assists) to one of five regional assessment committees consisting of a doctor, a lawyer, and an ethicist. The committee must be satisfied that the doctor has adhered to all criteria of due care, otherwise the case is forwarded to the public prosecution service and the Healthcare Inspectorate (BMJ 2001;322;947, doi:10.1136/bmj.322.7292.947).

This week’s annual report of the committees shows 3136 reported cases in 2010, a 19% increase on 2009. The number has nearly doubled since 2006. Since 2010 nine cases have so far been judged not to have met all the criteria of care (

Although no prosecutions have been brought under the present law, each year about a dozen cases are referred for further scrutiny. A preliminary investigation is then launched, questioning the doctor to see whether there is a criminal case to answer. To date these have resulted only in conditional warnings.

The average time taken to assess cases has risen from 30 days in 2007 to 63 days today. The committees have to respond within 12 weeks but they admit that they cannot prevent seriously exceeding this in several cases.

The Dutch Medical Association says that nearly 500 doctors are still waiting for a judgment on their euthanasia report from 2010. It has written to the minister of health demanding that from 2012 the time to assess cases will fall within the 12 weeks limit. The association’s policy adviser, Eric van Wijlick, said, “From the moment a doctor carries out euthanasia there is a lot of tension. Having then to wait such a long time for a definitive confirmation that their treatment has been careful creates a lot of unrest.”

He added that the problem was evident in 2009. “If the number of reports overtakes the capacity of the assessment committees then it is obvious we need to strengthen them,” he said.

The chairwoman of the committees, Willie Swildens-Rozendaal, said, “We are extremely concerned and regret the delay. Since 2006 the numbers of reports have increased enormously. If you have a backlog then it remains into the next year.” Since last year the secretariat has been strengthened and two pilot projects have been launched to hasten the process. However, she accepted that more committee members may eventually be needed.

Doctors’ self reporting of euthanasia and the consequent transparency are central to Dutch euthanasia policy. Reporting rates are estimated to have risen from 54% in 2001 to 80% in 2005. Whether the current rise is due to better reporting or more actual cases of euthanasia will not be known until the next government review in 2012.

The criteria for care include the doctor ensuring that the patient has made a free and well considered request and is suffering hopelessly and unbearably. The patient must be referred to at least one independent doctor, and the euthanasia must be carried out in a medically stringent manner.


Cite this as: BMJ 2011;343:d5768

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