Intended for healthcare professionals


Holland decriminalises voluntary euthanasia

BMJ 2001; 322 doi: (Published 21 April 2001) Cite this as: BMJ 2001;322:947
  1. Tony Sheldon
  1. Utrecht

    The Netherlands has become the first country in the world to pass a law decriminalising voluntary euthanasia. Dutch doctors carrying out the practice under strict conditions will no longer be judged automatically as criminals when the law comes into force this autumn.

    The legislation will give statutory force to the conditions that apply to voluntary euthanasia, ending decades of uncertainty for the medical profession.

    It will empower the regional committees of doctors, lawyers, and ethicists, to whom doctors must report euthanasia cases, to decide whether a doctor has acted with due care and if so to close the case. Currently that power rests with the public prosecution service: the committees can only make recommendations to the service.

    An estimated 3600 cases of voluntary euthanasia are carried out each year in the Netherlands. The normally sober Dutch senate witnessed angry exchanges during the two day debate on the measure as opponents spoke of “Nazi practices,” a reference denounced as “disgraceful” by supporters.

    Outside the Parliament building 11000 mostly Christian demonstrators prayed and held banners declaring “euthanasia remains murder.” Since members of parliament passed the bill last November (BMJ 2000;321:1433) senators have been inundated by 60000 letters and emails on the topic from the public, but the balance of opinion has been in favour of the bill. The senate backed the government by a majority of 46 to 28.

    The spokeswoman for the opposition Christian Democratic party, senator Yvonne Timmerman, had called for doctors to be given a specific legal rights not to cooperate with euthanasia on moral grounds. She feared euthanasia could become a “viable treatment option,” creating a culture in which “doctors have to defend their choices not to commit euthanasia.”

    However health minister Els Borst said that professional standards already ensured that staff with moral objections could refuse to work on euthanasia cases, to carry out abortions, or to participate in in vitro fertilisation without any consequences. Ms Borst believes that enacting the law will not result in an increase in the annual number of voluntary euthanasia cases.

    She said that she had never met a doctor who agreed to a euthanasia request lightly. “A request for euthanasia presents a struggle for every doctor. That remains and should not be changed,” she said.

    Johan Legemaate, a professor of health law at Rotterdam's Erasmus University, said it was not the bill's intention to change procedures but to give the correct legal basis for those already existing.

    The Royal Dutch Medical Association has long urged a formal legislative framework which would resolve the “paradoxical legal situation” and ensure that doctors acting in good faith and with due care would not face criminal proceedings.

    The new legislation states that doctors must be “convinced” that the patient's request is voluntary and well considered and that the patient is facing “unremitting and unbearable” suffering. Doctors must also have advised patients of their situation and prospects and reached a firm conclusion with the patient that there is “no reasonable alternative solution.” Additionally, the doctor must consult “at least one other independent physician.” The law also offers legal recognition of written euthanasia declarations and allows minors aged 12 to 16 to request euthanasia with the consent of their parents.

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    Christians at the Dutch parliament pray in protest against euthanasia