Intended for healthcare professionals


Dutch court acquits suicide counsellor of breaking the law

BMJ 2007; 334 doi: (Published 01 February 2007) Cite this as: BMJ 2007;334:228
  1. Tony Sheldon
  1. 1Utrecht

    In a controversial ruling a Dutch court has acquitted a “suicide counsellor” of helping a 54 year old woman kill herself, judging that he had not actively initiated or directed her death. The counsellor's advice on the quantity of drugs to be taken to be certain of death was judged to be within legal boundaries.

    Ton Vink, a 53 year old philosopher, is attached to the Horizon Foundation, an organisation that offers help to people who choose to commit suicide. The woman rang him first in August 2003, 10 months before her suicide.

    The two had several contacts, through letters and telephone, to discuss suicide. In January she faxed him a letter listing her “supply” of drugs, with which she intended to kill herself.

    He later wrote confirming her plans to use dextropropoxyphene, flurazepam, and temazepam. He pointed out that the doses she planned were significantly higher than was recommended by websites which advise people about suicide, adding that this would “increase your sense of security.”

    The prosecution argued that this was not general information but amounted to offering concrete instructions to address the woman's special situation. It demanded an eight month prison sentence, five conditional.

    But Mr Vink's lawyer argued that this wording was a confirmation of the woman's intention to use more drugs. She had written to Mr Vink saying that she wanted as much certainty as possible and to die as quickly as possible. Only after her death did he discover that she had difficulty responding to anaesthetics, requiring more than most people needed when having an operation. So his confirmation of the high doses that she intended to take was not prompted by this knowledge about her particular requirements but simply by her desire for certainty.

    The court ruled that the woman had taken higher doses of drugs on her own initiative and that Mr Vink should be given the benefit of the doubt. It judged that he had not actively guided or directed the woman's suicide and that his actions, therefore, remained within the permissible boundaries for helping suicide. These actions include talking, giving information, and offering moral support.

    Assisted suicide remains an offence in the Netherlands. Only doctors are allowed a defence if they act within closely defined criteria, including the specification that the patient must be competent and must have a medically classifiable condition.

    Concerns have been expressed that the judgment loosens the law on assisted suicide by making it clear how people other than doctors could help someone commit suicide without breaking the law. Theo Boer, professor of ethics at Utrecht's Protestant Theological University, said that the judge could not convict Mr Vink because in the letter of the law he had done nothing wrong.

    He believed that the judge's decision represented a loophole that should be closed: “The verdict may in effect mark a further liberalisation of the Dutch practice. The state should have the . . . obligation to dissuade its citizens from choosing to commit suicide.”

    Last year the founder of the Horizon Foundation, Jan Hilarius, was sent to prison for helping a 25 year old woman kill herself (BMJ 2006;333:514).

    • In a survey of 3000 people by the UK's National Centre for Social Research, eight out of 10 supported a change in the law so as to allow doctors actively to end the lives of terminally ill patients who want to die.

    View Abstract