Intended for healthcare professionals


Dutch doctors publish guide to “careful suicide”

BMJ 2008; 336 doi: (Published 19 June 2008) Cite this as: BMJ 2008;336:1394
  1. Tony Sheldon
  1. 1Utrecht

A group of Dutch doctors and researchers has made its detailed advice on suicide available to the general public. The Foundation for Scientific Research into Careful Suicide argues that “a requirement exists within society for responsible information about an independent and dignified ending of life.”

The book, entitled Informatie over Zorgvuldige Levensbeëindiging (Information about the Careful Ending of Life), gives advice on refusing food and fluids and taking a combination of drugs to induce coma and death. It can only be ordered from the foundation’s website (

The Dutch Medical Association says that the book offers a balance to the large amount of unreliable information available on the internet. It recognises that doctors may refer patients to the book as part of their obligation to provide information.

Research by the foundation indicates that despite Dutch euthanasia laws that permit doctors, acting within specific legal limits, to help with suicide, there are about 4400 cases each year of what it calls “autoeuthanasia,” where a doctor is not directly involved.

Most of these cases are of elderly or chronically ill patients who refuse food and fluids in consultation with their family and friends. This is about twice the estimated number of deaths carried out under the euthanasia law.

The foundation’s book is targeted at people who do not meet the legal requirements for assisted suicide, which includes the specification that a doctor must believe that his or her patient is suffering unbearably and hopelessly. They include elderly people who may feel their life is complete but have no fatal illness and patients with a serious physical disease and a longstanding wish to die.

The authors emphasise that they do not wish to lower the threshold against suicide and advise people against solitary and impulsive acts. The methods described involve months of preparation. They emphasise that the book is not meant for young people who feel suicidal, who, they say, should seek professional help.

The foundation’s chairman, retired anaesthetist Pieter Admiraal, argued that although everyone had a right to this information, it was especially important for doctors: “Many people stop eating and drinking, but doctors have never had any training in these cases. This book provides a guide to what doctors should do without becoming actively involved.”

The medical association’s ethics policy adviser, Gert van Dijk, said that doctors cannot provide the means to commit suicide but still have a role to play. Even if they did not agree with the patient’s decision they retain an “obligation of care,” he argued. In cases of refusing food and fluids this could include providing mattresses against bed sores, treatment for fungal infections, and means to moisten the lips.

Marinus van den Berg, a Rotterdam nursing home pastor and writer on bereavement, said that more investigation was needed into people’s motives for choosing “careful suicide” and that doctors need more training in medical ethics and spirituality.

The foundation conducts scientific research into suicide but does not help individual cases. Dutch law permits information, discussion and moral support for suicide but bans providing the means or giving direct support.

View Abstract