What is euthanasia?
Euthanasia is an intentional ending of a life. Euthanasia should always be a voluntary request. It can’t be the result of outside pressure or influence. A person must ask for it themselves or have a document with their request for euthanasia. In the Netherlands, there are two legal forms of euthanasia:
- Clinician-administered euthanasia: The doctor administers a drug that causes death.
- Self-administered euthanasia: The doctor provides a drug that the person takes, and this results in death.
These two forms of euthanasia are regulated by the Euthanasia Act. This law contains all the rules that apply to euthanasia. The person’s request and situation must meet all six procedural safeguards of the Euthanasia Act. An ethics committee (with a doctor, ethicist and lawyer) assesses whether the primary doctor has complied with these safeguards.
Euthanasia is only permitted under specific conditions. For example, the suffering must have a medical basis. This means that the suffering is (for the most part) due to an illness or disability. By law, there are six procedural safeguards that a doctor must evaluate.
The six procedural safeguards of the Euthanasia Act are:
- A voluntary and informed request: A person can request euthanasia only for themselves. The doctor must therefore be convinced that the person has given the matter much thought and it’s requested out of free will.
- There is pointless and unbearable suffering: Is there no chance of a cure? Is the person suffering unnecessarily, and this can’t be relieved? This is considered pointless suffering. The doctor must be convinced of this fact.
- Inform about the situation and prospects: The doctor must inform the person so that they can understand the current and future situation. This allows them to give informed consent.
- No reasonable alternative: Are there other options to reduce suffering? The doctor must always find out if there are other options. The person making the request for euthanasia doesn’t have to try all the options. But they do need to discuss with the doctor whether euthanasia is the only reasonable option.
- Consult an independent doctor: The primary doctor must always consult at least one other independent doctor. That doctor must not be involved in the treatment. They must not have a personal relationship with either the person making the request for euthanasia, or the primary doctor.
- Medically stringent procedure: The doctor must perform euthanasia following medically stringent procedures. This means: With the appropriate drugs and following correct procedure. There are guidelines for this.
What's not permitted?
Euthanasia is only allowed if a person makes the request for themselves. So family or friends can't make the request for someone else. The doctor must always comply with all six procedural safeguards. Euthanasia is not permitted if people are healthy, tired of living, or find their lives complete. Is a doctor breaking the law? This is a punishable offence.
Euthanasia in dementia
A person with early dementia may request euthanasia themselves. Is the dementia so advanced that this isn’t possible anymore? Euthanasia can only be performed if the person made a (written) request when they were able to make their own choices. Instead of an oral request, a written request for euthanasia is therefore also permitted. Also with dementia, euthanasia is only permitted when all six procedural safeguards are satisfied.
Euthanasia in children
In an adult, euthanasia can only be performed if the patient makes the request themselves. Different conditions apply for children.
- Children 12 - 16 years: The parents or guardian must also give permission.
- Children 16 - 18 years: Children of this age are allowed to request for euthanasia independently; parents do not have to participate in the decision. However, the doctors are required to consult the parents.
Termination of life in newborns and late pregnancy
Does a newborn child suffer from a serious illness? In such cases, parents sometimes choose for euthanasia in consultation with the doctor. The doctor must comply with the procedural safeguards. The procedural safeguards also apply to termination of pregnancy after 24 weeks. An independent doctor verifies that the primary doctor is in compliance with the safeguards.
The Expertisecentrum Euthanasie is a professional health care organisation that provides euthanasia support. Do you meet all the procedural safeguard requirements of the Euthanasia Act, but your doctor doesn’t want to help? Then you can seek help from the Expertisecentrum Euthanasie. Please note: The Expertisecentrum Euthanasie isn’t an actual clinic. Doctors can visit patients at home.
Do you have a do-not-resuscitate order? There are different types of medical jewelry that you can wear as a medical directive. For example bracelets or a medallion on a necklace. Those giving first aid will be able to see that you have chosen not to be resuscitated if the situation arises.
Palliative sedation is sedation in the last phase of life. The doctor gives anesthetics for pain. Deep palliative sedation is the same procedure but where the patient becomes unconscious. This is only permitted in the very last phase of life.
Requests from abroad
What happens if someone from abroad requests euthanasia? In this case, too, a Dutch doctor must abide by the six procedural safeguards set out in the law. It may be more difficult for the doctor to get a good understanding of the medical background with requests from abroad. They may have to contact care providers abroad who have treated the person. A doctor is free to decide whether or not to accept a request for euthanasia from someone abroad.
Euthanasia and your health insurance
Euthanasia falls under the basic insurance and is therefore reimbursed by your health insurance. It doesn’t matter what kind of policy (restitution or in-kind) you have.