A new position paper just published by the Dutch Physicians Association (KNMG) says unbearable and lasting suffering should not be the only criteria physicians consider when a patient requests euthanasia.
The KNMG says the new guidelines will clarify the responsibilities, possibilities and limitations that physicians have within the regulations of the 2002 euthanasia law (Termination of Life on Request and Assisted Suicide [Review Procedures] Act or Euthanasia Act for short).
Dutch euthanasia law
Euthanasia, or assisted suicide, is legal in the Netherlands. But it can only be applied under very strict conditions, under medical supervision, and at the request of the patient.
A 2002 law, the Termination of Life on Request and Assisted Suicide [Review Procedures] Act, stipulates the following conditions:
- Euthanasia is available to individuals aged 16 or over
- Euthanasia is applied at the spoken or written request of the patient
- The patient's doctor has to be convinced that the patient's suffering is interminable and unbearable
- The doctor has explained the patient's situation to him or her
- The doctor and the patient have agreed that all other avenues have been explored
- An independent colleague of the doctor has agreed that the above conditions have been met
- The doctor applies every possible medical care during the euthanasia
Doctors are not obliged to accede to a patient's euthanasia request. In such cases, patients or their families could try and find another doctor.
Euthanasia cases have to be officially registered with regional supervisory bodies. In 2010 the five supervisors registered 3136 cases (Dutch population: 17 million). That is a 19 percent increase over the preceding year.
At the moment, there are approximately one million elderly people in the Netherlands with multi-morbidity (two or more long-term diseases or ailments) and that number is expected to rise to 1.5 million in the course of the coming decade. According to the new guidelines, vulnerability (or fragility) refers to health problems, and the ensuing limitations, as well as a concurrent decline in other areas of life such as financial resources, social network and social skills.
As people age, many suffer from a complex array of gradually worsening problems, which can include poor eyesight, deafness, fatigue, difficulty in walking and incontinence as well as loss of dignity, status, financial resources, an ever-shrinking social network and loss of social skills. Although this accumulation of ailments and diseases is not life-threatening as such, it does have a negative impact on the quality of life and make the elderly vulnerable or fragile. Vulnerability also affects the ability to recover from illnesses and can lead to unbearable and lasting suffering.
Under the Euthanasia Act, a request for euthanasia may be honoured only if a patient is undergoing unbearable and lasting suffering. The KNMG now says that, if non-medical factors such as income or loneliness are to be taken into consideration, other specialists must be consulted when a patient has requested euthanasia. In an interview broadcast on Dutch television, KNMG chair Arie Nieuwenhuijzen Kruseman said weighing up non-medical factors was far from simple:
"It's quite possible that the same constellation of factors would be experienced as unbearable and lasting suffering by one patient but quite tolerable by another. This makes it extremely difficult."
The physicians association says further investigation into non-medical factors is needed and Dr Nieuwenhuijzen Kruseman adds that euthanasia should be allowed even when a patient is not suffering from a terminal disease:
"It doesn't always have to be a physical ailment, it could be the onset of dementia or chronic psychological problems, it's still unbearable and lasting suffering. It doesn't always have to be a terminal disease."