Netherlands set to legalize long-tolerated euthanasia
CMAJ 2000;163(3):324
For 2 decades, mercy killings and assisted suicide involving terminally ill patients have been widely tolerated in the Netherlands, with prosecution of doctors for such acts becoming increasingly rare.
But with contentious legislation introduced last fall likely to be enacted when parliament resumes after its summer break, Holland will actually decriminalize euthanasia under certain criteria, giving the country the least restrictive laws on mercy killing and assisted suicide in the world. The draft legislation permits physicians to assist in the death of terminally ill patients as young as 12.
Although that age may be raised before the final vote, the core of the bill is not likely to change. Doctors' actions in helping patients die would no longer be routinely reviewed by prosecutors but instead by a committee of doctors, lawyers and ethicists. To qualify for assisted suicide or mercy killing, patients' requests must be "durable," they must face "unbearable suffering" and have no "reasonable alternative" to death. The doctor must also consult at least one other independent physician before helping a patient die.
The bill introduces for the first time the possibility of an "advance directive" so that patients may indicate that they wish to die at a certain point in their illness. This opens the door for patients suffering from dementia and Alzheimer's disease to get help to die if they have signed such a directive early in their illness. In the past, such patients have not qualified because they were not considered by some to be suffering "unbearably." Although their condition may cause anguish to their families, they themselves may be unaware of their situation.
Dutch lawmakers and health officials say the new legislation aims to ensure that events during a patient's final hours take place in the open, where they can be scrutinized and regulated.
"If it remains a punishable offence, we will never see the transparency that we are aiming for," said Jacob Visser, a spokesperson for the Medical Ethics Division of the Dutch Ministry of Health, which, along with the country's Ministry of Justice, helped shape the legislation. "To get that [transparency], we must get this out of the criminal system." — Gil Kezwer, Toronto
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