In the Netherlands, the ‘Normal Medical Practice’ refers to use of drugs to alleviate pain or other symptoms even though the dose used will more or less certainly hasten the moment of death. In also includes not initiating, or terminating life-prolonging treatment when this is ‘medically futile’, either in the sense that the treatment has no chance of success or that it would be (or has become) disproportionate to any benefit for the patient. In order to meet the substantive requirements of euthanasia, the patient’s request must, in terms of article 293, be ‘express and earnest’. The request must be explicitly made by the person concerned and the request must be voluntary. It must be well-considered, made after due deliberation and based on an enduring desire for the end of life. The request should preferably be in writing or otherwise recorded. The patient’s suffering must be ‘unbearable’ and ‘hopeless’. The suffering need not be physical nor is a somatic basis required, non-physical suffering can include such things as the prospect of inhuman deterioration and the possibility of not being able to die in a ‘dignified’ way. For somatic condition, other possibilities for treating the condition or relieving the suffering must have been exhausted or have been rejected by the patient. They must be no realistic possibility of treatment for the somatic condition. Only a doctor may legally perform euthanasia and life-prolonging treatment should be discontinued before euthanasia performed. With reference to the procedural and professional requirements, the doctor must take adequate steps to satisfy himself with the substantive requirements set out above. He must formally consult at least one another independent doctor, a psychiatrist if suffering from a psychiatric disorder. For non-somatic origin, the consultant must himself examine the patient. The consultant should make a written report. He must discuss with immediate family or intimate friends of the patient. He must discuss with nursing personnel responsible. He must keep a full written record. The procedure must carry out professionally in a responsible way and the doctor should stay with the patient until the patient dies. Euthanasia is not ‘natural death’. The substantive requirements for justifiable euthanasia are enforced through the criminal law. The patient’s right to euthanasia is limited by the willingness of doctors to perform it. Pharmacists had a number of ‘requirements of careful practice’. There must be written request from the doctor and the pharmacist’s records must be maintained. Patient’s name and doctor’s information must be recorded. Consultation must be made with an independent pharmacist. The pharmacist must not permit his staff to be involved in preparation or delivering of the euthanatica. Drugs must be properly labeled with instructions included. The pharmacist may refuse to supply the euthanatica. Lay persons cannot legally perform euthanasia. The 1993 legislation authorizes the Minister of Justice and Health to provide by order in council for the form on which euthanasia, assistance with suicide and termination of life without an explicit request are reported by the coroner to the local prosecutor.
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