Euthanasia and the Netherlands - Part I

We need to firstly understand the health care system in the Netherlands before we explain the current situation of euthanasia in the Netherlands. Virtually everyone in the Netherlands is covered by health insurance. About 10% of the total cost of health care is paid out-of-pocket by patients, another 10% paid by government through taxation, and remaining 80% paid by insurance premiums. The hospitals are largely private and doctors are not employees so the control of hospital over doctors on euthanasia is limited. For the nursing homes, the doctors are employee so the nursing homes can exert far more control on euthanasia. There are also residential homes. Own personal general practitioners look after the residents and euthanasia is a matter between a resident and his general practitioner. The pharmacists are responsible for administration of all drugs used as euthanatica.

Legal Changes related to Euthanasia

On 11 March 1952, a doctor from Eindhoven ended his brother’s suffering from advanced tuberculosis by giving his brother Codinovo tablets and injected him with morphine. This is the first case of euthanasia and the doctor was sentenced to one year probation. In 1969, Van den Berg suggests a doctor may passively or actively shorten life that is no longer ‘meaningful’. Around 1970, euthanasia became the subject of public debate in the Netherlands. Medical Power and Medical Ethics inspired a Member of Parliament to propose setting up a commission to study the issue Van den Berg raised. Dutch Association for Voluntary Euthanasia (NVVE) admitted that passive and active indirect voluntary euthanasia as an ethical matter are quite generally accepted. The first acquittal took place in 1983 and this was upheld by the Dutch Supreme Court in the Schoonheim case in 1984. The decision in Schoonheim led to a series of judicial decisions in which the conditions and limitations of the defence were gradually worked out. In this case, the Supreme Court specifically referred to the patient’s ‘unbearable suffering’, including the prospect of increasing ‘loss of personal dignity’, the risk that it might become impossible for the patient to ‘die in a dignified manner’, and the existence of alternative ways to relieve her suffering as relevant considerations. For the first time, a doctor who had performed euthanasia was found not to be criminally liable. On 19 October 1982, the State Commission on Euthanasia was installed. The State Commission organized public hearings where interested persons and organizations could state their views on euthanasia and assistance with suicide. In January 1987, the government notified Parliament that it would look into the possibility of a limited bill as advised by the Council of State. In April 1989 the NVVE published an extra-Parliamentary bill as an alternative to the government’s bill that is to remove euthanasia from criminal code. On 8 November 1991, the government concluded that ‘medical practice in connection with end of life is characterized by great conscientiousness and responsibility’. The legislation ultimately adopted in 1993 and currently in effect was an amendment to the Law on the Disposal of Corpses. Between 1990 and 1994 the Commission on the Acceptability of Medical Behavior that Shortens Life (CAL) of the Medical Association produced four provisional reports on the legitimacy of terminating life without an explicit request or in cases where the patient’s competence is questionable: severely defective newborn babies, patients in a long-term coma, demented patients who are not entirely competent during the entire course of the decision-making and the legitimacy of assistance with suicide in the case of psychiatric patients. The NVVE published a new proposed bill in April 1996, the gist of the proposed revisions is that euthanasia and assistance with suicide by a doctor are not illegal when performed in accordance with the ‘requirements of careful practice’, which are to be included in the criminal code. The bill add a new article which makes it legal to supply a person who is not currently suffering, but who does not want to undergo physical or mental deterioration, the means for a ‘gentle death’. It is the so-called ‘Drion pill’.