荷蘭提供安樂死的監管和框架是如何?

Is euthanasia allowed?

Euthanasia is when a doctor terminates life at the patient's request. The goal is to end pain that is intolerable and has no hope of improvement. Physician-assisted suicide also falls within this definition. Euthanasia is not considered a crime only under certain conditions.

euthanasia status

It is not an offense for doctors to perform euthanasia as long as they adhere to the due standard of care set out in the Termination of Life on Request and Assisted Suicide (Review Procedure) Act and report each case after it is carried out. Under the due standard of care, the physician must, among other things, be satisfied that the patient's request for euthanasia is voluntary and well-considered and that the patient's suffering is intolerable and there is no hope of improvement.

Euthanasia can only be performed at the patient's request, not at the request of relatives or friends.

Doctors are not obliged to perform euthanasia

Doctors are under no obligation to grant requests for euthanasia. Doctors who do not want to perform the procedure themselves should discuss the matter with the patient and may decide to refer him to another doctor.

due care in assessment

Doctors who perform euthanasia procedures must report the matter to the municipal pathologist. Both the notifying physician and the municipal pathologist are required to report cases to the regional euthanasia review committee.

If the board finds that the notifying doctor did not exercise due care, the case will be referred to the Healthcare Inspectorate (IGZ) and the Public Prosecutor's Office (OM). The latter may decide to sue the doctor.

A model notification form for termination of life or assisted suicide and a model report form are available to physicians upon request and can be downloaded from the Regional Euthanasia Review Committee's website. Forms cannot be ordered by mail.

Not euthanasia

The following types of cases do not fall under the purview of the Requests to End Life and Assisted Suicide (Review Process) Act:

  • A physician stops or does not begin a medical procedure at the request of a patient;
  • Doctors stop performing surgeries that have no medical significance;
  • Doctors try to alleviate patients' pain by giving them increasingly stronger drugs, which are intended to relieve pain but have side effects that may shorten the patient's life;
  • Doctors use drugs to render patients unconscious at the end of life, with the goal of relieving symptoms that cannot be relieved by any other means (sedation).

Euthanasia and non-residents

Doctors who perform euthanasia should be satisfied that the standards of care due under the Request to End Life and the Assisted Suicide (Review Process) Act are met.
This means that doctors must know enough about a patient's medical history to assess whether the patient's pain is unbearable and there is no hope of improvement. Furthermore, the physician must be satisfied that the patient's request is voluntary and well-considered.
This involves a complex and multi-faceted assessment and it is up to the doctor to decide whether this can be done if the applicant does not live in the Netherlands and has only recently arrived.

In the Netherlands, euthanasia is performed by the attending physician by administering a fatal dose of appropriate drugs to the patient based on the patient's explicit request. Physician-assisted suicide (where the doctor provides the medication but the patient self-administers it) is also covered by relevant Dutch legislation. Hospice is not a form of euthanasia: the patient is simply rendered unconscious with pain medication and dies of natural causes.

what the law says

Euthanasia and assisted suicide are legal only if the standards set out in the Dutch Requests to End Life and Assisted Suicide (Review Procedure) Act are fully complied with. Only in this way can the doctors involved be immune from criminal prosecution. Requests for euthanasia often come from patients who are experiencing unbearable pain with no hope of improvement. Their requests must be sincere and confident. They believe euthanasia is the only way out of this condition. However, patients do not have an absolute right to euthanasia, and doctors do not have an absolute obligation to perform euthanasia.

Guidelines for euthanasia for semi-conscious patients

Sometimes, a patient may slip into a semi-conscious state before scheduled euthanasia. If there are still signs of distress, doctors may perform euthanasia while the patient is unconscious. This is stipulated in a guideline on the subject prepared by the Royal Netherlands Medical Association at the request of the Attorney General's Council of the Public Prosecutor's Office and the Healthcare Inspectorate. These guidelines on euthanasia for patients with low consciousness do not represent any implicit relaxation of the law; they are intended solely to provide guidance to physicians in this difficult situation.

advance directive

Some people believe that they would wish to undergo euthanasia if they found themselves in a particular situation that they now consider intolerable and with no hope of improvement. Their best course of action is to discuss the scenarios they envisage with their GP and develop written instructions covering those scenarios. This type of advance directive clarifies the specific circumstances under which the patient wishes to undergo euthanasia. This document constitutes a request to the physician and must contain a clear and unambiguous expression of the patient's wishes.

Euthanasia and assisted suicide

Termination of life upon request can take two forms. In the case of euthanasia, doctors administer a fatal dose of a suitable drug to the patient. In assisted suicide, by contrast, the doctor provides the lethal drug but the patient is responsible for taking it. Both forms are governed by the Act and in both cases the doctor must meet the statutory standard of due care. Every incident of euthanasia and assisted suicide must be reported to one of five regional euthanasia review committees. The committee will judge whether the doctor took due care. If the doctor fails to do this, he may be sued. Penalties vary, but euthanasia is punishable by up to 12 years in prison and assisted suicide is punishable by up to three years in prison.

Euthanasia and minors

Minors can request euthanasia on their own from the age of 12, but must obtain the consent of their parents or guardians before reaching the age of 16. In principle, adolescents aged 16 and 17 do not need parental consent, but parents must be involved in the decision-making process. From the age of 18, young people have the right to request euthanasia without parental involvement.

Euthanasia and newborns

Children sometimes suffer from serious illnesses and terminating life is considered the best option.

The law allows doctors to terminate the life of newborns and perform late-term abortions, but only if they meet the following due standards of care:

  • According to popular medical opinion, the child's pain must have been excruciating, with no hope of improvement. This means that the decision to discontinue treatment was justified. The diagnosis and prognosis must be beyond doubt;
  • Both doctors and parents must be convinced that there are no reasonable alternatives given the child's circumstances;
  • Termination of life requires parental consent;
  • Parents must fully understand diagnosis and prognosis;
  • At least one other independent physician must have examined the child and given a written opinion as to whether the above standards of appropriate care are met
  • Termination must be done with caution.

late miscarriage

The Dutch Termination of Pregnancy Act allows abortion up to 24 weeks of pregnancy. This is the point at which a fetus can survive outside the mother's womb. Late-term abortions (after the 24th week) do not fall within the scope of the Termination of Pregnancy Act and fall under the penal code. Physicians are obliged to inform the review board.

Late-term abortions are only available in exceptional circumstances. The following due care standards apply:

The unborn child must be suffering from a disease so severe that medical experts believe that treatment after birth will be futile. The diagnosis and prognosis must be beyond doubt;

  • The unborn child must be suffering, or must be likely to suffer after birth, with no hope of improvement;
  • The mother must make a clear request to terminate the pregnancy on the grounds of the physical or mental distress caused to her by the condition;
  • Doctors must explain the diagnosis and prognosis to parents in detail. This means that both doctors and parents must be convinced that there are no reasonable alternative solutions given the child's circumstances;
  • At least one other independent physician must have examined the child and given a written opinion as to whether the above standards of appropriate care are met;
  • Pregnancy must be terminated with caution.

physician notification process

After a late-term abortion or termination of a newborn's life, the physician is immediately obliged to comply with the following procedures. He must notify the municipal pathologist, who will then contact the prosecutor's office.

If there is no special reason for the delay, the prosecutor's office will issue a funeral consent letter. Thereafter, the pathologist will send details of the case to the Central Expert Committee on Late-Term Miscarriage and Termination of Infants.

Pathologists evaluate whether doctors acted with caution. The committee reports its findings to the prosecutor's office. Ultimately, the prosecution decides whether to take any action against the physician involved.

Euthanasia and dementia patients

For some people, the possibility of dementia may be a good reason to make an advance directive (living will). This can be done independently or discussed with your GP first. Doctors may euthanize a patient with dementia only if such an indication exists, statutory care is in place and the doctor considers that the patient is experiencing intolerable suffering with no hope of improvement.

review board

It is the physician's duty to report all unnatural deaths to the municipal pathologist. In the case of euthanasia, the latter informs the regional review board. These committees include at least a physician, an ethicist, and a legal expert. The committee assesses whether doctors who perform euthanasia meet statutory standards of due care. The Review Board process is designed to ensure greater transparency and consistency in the way cases are reported and assessed.
The procedure benefits both prosecutors and doctors. The findings of statutory standards and review boards tell doctors how their conduct in a given situation stands up to legal, medical and ethical scrutiny.

Tranquility and Sedation: Normal Medical Procedures

Sedation is the administration of drugs to render a patient unconscious at the time of death. It is considered part of the normal medical procedure: it does not constitute the end of life because the drugs administered are not the cause of death. Its purpose is to relieve pain at the end of life, especially unbearable pain that can no longer be relieved in any other way.

Tranquil sedation is allowed when the patient's remaining life span is less than 2 weeks. Because it is considered a normal medical procedure, doctors are not required to notify or review such cases.

Requests for sedation may be made by the patient or by an immediate family member and/or professional caregiver. If the patient is no longer able to make an informed decision, the doctor will discuss the matter with the patient representative. The Royal Netherlands Medical Society guidelines provide clear definitions of the circumstances under which sedation is considered good medical practice.

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