In the United States, debates about physician-assisted suicide are generally framed in terms of patient autonomy. However, the rationale behind the landmark 2002 euthanasia law in the Netherlands was that it codified a legal option for doctors whose main responsibilities – saving lives and alleviating suffering – were in conflict in the case of some tormented patients. In the decades leading up to 2002, a series of court decisions provided legal protection to Dutch doctors who facilitated the death of patients. In its final recommendations, the 3rd five-year evaluation report (2012-2016) of the Dutch law nevertheless stresses that „the government should reaffirm the fact that doctors are not obliged to accede to requests for euthanasia. The report also included the following suggestion: „Waiver of the legal obligation to require referral to a colleague in cases where physicians deny a request for euthanasia or assisted suicide (conscience clause).“ 1) The patient`s request for euthanasia must be voluntary and well considered. The consent of the patient who is no longer able to express himself may be taken into account if he has previously made a written declaration to this effect and is at least 16 years old. The Dutch government has approved plans to allow euthanasia for terminally ill children aged one to 12. It is not easy to distinguish between a suicidal patient and a patient qualified for psychiatric euthanasia because they share many key characteristics. In some cases, psychiatric euthanasia is simply a very effective means of suicide, as in the case of a man who attempted suicide, was hospitalized and then received psychiatric euthanasia. In Belgium, which will celebrate its two decades of euthanasia in May, about 40 French citizens also benefited from the practice last year. Without decriminalizing euthanasia itself, current Dutch legislation allows it for certain specific cases. In fact, euthanasia, inducement or inducement to commit suicide and assisted suicide are still considered criminal offences.

However, the law contains a disclaimer for physicians who comply with five „due diligence tests“: About two years before the practice of NVE was exposed, the Royal Netherlands Medical Association stated in 1987 in the preamble to its euthanasia guidelines: „If there is no request from the patient, So the end of one`s life is legally a matter of murder or homicide, not euthanasia.“ When it became clear that this practice was already practised, the authorities never directly condemned the practice, nor did they take direct action to prohibit it. Official references to this phenomenon deviated from the 1987 opening to now imply that NVE was only a variant of EVs in certain circumstances, without any particular moral or legal differentiation. The law explicitly states that the patient`s request must be voluntary and well thought out. Therefore, it is problematic to grant euthanasia to patients with psychiatric disorders or dementia. For a decision as irreversible as euthanasia, the question posed by free choice applies until the last moment. For patients with mental health issues, it is even more difficult to express free will. But euthanasia is not uncommon in these situations. The reference to a living will (a written document requesting euthanasia in cases where the person can no longer give informed consent) is common to justify euthanasia in dementia.

Euthanasia and assisted suicide have been legal in the Netherlands since 2002, followed a few months later by neighbouring Belgium. In 2002, the first year of the Act, 1,882 cases of euthanasia were reported. By 2012, that number had risen to 4,188; and in 2016, it reached 6,091 cases. In 10 years, the number of euthanasia cases has doubled and tripled in 15 years. In comparison, the population of the Netherlands grew by only 4% between 2002 and 2016. On three occasions in 2014, the end-of-life clinic was accused by regional review committees of irregularities in its application files. Nevertheless, this clinic has continued to develop its activities shamelessly. In 2015, two cases of euthanasia were classified as non-compliant with legal requirements. Despite this, the end-of-life clinic responsible for the procedure was not prosecuted. 1 The law on euthanasia was passed „far too early“ In addition, on 26. August 2016 published a study conducted by doctors „SCEN“ (Steun in Consultancy bij Euthanasia in Nederland) states that many cases are practiced because the person requesting euthanasia has not received adequate care. Proponents of the right to die often cite Holland as a model of how voluntary physician-assisted euthanasia can work for terminally ill and competent patients without abuse.

But the facts suggest otherwise. In 2016, these review committees requested additional information for only 77 of 6,091 cases, representing 1.3% of the total. Of these 77 cases, euthanasia was performed in 10 cases, although the doctors did not meet the required conditions. It is also legal for babies up to one year with parental consent. The following graph shows the increase in the number of euthanasia and euthanasia cases since 2002. In May 2016, the Minister of Health stated that the adoption of a new law for the extension of these practices was not necessary: „It is a mistake to believe that the current legal guidelines do not allow the death of seriously ill children. In fact, in the case of „absolute necessity,“ a physician can always invoke the condition of necessity. At the end of 2000, after about 18 months of public debate on its new bill, the Dutch government presented its proposal to legalize euthanasia to the second chamber of Parliament, where it was adopted without any problems. It was presented to the First Chamber in early 2001, where it was easily adopted and then promulgated. The provisions include: In 2010, this number was 4,050 and, according to research by the Vrije Universiteit, Utrecht University Hospital and Statistics Netherlands published in The Lancet, this was no more than before the entry into force of the Act on Interruption of Life on Demand and Assisted Suicide (Examination Procedures) in 2002; [6] And the study concluded that the law did not lead to more cases of euthanasia and assisted suicide on request.

[7] While some denounce violations of the law, others want to expand the conditions of access to euthanasia and practices. Parliament is under pressure to allow assisted suicide to people over 70 who request it, for no reason other than their age and „tired of life.“ At the beginning of 2010, for example, the association „Aus freier Willen“ (Uit vrije will) organised a citizens` initiative petition to force a parliamentary debate. A draft law presented by the government in October 2016 is currently under consideration. Belgium followed later that year, and Spain last year became the sixth country to introduce euthanasia – the act of deliberately ending a life to relieve a person`s suffering, for example by a lethal injection by a doctor. In July 2009, the UN Human Rights Committee expressed concern about the high number of cases of euthanasia and assisted suicide. The Netherlands was „urged“ to revise the law to bring it into line with the provisions of the 1966 International Covenant on Civil and Political Rights. In 2009, the Regional Review Committee reported 12 cases of euthanasia for neurological conditions, including people in the early stages of Alzheimer`s disease. In 2016, 201 cases of euthanasia were reported for psychiatric illness (60 cases) and dementia (141 cases), according to the data. The capacity of a person with a mental disability to consent is difficult to determine and, as a result, many physicians reject euthanasia for these patients. The issue of „suffering with no prospect of improvement“ could also be raised in some psychiatric cases.

Official guidelines require that the patient`s decision be voluntary, thoughtful and persistent, in case of unbearable pain with no hope of improvement. The decision should be made by more than one physician, and both the physician and patient should agree that euthanasia is the only reasonable option. Over the years, much evidence has accumulated that these guidelines are often ignored, in whole or in part, and that some of them cannot support a uniform interpretation of the law. Still others were watered down by the courts to such an extent that no physical suffering, or even physical illness, was necessary. In 2000, a case was reported in which a doctor assisted in the suicide of an 86-year-old man simply because his life no longer had meaning. He was later charged with murder, but received a symbolic sentence. In addition, under-reporting and lifetime withdrawals without the patient`s request have haunted Dutch euthanasia for many years.

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