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Euthanasia as a legal question

In the Netherlands, euthanasia has no longer been a criminal offence since 2002. The practice is governed by very strict conditions. Nonetheless, the legal issues surrounding it are still the focus of heated discussion, according to Leiden professors. They are discussing the issue on 18 March during a symposium at the Legal Faculty association Grotius.

JFV Grotius is organising the symposium on Sterven op verzoek (Dying on request) at a very particular point in time. The discussion on euthanasia flared up again a month ago as a result of the Levenseindekliniek (End of life)  documentary, in which the film makers recorded the final moments of several people whose lives were being brought to an end. Every year, some four to five thousand Dutch people take the option of ending their lives via euthanasia or assisted suicide. 

Difficult legal question

Leiden professors explain that the documentary shows precisely why euthanasia is such a difficult legal question. 'You can compare Dutch euthanasia legislation with our drugs policy to some extent,' says Tineke Cleiren, Professor of Criminal Law and one of the speakers at the symposium. ‘Euthanasia and assisted suicide are still not legally permissible, but since 2002 we have introduced some exceptions to the law: provided certain criteria of due care are taken into account, these acts are no longer punishable by law.' 

'You can compare Dutch euthanasia legislation with our drugs policy.' 

Just like cannabis

One of the conditions is, for example, that the patient has to be suffering unbearably and without the prospect of relief; there has to be an independent doctor present at the time of euthanasia, and the patient himself  or herself has to make the decision to end their life. Every instance of euthanasia has to be reported by the doctors involved to a regional review committee. The government's aim is to make sure that euthanasia - like the sale of cannabis - is transparent and properly controlled.  

End of life clinic

The Levenseindekliniek documentary shows where this legislation falls short. Hannie Goudriaan underwent euthanasia. She was suffering from dementia and had previously expressed the wish to end her life. 'That posed a problem for the doctor treating her,' comments the second speaker at the symposium, Aart Hendriks, Professor of Health Law. 'The doctor has to decide whether, at the point in time when the desire for euthanasia is current, the patient is able to can repeat that request.  For a patient who is suffering from dementia and who is in a coma, that is of course very difficult.' In the case of Goudriaan, the doctor decided that the condition for euthanasia had been met, but another doctor reached a different decision.

Unbearable and without prospect of relief

The doctor also has to be convinced that a person is suffering unbearably and without prospect of relief as a result of a medical condition. Hendriks: ‘In some cases, that's simply not possible. For example, if a patient is suffering not physically but psychologically, without there being any medical condition. In such a case, the conditions for euthanasia cannot be met. Many patients find this difficult to understand. Not everyone realises that euthanasia is not a right under Dutch law, but an exception to a prohibition.' 

A life completed

Does this mean that the law needs to be modified? Professor Tineke Cleiren thinks not. As a member of the independent Adviescommissie voltooid leven (the advisory committee on end-of-life decisions) she examined whether it needs to be determined in law that people who feel they have reached the end of their life have the right to euthanasia. The committee concluded in February unanimously that it would not be wise - and would even be undesirable - to alter the law in this respect. 

'It is not the intention that elderly people should feel so much of a burden that they allow their lives to be ended by euthanasia.' 

Legislation is adequate

Cleiren: ‘In most cases, the present legislation is adequate. If we broaden the legislation to include assisted suicide for a person who feels their life has run its course, this could leave a door open for malicious intent and unsafe eventualities. Take the case where adult children are finding it hard to care for their elderly parents. It's not the intention that these parents should feel so much of a burden that they allow their lives to be ended by euthanasia. Certainly not if there is any question of an inheritance. The safeguards of a precise and careful procedure and an independent doctor should prevent this kind of occurrence.' 

Philosophising about alternatives

Aart Hendriks, too, believes that the present legislation meets requirements. 'The law makes provision for a situation where there is a strong need, but is applied with caution. There are numerous safeguards to prevent misuse.' But he is looking foward to philosophising with students on 18 March about possible alternatives. 'Imagine you could put the present legislation to one side and start again from scratch. How would you go about it?  That's an interesting legal exercise.' 

Photograph: ANP Lex van Lieshout

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