I have researched the Netherlands’ experience in detail and written a number of peer-reviewed papers about it. In Dutch usage, the term euthanasia legally covers cases in which medical professionals administer lethal injection and those in which doctors provide drugs that patients ingest to end their life. The Dutch system gives deference to doctors’ expertise; it respects the relationship between an individual doctor and a patient; and it recognizes that mental illness can be painful and debilitating. Yet this system illustrates how priorities that appear logical on their own terms combine, in some cases, to produce disturbing results. A respected Dutch-language medical journal recently reported that an 18-year-old had died via medically assisted suicide for psychiatric problems.
In the United States, debates about physician-assisted suicide are typically couched in terms of patient autonomy. The rationale for the landmark 2002 euthanasia law in the Netherlands, though, was that it codified a legal option for doctors, whose primary duties—to preserve life and to relieve suffering—were thought to conflict in the case of certain anguished patients. In the decades before 2002, a series of court rulings had offered legal protection for Dutch physicians who facilitated patients’ deaths.
Unlike in most other jurisdictions where medically facilitated deaths are legal, the euthanasia law in the Netherlands has no requirement that a patient be close to death. The law’s directives are few and broadly drawn. Aside from obtaining formal consent—a patient’s request must be “informed” and “voluntary and well considered”—the doctor must be “satisfied” that two conditions are met: The patient has “unbearable suffering, without prospect of improvement,” and there is “no reasonable alternative” to address it. The doctor must use the euthanasia medications properly, and she must consult an independent physician—though she is not bound by this outside consultant’s opinion. Indeed, as long as the patient is at least 16, no other person’s consent except the patient’s is mandatory. (Parents of 16- and 17-year-olds are involved in the discussion, but their permission is not required. Patients as young as 12 can seek euthanasia with parental consent. In about 10 cases since 2002, children ages 12 to 17 have received euthanasia; as far as I know, all were for physical illnesses.)
After the patient’s death, the doctors involved submit written reports, which are reviewed by one of five regional review committees consisting of a physician, a lawyer, and a bioethicist. These positions are not full-time jobs, but the five committees handle more than 6,500 cases a year. (In the United States, the per-capita equivalent would be 126,000.) Needless to say, the single physician on each committee cannot be a specialist on every disorder at issue. Over the years, only 0.18 percent of cases have been classified as “due care not met.” The doctor is virtually always right when it comes to euthanasia. Only one doctor has ever been prosecuted for violating the 2002 law.