Assessing Physician Compliance With the Rules for Euthanasia and Assisted Suicide

When any state or country considers permitting physician-assisted suicide or euthanasia, one of the most important and difficult questions to be faced is how to make sure that physicians follow the rules. The rules in the Netherlands^1- 6 require a physician to determine that (1) the patient’s request was voluntary and informed, (2) the patient’s suffering is unbearable, and (3) there is no reasonable alternative. Patients must be at least 16 years old to make the request, although patients aged 12 to 15 years may request assisted suicide or euthanasia if the parent agrees. The physician must assess the requesting patient’s physical and psychological condition and obtain a second opinion. After a patient dies from euthanasia or assisted suicide, the physician must complete a report and notify the municipal pathologist of a death from nonnatural causes. The pathologist performs an autopsy and prepares a report, which goes to the public prosecutor. In addition, both reports go to a regional review committee, which decides whether the physician followed the rules. If the committee decides that the physician followed the rules, he or she will not be prosecuted. If the committee finds otherwise, it refers the case for possible prosecution.