Dutch take a further step to legitimising euthanasia

Petra Brockmoller lives life to the full. At 65, she goes to concerts, enjoys nights out with friends and walks two or three miles a day from her flat in central Amsterdam.

Petra Brockmoller lives life to the full. At 65, she goes to concerts, enjoys nights out with friends and walks two or three miles a day from her flat in central Amsterdam.

She also has terminal cancer and has told her doctor she wants him to end her life when she feels the time is right, rather than cling on to the bitter end.

Mrs Brockmoller is fortunate that she lives in the Netherlands, where assisted suicide has been tolerated for many years. Today, the country will move to legitimise the practice with a law that guarantees immunity from criminal prosecution for doctors who help patients to die, provided they follow certain guidelines.

After 30 years of public debate the Bill has wide political support and is almost certain to be approved by the Upper House.

Although euthanasia will remain a criminal offence, doctors will now be granted the protection they have long sought. The Bill states that doctors who help terminally ill patients to die will never face prosecution as long as they abide by the rules.

Under existing practice, patients must have made a voluntary and carefully considered request to die, the doctor must be convinced their suffering is "unbearable" and there is no chance of improvement, the GP must have consulted at least one other physician, and the life must be terminated with due medical care.

Unnatural deaths must then be reported to a coroner. A special committee decides whether doctors observed the "due care" requirements. The new Bill will allow the review panel, if satisfied the guidelines have been respected, to take no further action.

To a great extent, the Bill is a "symbolic" change to give doctors more reassurance. Johan Legemaate, a professor of health law at Erasmus University, Rotterdam, said: "It takes away the stigma of technically having committed a crime when in their own minds they were just helping the patient."

During the 1990s, when euthanasia had a less solid legal footing, 20 doctors were prosecuted, although most had the charges dropped. But cases that went to court widened the conditions under which euthanasia was deemed acceptable, so that it was no longer restricted to terminal physical illnesses but could be applicable to mental illnesses as well.

In one case, a court declined to punish a psychiatrist who assisted in the death of a social worker who was suffering from chronic depression. In another, a retired senator in his 80s, who had neither a chronic physical nor mental illness but said he had a "pointless and empty existence", was also helped to die. The doctor involved was acquitted by the court, but the prosecution is now appealing.

In a third case, an Amsterdam GP was convicted of murder in February for giving a fatal anaesthetic injection to a woman of 84 who was suffering from severe bed sores but was so close to death that staff in her nursing home would not wash her for fear it would kill her. Dr Wilfred van Oijen received widespread sympathy, but the court found him guilty because he failed to seek the patient's consent, for which he received a conviction but no punishment.

Critics said the case proved that compassionate medical decisions should not be regulated. One opponent, Andre Rouvoet, of the Christian Union party, said: "Anyone who studies euthanasia in this country can see again and again new steps have been taken. Originally it had to be a terminal illness ... Then it was 'unbearable suffering' which had to be physical. Then came a ruling which allowed it to be mental suffering. Now another ruling says there can be unbearable suffering simply if someone does not want to live any more."

Two-thirds of all euthanasia requests are turned down by Dutch doctors. Dr Nico Mensing, a GP who has helped several to die, said the death of a young women 20 years ago was the most difficult. "She was a young mother of 31 with three kids of five, three and six months old. She had cancer all over her body, she suffered for months and months. It was very heavy."

Leading article, Review, page 3