The regulation of euthanasia: how successful is the Dutch system?

Euthanasia and physician-assisted suicide have been legal in the Netherlands since 1984, first by judicial legislation and since 2002 by statute, if enacted by a doctor who meets a number of requirements of due care and makes it possible to assess whether he or she met them. How successful is this Dutch model? The answer to that question of course depends on what we understand "success" to mean. In this chapter, I will try to assess the extent to which the Dutch model is successful on its own terms. I will therefore start in §1 by explaining the underlying morality of the Dutch law, which informs both the substantive and procedural requirements of due care. This will give us the frame of reference we need for judging the success of the system.

Of course, many people will not be happy with these moral foundations of the legal system themselves because on their view, they do not sufficiently respect either the sanctity of human life or the autonomy of patients. For such people, the system is inherently flawed because it is either too liberal or too paternalistic. Even for them, however, it will be of some interest to have the system evaluated on its own terms because a common view of foreign observers has always been that it has failed as such. In §2 and §3 I will discuss the main points of criticism, which concern the reporting rate and the number of cases in which patients’ lives have been ended without their explicit request. In addition, in §4 I will consider the criticism that what doctors consider to be terminal sedation should often be seen as euthanasia (and reported as such), and in §5 the criticism that the whole system of monitoring and control is only a façade, because it never leads to the criminal sanctioning of any doctor violating the requirements.