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Summary of the Bill
Special provision on exemption from punishment
A physician who helps a patient to die must comply with two conditions to remain exempt from punishment:
1. He must practice due care as set forth in a separate law, the Termination of life on request and assisted suicide (Review) Act;
2. He must report the cause of death to the municipal coroner in accordance with the relevant provisions of the Burial and Cremation Act.
The incorporation of a special provision on exemption from punishment in Criminal Code (Article 293, paragraph two, and in Article 294, paragraph two, sentence two),does not decriminalise other forms of euthanasia and assisted suicide. Therefore, to say that euthanasia and assisted suicide are no longer punishable is not a correct presentation of the tenor of this bill.
Due care requirements
Under current legislation termination of life on request is punishable but will not be prosecuted if due care requirements have been complied with. The due care requirements stipulate, among other things, that the patient's request to die must be voluntary and well-considered, that his condition is hopeless and his pain unbearable, that a second doctor must be consulted and that the euthanasia or assisted suicide is performed with due medical care. Furthermore, the physician is obliged to report that the cause of death is euthanasia or assisted suicide. The physician's action is then examined by a regional review committee to determine whether it was performed with due care. The judgement of the review committee is then sent to the Public Prosecution Service, which uses it as a major argument to decide whether or not to institute proceedings against the physician in question.
The new legal regulations do not essentially change anything in the grounds permitting termination of life on request and assisted suicide. However, the due care requirements have been formulated somewhat more extensively. The due care requirements mentioned in Criminal Code Article 293, paragraph two, stipulate that the physician:
1. must be convinced that the patient has made a voluntary and well-considered request to die;
2. must be convinced that the patient's is facing interminable and unendurable suffering;
3. has informed the patient about his situation and his prospects;
4. together with the patient, must be convinced that there is no other reasonable solution;
5. has consulted at least one other independent doctor of the patient;
6. has seen and given his written assessment of the due care requirements as referred to in points 1 to 4;
7. has helped the patient to die with due medical care.
Regional review committees
The five regional review committees continue to exist under the new legislation but they will play a different role. The will continue to assess whether a case of termination of life on request or assisted suicide complies with the due care criteria. If the committee is of the opinion that the physician has practised due care, the case is finished. But if that is not so, the case is brought to the attention of the Public Prosecutor. The Public Prosecutor does of course have the power to launch his own investigation if he suspects that a criminal act may have been committed.
A regional review committee is composed of an uneven number of members, though at least three. In any case, it must consist of a legal expert cum chairman, a doctor and an expert in the field of ethics or philosophy. For each of the members, one or more substitutes are appointed.
If necessary, the committee will personally discuss with the physician the assessment it has given. In this way, the committee can provide insight into its assessment process and give the physician feedback about the working method he has used.
Through annual reports in which, without mentioning names, concrete cases are discussed with considerable candour, the committees can contribute to the public awareness of termination of life on request and assisted suicide and the supervision exercised. In the end, all the aspects mentioned will stimulate physicians to act with the greatest care.
To monitor the uniformity of the assessments of the different review committees, the chairs of the committees will consult regularly in a meeting attended by representatives of the Council of Procurators-General and the Health Care Inspectorate of the State Supervisory Agency for Public Health.
Minors
The legislation also includes regulations regarding termination of life on request and assisted suicide involving minors. It is generally assumed that minors too have the discernment to arrive at a sound and well-considered request to end their life. Regarding the various age groups, the new legislation links up with the existing legislation concerning medical conduct towards minors. Children of 16 and 17 can, in principle, make their own decision. Their parents must, however, be involved in the decision-making process regarding the ending of their life. For children aged 12 to 16, the approval of parents or guardian is required.
Furthermore, the doctor must comply with the due care requirements mentioned above when he agrees to help a minor commit suicide.
Declaration of will
Finally, the legislation offers an explicit recognition of the validity of a written declaration of will regarding euthanasia (the so-called euthanasia declaration).
The presence of a written declaration of will means that the physician can regard such a declaration as being in accordance with the patient's will. The declaration has the same status as a concrete request for euthanasia. Both an oral and a written request legitimises the physician to accede to the request. However, he is not obliged to do so. And he may only accede to the request while taking into account the due care requirements mentioned in the bill. The due care requirements must be complied with, regardless of whether it involves a request from or lucid patient or a request from a non-lucid patient with a declaration of will. In each case the doctor must be convinced that the patient is facing interminable and unendurable suffering. If he believes that this is not so, he may not accede to the request for euthanasia, no matter what the declaration of will states.
The doctor may only provide information to the patient and discuss with him a reasonable alternative solution if the patient is able to communicate, and in many cases this will not be so.
It is important that the contents of the declaration should, if possible, be discussed by patient and doctor. In this way, the patient can make clear what he means by his declaration and what his precise wishes are. The doctor can, in his turn, make clear to the patient what the conditions are for acceding at any time to this written request for euthanasia.