Dutch euthanasia review committees updated their Euthanasia Code (not a broadening of the law)

This november, the Dutch regional euthanasia review committees (RTE) have brought their Euthanasia Code 2018 (EC 2018) in line with a judgment of the Supreme Court earlier this year. Contrary to what the media say, this change does not broaden the rules.

Court case

In this lawsuit the question was raised how to deal with a written request for euthanasia of a patient who was meanwhile incapacitated as a result of advanced dementia. The law states that such an advance directive can replace the actual oral request. The question in this case was whether a pshysician should ask for a confirmation of this request, just before the euthanasia would be performed. The answer of the court was no.

Euthanasia Code 2018

The Euthanasia Code 2018 (EC 2018) aims to provide physicians with a handy overview of the way in which the due care criteria of the law are interpreted by the RTE. The RTE not only assesses euthanasia reports against the law, but also against case law. The Supreme Court (HR) answered a number of crucial questions about the interpretation of the law. The full changes can be found in sections 4.1 (Written living will) and 4.4. (Patients with dementia) of the Euthanasiacode.

Four additions to the Euthanasia Code 2018

1. The advance directive on which the euthanasia is granted must be interpreted with a view to ascertaining the intention of the patient. In doing so, the physician must pay attention to all circumstances of the case and not just the literal wording of the advance directive. This means there is room for interpretation.
2. Determining whether in the case of advanced dementia there is in fact hopeless and unbearable suffering involves a medical professional judgment that is reserved for the doctor. The RTE should therefore exercise caution in testing this medical professional judgment and wonder whether the doctor could reasonably conclude that there was unbearable suffering.
3. When providing euthanasia to a patient who is incapacitated as a result of advanced dementia, it is not necessary for the physician to consult with the patient about when and how the euthanasia will be performed. Such a conversation is pointless because such a patient lacks understanding about these topics.
4. If there are indications in an incapacitated patient that restlessness, agitation or aggression may arise during the performance of euthanasia, the medical standards to be observed by the doctor may lead him to conclude that premedication is indicated.

No broadening of the law

With the update of the Euthanasia Code 2018, no new law is created. The law is still the same, and even the interpretation of it did not change. The only thing that has changed is that there is more clarity about issues which were therefore not explicitly described in the RTE’s Euthanasia Code 2018. Now that the Supreme Court has explicitly ruled on a number of issues, the RTE have included these outcomes in their code. So the only thing that happened is that the RTE now provides more clarity on a number of things that were not explicitly clear up to now.