The thesis starts with the historical and legal background of assistance in suicide in the Netherlands. Dutch case law has clarified that – outside the Dutch Euthanasia law – assistance in suicide is not punishable when this assistance is limited to (1) having conversations about the wish to end life, (2) offering moral support (including being present on the condition that no active assistance has been offered), and (3) providing general information about methods to end one’s own life. Several Dutch right-to-die organisation offer this non-punishable assistance in suicide in the form of non-directive counselling.
Martijn Hagens investigates the characteristics of this non-punishable assistance in suicide, and the characteristics of people who seek this assistance. Amongst others it describes how seeking such assistance is related to seeking physician assistance in dying under the Dutch Euthanasia law, how counselees experience the assistance they received, and it describes the number and the characteristics of people who have intentionally ended their own life after receiving such assistance.
The results are derived from a nationwide mortality-follow back study among physicians, a cross-sectional study amongst counsellors working with right-to-die organisation Foundation de Einder, and an in-depth interview study with counselees who sought assistance from these counsellors.
The main findings are interpreted in relation to three overarching themes: (1) the terminology for assistance in dying, (2) physician involvement with people intentionally ending their own life, and (3) the practice of assistance in suicide outside the Dutch Euthanasia law. The thesis concludes with several implications and recommendations for further research, practice, and policy.