A Dutch general practitioner found guilty of helping an infirm but not seriously ill elderly patient to commit suicide could face a retrial.
The Netherlands solicitor general Nico Keijzer has advised the High Court that the legal test case should be retried in the light of the new law on euthanasia and assisted suicide that came into effect after the case was heard in December last year (BMJ 2001;323:1384).
He writes that it should be investigated whether applying the new law could be more favourable to the accused. He also argues that last year's judgment does not sufficiently explain why it was felt that the GP should have consulted further experts, having already involved a psychiatrist and a doctor colleague.
In 1998 Philip Sutorius helped his patient, 86 year old former senator Edward Brongersma, to die, believing he was experiencing "unbearable suffering," even though he had no serious physical or mental illness. Brongersma, who was obsessed with his physical decline and hopeless existence, had often spoken to Sutorius of his wish to die, saying he was "tired of life."
A first court acquitted Sutorius in November 2000, but the Amsterdam appeal court found him guilty of assisted suicide, claiming that Brongersma's suffering was not medical and that GPs therefore had no experience to judge such an issue. The court believed Sutorius had promised to fulfil Brongersma's wish to die too soon, instead of seeking other solutions.
However, it imposed no punishment, recognising that Sutorius had acted out of concern for his patient. Sutorius appealed to the High Court to quash his conviction and clarify the position of doctors. Legal experts consulted by the appeal court have concluded that there is currently no legal framework for doctors to act other than over demonstrable medical suffering.
Keijzer agrees that the appeal court was right to reject the GP's defence: that he faced a conflict of interests because of his patient's suffering. But his main argument is that his suffering was "not so serious" as to justify assisted suicide.
The case raises the question of whether euthanasia could in principle apply to so called "existential" suffering. Experts in health law are concerned that the advice could be interpreted as allowing doctors to act in such cases if the suffering is serious enough.
The Royal Dutch Medical Association sees uncertainty over the doctor's role regarding existential suffering, which is seen as falling outside the legal criterion of care for euthanasia in which a doctor must judge whether the patient is suffering unbearably and hopelessly. A committee set up by the association is currently considering this question.
The so called "tired of life" case is seen as defining the limits of Dutch euthanasia law. The High Court will respond to the solicitor general on 17 December.