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. Author manuscript; available in PMC: 2017 Jul 27.
Published in final edited form as: JAMA Psychiatry. 2016 Apr;73(4):362–368. doi: 10.1001/jamapsychiatry.2015.2887

Table 1.

Brief background on euthanasia and physician assisted suicide (EAS) practice and regulation in the Netherlands.

The practice of legally protected EAS has been in existence for several decades in the Netherlands although formal legislation was not enacted until 2002—the Termination of Life on Request and Assisted Suicide (Review Procedures) Act.1 Under the law, the Dutch Regional Euthanasia Review Committees (Regionale toetsingscommissies euthanasia, or RTE) review all EAS reports regarding whether the notifying physicians (physicians of record for performance of EAS) have conformed to the due care criteria laid out in legislation.(See Table 2) There are five regional committees but the goal is to provide uniform guidance. The RTE has a strong commitment to transparency and its Publication Committee publishes a selection of case reports that are deemed “important for the development of standards” in order to provide “transparency and auditability” of EAS practice and “to make clear what options the law gives physicians.”7 Given the controversial nature of psychiatric EAS, barring any special confidentiality reasons, the RTE published large majority of the cases (available at https://www.euthanasiecommissie.nl/oordelen/). In fact, in early 2014,18 the Minister of Health prompted the publication of all psychiatric EAS cases from 2013 that had been reviewed at the time to be published. However, the RTE has since decided to make the number of published psychiatric EAS smaller, so that going forward it will be more proportional to the fraction of psychiatric cases in the overall EAS cases (0.8% of 5306 cases in 2014) (personal communication, N. Visee, general secretary of RTE). Our study, by capturing 66 of 67 published cases from 2011–2014, therefore covers an opportune window in which vast majority of psychiatric EAS cases were published.
SCEN (Support and Consultation on Euthanasia in the Netherlands)31 doctors are physicians specially trained to assist colleagues in the EAS process. They usually serve as the official independent physician EAS consultant but can dispense less formal advice and assistance. Most SCEN are general practitioners but some are psychiatrists.
In March of 2012, a new organization called the End-of-Life Clinic (Levenseindekliniek, sometimes referred to as SLK) began to provide EAS to patients whose own physicians had declined to perform EAS. It consists of mobile teams of a physician and a nurse funded by Right to Die NL (Nederlandse Vereniging voor een Vrijwillig Levenseinde – The Dutch Association for a Voluntary End of Life), a euthanasia advocacy organization. A review of their activity has recently been published.32
The Dutch Psychiatric Association (Nederlandse Vereniging voor Psychiatrie, NVvP) has published guidelines regarding how to evaluate psychiatric EAS requests (Richtlijn omgaan met het verzoek om hulp bij zelfdoding door patiënten met een psychiatrische stoornis [Guidelines for responding to the request for assisted suicide by patients with a psychiatric disorder]).33 The Guidelines are professional practice recommendations (not law) but are frequently referenced by the RTE. The NVvP Guidelines, for example, outline when a patient’s refusal of treatment is compatible with providing EAS and recommends independent psychiatric EAS consultation when patients request EAS for suffering due to mental disorders.