The Living Force
Source (Dutch only): De nieuwe euthanasiecode geeft artsen meer vrijheid, maar ook extra druk

Coffee euthanasia
The new euthanasia code gives doctors more freedom, but also extra pressure

The new euthanasia code gives doctors a large professional role, but also makes it more difficult for doctors with objections.

Marten van de Wier - November 25, 2020, 10:50 am

Doctors need to feel less fear of the judge and review boards when euthanasia is performed on people with advanced dementia. They do get pressure from society in return.

That is the assessment after the publication of the new rules for doctors, written last week by the Regional Euthanasia Review Committees (RTE). They are the culmination of a discussion about the limits of the Euthanasia Act, which began more than four years ago when Trouw daily published on the ''coffee euthanasia''. A woman with advanced dementia was given euthanasia on the basis of a declaration of will on paper, which, according to the review committee, was not entirely clear. The doctor first gave the woman a soporific in her coffee.

Last year the judge dismissed the doctor involved from all legal proceedings. Now that the euthanasia committees have converted this ruling into practical guidelines, it is clear that the reins for doctors in euthanasia cases are not being tightened. The review committees and the judge argue that doctors have great professional leeway. The committees and the judge test only 'marginally'. "Doctors now have less to worry about sticking their necks in a noose by performing a euthanasia", said Jacob Kohnstamm, chairman of the review committees, in de Volkskrant.

Own interpretation

Constance de Vries, physician at the Expertise Center Euthanasia, already took the liberty of interpreting a declaration of will with the help of loved ones, as is allowed under the new guideline. "For doctors this was quite a challenge, whether the review committee would agree with you. I can be a little less afraid now if I give my own interpretation to that declaration of will", she states.

But that also poses a problem for doctors. They can now point less easily to the law or the euthanasia code if they object to the granting of euthanasia. For example, when they have to do so on the basis of a written will that a patient can no longer confirm verbally.

As a result of the coffee euthanasia, 450 doctors announced in full-page advertisements in national media that they are not willing to give a lethal injection to incapacitated patients. According to them, there is increasing pressure on doctors to perform euthanasia in situations where they don't really want it.

Moral consideration

One of them, GP Jaap Schuurmans, is not happy with the new code. "The doctor is being thrown back on himself," he says. On the other hand, he believes that doctors should be strong enough to 'find a response' to social pressure. According to him, about half of the doctors go along with this social development, and the other half still oppose euthanasia in the case of dementia.

He argues that physician organizations should organize a 'moral deliberation' for general practitioners: they should be able to discuss difficult ethical considerations surrounding euthanasia with colleagues or meaning experts in life questions, so that they are less alone.

De Vries expects that the amended code will lead to new questions from 'concerned relatives' to the physician: does father or mother with advanced dementia now not qualify for euthanasia? She does not experience such questions as pressure. "They are relevant questions, which we as doctors have to look at carefully and which we can then answer".

De Vries's answer, however, will be no different than in the time before the new code. "People often forget that, according to the law, there must also be unbearable suffering, and that suffering must be visible," says De Vries. According to her, this means that doctors can do nothing more with the new code than under the old one. A patient with advanced dementia who is not clearly suffering is not eligible for euthanasia.

Translated with (free version)


The Living Force
Source (Dutch only): D66 en VVD willen opheldering over blokkering lid euthanasiecommissie

NOS News - Interior - Politics - Today, 09:56am - Modified today, 11:11am

D66 and VVD want clarification about blocking member euthanasia committee

Coalition parties D66 and VVD want clarification from CDA Minister Grapperhaus (Justice and Security) about his refusal to appoint a member of a regional euthanasia committee. It is highly unusual for a minister to block the appointment. D66 wants to ask verbal parliamentary questions about this matter this afternoon.

Grapperhaus does not want Miriam de Bontridder, deputy counsel at the Amsterdam Court of Appeal, to join one of the review committees. It is not clear why he is vetoing; the ministry does not want to say anything about it.

Until last year, De Bontridder was a board member of De Einder, an organization that advises people on how to get out of life legally without the involvement of a doctor. She is a great advocate of euthanasia and regularly speaks out in public about it. Earlier this year she criticized leader of the ChristenUnie Gert-Jan Segers, who is against euthanasia.

Highly qualified lawyer

There are five regional review committees. Each committee includes a lawyer, a doctor and an ethicist. They judge whether a doctor has acted carefully during euthanasia. If they conclude that a doctor has been careless or if there are doubts, the case goes to the Public Prosecutor's Office for investigation.

De Bontridder had already been nominated by the application committee, but Minister Grapperhaus is going to stand against it. "She is a very qualified lawyer and therefore nominated with great conviction, but it is the Minister's right to decide not to appoint someone," says Jacob Kohnstamm, coordinating chairman of the regional review committees. Kohnstamm is going to ask Grapperhaus why De Bontridder is not allowed to become a member.

D66 Member of Parliament Pia Dijkstra speaks of a serious matter and wonders whether De Bontridder was refused because she worked for De Einder.

[in Dutch]

Translated with (free version)

Source (Dutch only): Grapperhaus: kan niet zeggen waarom ik lid euthanasiecommissie blokkeerde

NOS News - Politics - Today, 15:21 - Modified today, 17:58

Grapperhaus: can not say why I blocked member euthanasia committee

Minister Grapperhaus does not want to say whether Miriam de Bontridder's personal views played a role in blocking her appointment to become a member of a regional euthanasia committee. Grapperhaus said in the House of Representatives that he and Minister De Jonge have made a careful assessment, about which he cannot report for privacy reasons.

This morning it became apparent that Grapperhaus has blocked De Bontridder's appointment as a member of a review committee by vetoing it. D66 Member of Parliament Dijkstra asked him in the Lower House if this could have something to do with the fact that until last year she was a board member of De Einder, an organization that advises people on ways to get out of life legally.

There are five regional assessment committees. Each committee includes a lawyer, a doctor and an ethicist. They judge whether a doctor has acted carefully during euthanasia. If they conclude that a doctor has been careless or if there are doubts, the case goes to the Public Prosecutor's Office for investigation.


Grapperhaus says that he simply abides by the law on euthanasia. This means that two ministers, in this case the Ministers of Justice and Security and of Health, among other things test the specific expertise and suitability of the nominated candidate. "Occasionally this does not lead to an appointment".

The Minister of J&S says that he has informed the chairman of the assessment committee of the decision verbally and confidentially. He will still send a confidential letter later this week. But he cannot inform the House of Representatives about it. "The interest of the individual is more important in this case".

De Bontridder herself does not want to respond.

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The Living Force
Source: Major regional differences in approved euthanasia requests

Friday, January 15, 2021 - 14:20

Major regional differences in approved euthanasia requests

There are major regional differences in how many euthanasia requests are granted in the Netherlands, according to research by Radboud UMC in Nijmegen and the Protestant Theological University in Groningen. The percentage of euthanasia deaths in some municipalities is 25 percent higher than others, Nieuwsuur reports.

The researchers looked at euthanasia figures up to 2017, the most recent available. In that year, euthanasia was used in 4.4 percent of deaths in the Netherlands.

Euthanasia was most often used in postcode area 13, the area around Almere, in 2017. In that area, euthanasia was involved in 7.37 percent of all deaths. Almost the entire Kop van Noord-Holland is in the top 10 of most granted euthanasia requests. Postcode area 91, which includes Ameland, Schiermonnikoog and Dokkum, had the lowest percentage of euthanasia deaths at 2.15 percent.

The differences are even greater at municipal level. In Almere, euthanasia was about four times more common between 2013 and 2017 than in Dokkum.

"If we were to do this research for other medical procedures, say cataract operations, you'd rather think of a factor of two or one and a half," health scientist and medical ethicist Stef Groenewoud said to the program. He did this study with ethicist Theo Boer.

The researchers found that religion clearly plays a role in how common euthanasia is in an area. The Bible Belt, a strip of municipalities with many Christian residents, had much fewer cases of euthanasia than less religious municipalities. "You see that euthanasia is less common in the entire region of Zeeland, Zuid-Holland, across the Veluwe to the northeast of the Netherlands," Groenewoud said.

In addition to religion, the researchers also found a correlation between euthanasia and political preference, the health of the residents, and the social cohesion in an area. After they correct their results for these factors, euthanasia was still 7 percent more likely in in the municipalities at the top of the list and those at the bottom.

Groenewoud and Boer did not find a clear explanation for that difference. "Regional customs" may have developed around euthanasia, Boer speculated. "Just as people, so to speak, drink Berenburg in Friesland and it boluses in Zeeland, it may be that in certain parts of the Netherlands people use euthanasia more."

They would like to continue this study, working with general practitioners. "It is important to understand why people resort to euthanasia quite en masse in certain areas and not in other areas," Boer said.

Other sources:
Euthanasia in the Netherlands: a claims data cross-sectional study of geographical variation | BMJ Supportive & Palliative Care (includes link to PDF download)
Unexplained 7-fold variation in euthanasia rates across The Netherlands – BMJ Supportive & Palliative Care

In Dutch:
Er zijn grote verschillen in euthanasiepraktijk tussen de regio’s
Grote regionale verschillen bij euthanasie, in sommige gemeenten 25 keer vaker


The Living Force
Source: Portugal legalises euthanasia despite public anger

Portugal legalizes euthanasia despite public anger

1 day ago

Portugal becomes the fourth country in Europe to move to decriminalize euthanasia, but only for national citizens and legal residents in order to prevent people from traveling to Portugal to get medical help to end their life.


Demonstrators protest against euthanasia before a vote at the Portuguese Parliament in Lisbon, Portugal, February 20, 2020 (Reuters)

Portugal's Parliament has voted to legalize euthanasia, with the country set to become the seventh in the world to allow terminally ill patients to seek assistance from a doctor to end their life.

According to the legislation that passed on Friday, people aged over 18 will be allowed to request assistance in dying if they are terminally ill and suffering from "lasting" and "unbearable" pain – unless they are deemed not to be mentally fit to make such a decision.

The process will only be open to national citizens and legal residents in order to prevent people from traveling to Portugal to get medical help to end their life.

The law is now in the hands of President Marcelo Rebelo de Sousa, a conservative, for a final stamp of approval. He previously said he would respect parliament's vote.


Some have criticized the timing of the vote, with opposition party PSD saying due to the corona-virus pandemic raging across Portugal there was "great anxiety, great fear among people that has to do with issues of life and death."

In a letter to parliament, two groups managing the majority of Portugal's care homes, which were hit hard by the pandemic, said "the approval of euthanasia represents a disrespect for all these people."

But parliamentary leader of the People-Animals-Nature party, Ines Real, said, "It is dishonest to invoke an extremely difficult moment in the country ... to confuse deaths related to Covid-19 with the legislative process that aims to allow euthanasia to those suffering."

Portugal, a Catholic-majority country that spent a large part of the 20th century until the 1974 Carnation revolution ruled by a fascist regime, has since made strides in liberal reforms upholding human rights.

It legalized abortions in 2007 and allowed same-sex marriage in 2010.

Euthanasia: Where it's legal in Europe

The Netherlands has legalized active and direct euthanasia since April 2002. Requested administration of a drug in lethal doses is authorized if patients make the request while lucid.

They must also be experiencing unbearable suffering from a condition diagnosed as incurable by at least two doctors.

In 2020, the country's highest court ruled that doctors will be able to conduct assisted suicides on patients with severe dementia without fear of prosecution, even if the patient no longer expressed an explicit death wish.

The Netherlands also moved towards making euthanasia legal for terminally ill children aged between one and 12.

Belgium lifted restrictions on euthanasia in 2002 for patients facing constant, unbearable, and non-treatable physical or psychological suffering.

They must be aged 18 or over and request termination of life in a voluntary, deliberated, and repeated manner free from coercion.

In 2014, Belgium became the first country to authorize children to request euthanasia if they suffer a terminal disease and understand the consequences of the act.

In Luxembourg, a text legalizing euthanasia in certain terminal cases was approved in 2009. It excludes minors.

Swiss exception

Switzerland is one of the rare countries that allows assisted suicide with patients administering a lethal dose of medication themselves. It does not allow active, direct euthanasia by a third party but tolerates the provision of substances to relieve suffering, even if death is a possible side-effect.

Other ways of assisted death

Spain's Parliament voted in 2020 to approve a bill that will allow euthanasia under strict conditions despite fierce opposition from the Catholic church and conservative parties. It still faces a vote in the Senate early in 2021.

Italy's Constitutional Court ruled in 2019 it was not always a crime to help someone in "intolerable suffering" commit suicide. Parliament is set to debate a change in the law banning the practice.

The halting of medical procedures that maintain life, called passive euthanasia, is also tolerated.

In France, a 2005 law legalizes passive euthanasia as a "right to die." A 2016 law allows doctors to couple this with "deep and continuous sedation" for terminally ill patients, while keeping euthanasia and assisted suicide illegal.

Sweden authorized passive euthanasia in 2010.

Britain has allowed medical personnel to halt life-preserving treatment in certain cases since 2002. Prosecution of those who have helped a close relative die, after clearly expressing the desire to end their lives, has receded since 2010.

In Austria and Germany passive euthanasia is permitted if requested by the patient.

Austria's constitutional court ruled in October the country was violating fundamental rights in ruling assisted suicide illegal and ordered the government to lift the ban in 2021.

Since 1992 Denmark has allowed people to file written refusal of excessive treatment in dire situations, with the document held in a centralized register.

In Norway, passive euthanasia is permitted if requested by the patient or by a relative, if the patient is unconscious.

In Hungary, people with incurable diseases can refuse treatment.

It is also legal to end treatment of terminally ill people in Lithuania and Latvia.

Source: TRT-World and agencies

Similar sources (out of many):
Portugal moves to legalise euthanasia
Portuguese parliament votes to legalise euthanasia
Law allowing euthanasia in Portugal moves a step closer
Portuguese parliament approves decriminalisation of euthanasia - Portugal Resident

Coverage in Dutch:
Euthanasiewet goedgekeurd in Portugal


The Living Force
Archiving an overview article on SOTT by Rosemary Frei (Mon, 12 Apr 2021 00:01 UTC) about the pro's and con's of euthanasia and physician assisted suicide in all relevant countries:

Three Things Most People Don't Know About Physician-assisted Death --

After obtaining an MSc in molecular biology from the Faculty of Medicine at the University of Calgary, Rosemary Frei became a freelance writer. For the next 22 years she was a medical writer and journalist. She pivoted again in early 2016 to full-time, independent activism and investigative journalism.


The Living Force
Source: Highest ever number of euthanasia procedures in 2020 -

Highest ever number of euthanasia procedures in 2020

April 23, 2021 - By Senay Boztas

The RTE Regional Euthanasia Review Committees, which each year analyze all deaths by euthanasia and test whether strict criteria have been met, reported 6,938 procedures.

All but two of these were judged to have met the six legal requirements (in Dutch), which include that someone has carefully thought over the request and makes it freely, and is suffering unbearably with no other reasonable prospect of relief.

The number of euthanasia cases exceeds the previous peak of 2017, when there were 6,585 deaths. Numbers fell after a doctor was prosecuted but eventually found not guilty of manslaughter for a controversial procedure involving a woman with advanced dementia. But the 2020 total was a 9% increase on 2019, when there were 6,361 cases.

Chairman of the RTE Jeroen Recourt told Trouw (in Dutch) that he was not surprised by this growth. ‘These figures are part of a larger development,’ he reportedly said. ‘More and more generations see euthanasia as a solution for unbearable suffering…and the thought that euthanasia is an option for hopeless suffering brings [many people] peace.’

For four people, contracting the corona-virus had a role in their request for an assisted death, but Recourt said that social problems such as increased loneliness are not considered valid medical grounds.

‘Euthanasia is only granted for hopeless suffering from a medical cause,’ he said. ‘In the case of loneliness, however awful it may be, you can mostly ask if there really is no other solution than death. Otherwise you are playing with the limits of the law.’


As in previous years, dementia was a factor in 2% of the deaths, and psychiatric disorders represented just over 1%. The vast majority of people had terminal cancer, and just two people had advanced dementia.

The Expertisecentrum Euthanasie (in Dutch), formerly called the End of Life Clinic, did however deal with 221 fewer requests than in the previous year, according to its annual report. The body is an option for people whose GP cannot or will not grant a request, or to support complex cases, and last year it was involved with 899 euthanasia procedures.

Agnes Wolbert, director of the NVVE organization that campaigns for the right to request euthanasia, said in a press release: ‘It is a great achievement that people can die in this way at home, and certainly isn’t self-evident when you look abroad. This is a great compliment to GP's, who carry out more than 80% of euthanasia cases themselves, and are ever more often supported by experts from the Expertisecentrum Euthanasie.’

Although euthanasia has broad public support (in Dutch) in the Netherlands, a law proposal to assist over-75s with death for no medical reason is highly controversial.


The Living Force
Archiving the latest from SOTT. The Telegraph article (Sat, 01 May 2021 20:00 UTC) mentions new steps to re-open the discussion on doctor assisted suicide in Britain.

UK Health Sec takes first steps towards legalizing assisted suicide --

Matt Hancock has opened the door to legalising assisted suicide in Britain by asking for official figures on how many people who have killed themselves for medical reasons.

The Health Secretary wrote to Sir Ian Diamond, the national statistician, last week to ask for data on how many Britons who kill themselves have terminal medical conditions.

Comment: Hancock might want to inquire about the rise in mental health issues caused by the lockdowns that he has supported: As a headmaster I see children suffering mental health issues unlike anything before, this new shutdown of schools is disastrous

Mr Hancock told a private meeting of MPs and peers that he wanted the figures to inform a new debate on legalising doctor-assisted suicide in the UK, The Telegraph can disclose.

Currently, doctors who help someone to die in the UK can be jailed for up to 14 years. This means that hundreds of Britons have had to pay thousands of pounds to travel to the Dignitas clinic in Switzerland to end their lives. In the 22 years to 2020, 475 Brits have gone to Dignitas to kill themselves.

Comment: Why is he prioritising this issue over others?



The Living Force
Source (Dutch only): Verzet tegen Spaanse euthanasiewet, maar voor Rafael is wet 'de laatste kogel'

NOS News - Foreign - yesterday, 20:01
Opposition to Spanish euthanasia law, but for Rafael, law constitutes 'the last bullet'

Rop Zoutberg - reporter Spain


Rafa Botella in his room in Valencia
- Image: Rop Zoutber

In March, a law unprecedented for Catholic Spain was passed, making euthanasia legal in the country. But its implementation is hampered by a number of states and some doctors. For them, the Netherlands is the specter of an out-of-control practice.

Spain is now the fifth country in the world with a euthanasia law, after the Netherlands, Belgium, Luxembourg and Canada. But it is not easy to put the Spanish law into practice because health care is organized by federal state. It means that in 17 states, 17 commissions will have to be set up to ensure that the euthanasia law is properly enforced.

Javier Velasco, president of the euthanasia association Dignified Dying, says that in regions where conservative parties govern, the implementation of the law will be quite inhibited. His fear is that people who want to make a request for euthanasia will soon have to travel to other parts of Spain in practice.

"There could be a back-and-forth trip by people who want to appeal to the law, a kind of euthanasia tourism," Velasco says. "That also happens with abortion. Women have to travel to other states for that, because their own region makes it difficult to implement the law."

Law resembles Dutch law

The Spanish euthanasia law, which is due to take effect at the end of June, resembles the Dutch one. The text talks about people who ask for help to end their lives because of "a serious, incurable disease, or a serious, chronic suffering that makes life impossible."

Regardless of opposition from the states, conservative organizations are still trying to have the law repealed by means of a lawsuit at the Constitutional Court. The president of the Medical College in Madrid is also concerned. The arrival of the law means, according to him, a sliding scale which will cause euthanasia to get out of hand.

For example, the practice in the Netherlands would make elderly people afraid to go to a nursing home for fear of being killed, believes doctor Manuel Martínez-Selles. "In the Netherlands and Belgium, euthanasia is performed on disabled children and elderly people with Alzheimer's," he says. According to him, professional ethics therefore forbid doctors to participate in the implementation of the law.

One person who does look forward to the introduction of the euthanasia law is Rafael Botella. He became paralyzed from his chest to his toes in a serious car accident that killed his girlfriend. For the past few years, he has been confined to bed in constant pain.

"When the time comes that I'm not happy anymore, that law is my last bullet," Botella says. "Then I want to be able to use it. With no-one to stop me. Maybe I'll never use that bullet. But I want to have that chance.

<video-clip (1:45 min) omitted>

It is expected that in Spain, a request for euthanasia will eventually be made in 1 percent of deaths. Converted, this would amount to about 4,000 requests per year.

Translated with (free version)


The Living Force
Source (Dutch only): ‘Doodswens van 75-plussers ook zeldzaam en veranderlijk’

'Death wish of over-75s also rare and changeable'

'Completed life' Researcher Els van Wijngaarden looked specifically at the group of over-75s that D66 wants to help with a completed life law. She is critical: "This is a vulnerable group of people."

Pim van den Dool - June 10, 2021 at 16:52

The group of 75-year-olds who are not seriously ill but who do have a serious wish for life termination, is very small. In addition, the death wish of these seniors is just as "changeable" as that of younger seniors, they are often less educated, and behind their death wish there is often a "complex set of problems." These are the main conclusions of new research that associate professor Els van Wijngaarden (University for Humanism) and colleagues publish this Friday in the Dutch Journal of Medicine. *

Van Wijngaarden is considered an authority in the field of what has come to be known as 'completed life'. In the Dutch House of Representatives, a bill proposed by D66 is awaiting debate, which should give elderly people who are tired of life the right to choose to terminate their lives, even if they are not suffering hopelessly. A special 'death counselor' would have to have several conversations about this and would also have to involve the family and the general practitioner. Last year, at the request of the Cabinet, Van Wijngaarden published an extensive study (in Dutch) on the problems of the end of life among people over 55. At the time, she called the term "too rosy" and "obfuscating" for the multitude of problems these people face.

'Completed life' could once again cause political tension if D66 and the Christian Union, a fierce opponent of the idea, were to renegotiate during the cabinet formation. In response to Van Wijngaarden's earlier research, former D66 MP Pia Dijkstra said in Nieuwsuur [program] that the research among people over 55 was too broad for her. "It deals with a different group to me," said Dijkstra, who included an age limit of 75 in her bill. For Van Wijngaarden, this reaction prompted her to take a closer look "at whether the death wish increases as people get older." She made a specific analysis of the group over 75 for her latest study.

15,000 persons with an active death wish

That analysis shows that of the approximately 1.4 million over-75s in the Netherlands, it is estimated that about 2 percent have a death wish for more than a year without being seriously ill: about 29,000 people. About 15,000 of those have an "active death wish," meaning that they sometimes talk about euthanasia or think about a treatment ban. Only 0.2 percent of over-75s report actually having a "wish to terminate life." The researchers do not give a precise estimate in the article, but it would be a few thousand people at maximum. Van Wijngaarden considers that to be "a very small group".

Van Wijngaarden sees no major differences with the percentages of over-55s with a death wish from her earlier research. D66 wrote in the explanatory memorandum of the bill that among people over 75 "a significant increase" of a death wish can be observed. Van Wijngaarden disputes that: the percentage of over-75s with a long-term death wish is slightly higher at 2 percent than among over-55s (1.3 percent), but according to the researcher that difference is very small. "When you say significant, you might think of a substantial increase, whereas the increase is minimal."

The character of the death wish is also often "changeable" and "ambivalent" among those over 75, says Van Wijngaarden, who encountered many older people from lower social classes struggling with issues such as loneliness and physical deterioration. "The dominant image of 'completed life' has long been that of self-confident, autonomous elderly people who want to determine their own end of life. We can strike out on this point; this group does not seem to exist as such. It is more a question of a predominantly vulnerable group of people who seem unable to cope with life and who are in a precarious situation. The problem is more multi-faceted and therefore more complex."

Should the subject come up again in the formation or later in the Lower House, Van Wijngaarden hopes that politicians will "reconsider" around 'completed life' and weigh up whether a law is the right answer. For now, it is uncertain whether a majority will support the D66 proposal. "I hope that politicians really take the insights from our studies on board and ask themselves whether such a law is desirable for this group."

Translated with (free version)

* article in Dutch behind paywall in principle but accessible for free after registration
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