Netherlands Euthanasia Cases Examined by Board of Procurators General Since 2016

By Richard Egan (researcher with the Australian Care Alliance)

Twenty three cases of failure by physicians to comply with all the requirements of the Netherlands euthanasia law referred by the Euthanasia Review Committees to the Board of Procurators General since 2016 have been considered with the following results: 

• four cases are still subject to criminal investigation; 
• five have resulted in a physician being placed on one year probation with the possibility of prosecution if there is a further breach of the law, and 
• the remaining fourteen cases have been unconditionally dismissed. 

Criminal investigation

On 28 September 2017 it was announced that the Chief Public Prosecutor of the Public Prosecution Service in The Hague would lead a criminal investigation into a suspect who was acting as a physician when she carried out euthanasia on a 74-year old severely demented and incapacitated woman in the spring of 2016.

The woman had had a will drawn up some years ago before her admittance to the nursing home, but it was ambiguous and contradictory. Furthermore, in the opinion of the Review Committees the physician crossed a line in carrying out the euthanasia - physically restraining her when she resisted being given a lethal injection!

On 8 Mar 2018 it was announced that a further four cases were now under criminal investigation.

Two cases to be investigated by a prosecutor in Noord-Holland involve the same physician. The first investigation revolves around the death in May 2017 of a 67-year-old female, who lacked the capacity to express her own will and suffering from Alzheimer. The review committee found that the physician, at the time the life of the woman was terminated, was not able to ascertain if it was a voluntary and deliberate request for euthanasia because the living will had been drafted years before and had not been reconfirmed since. Furthermore the physician failed to substantiate why the suffering of the woman was unbearable.

The second investigation is about the termination of the life of an 84-year-old woman in June 2017. The woman regarded her life as hopeless because of several physical illnesses. The review committee considered, inter alia, that the physician could not have arrived at the conviction that other solutions to eliminate the suffering were lacking and that the suffering therefore was hopeless.

A prosecutor of the Prosecution Service in The Hague has instituted an investigation into the death of an 84-year-old woman in February 2017. Her freedom of movement had been very much restricted by pulmonary emphysema. The woman had a euthanasia statement and had clearly expressed that she no longer wanted to live. She refused to undergo any further examinations or treatments. One of the conclusions of the review committee was that the physician concluded to easily that the suffering of his patient was hopeless

Nineteen other cases finalised: Most (14) unconditionally dismissed

The details of and findings on a further 19 cases referred by the Review Committees to the Board of Procurators General are available (in Dutch only).

Botched execution of assisted suicide and euthanasia

• Doctor ordered the wrong drug for an assisted suicide – patient woke up after an hour. Euthanasia then performed. (One year probation) 
• After an assisted suicide failed and the doctor had failed to follow the required precaution of previously inserting an intravenous cannula, the doctor administered the euthanatics intramuscularly. This is in violation of the guidelines as this route could be both painful and ineffective. (Dismissed unconditionally) 
• Doctor used a lower than recommended dose of sedative, failed to do a complete coma check and administered the muscle relaxant while the patient still had a clear heartbeat. (Dismissed unconditionally) 
• Before administering a barbiturate drink for assisted suicide the doctor intended to flush the infusion needle with saline but mistakenly used the muscle relaxant instead causing the possibly painful death of the patient. (Dismissed unconditionally) 
• After the inserted infusion needle ruptured the vein of the patient, the doctor served the remaining amount of the 2000 mg sedative intramuscularly, after which he administered the patient an intracardiac injection with 150 mg muscle relaxant. The doctor has taken a great risk of possible complications and pain in the patient. (One year probation) 
• After an assisted suicide failed the doctor injected the muscle relaxant without doing a full coma check. (Dismissed unconditionally) 
• Doctor injected the muscle relaxant while the patient was clearly not in a sufficiently deep coma. (Dismissed unconditionally) 
• The first two attempts at performing euthanasia on the patient failed before the doctor realised that the intravenous cannula was not properly placed and the sedative and muscle relaxant would have only been delivered subcutaneously not intravenously. In both attempts the muscle relaxant was delivered while the patient was not in a complete coma. A third attempt succeeded after the placement of a new intravenous cannula. (One year probation)

Leaving the patient after a failed attempt to get euthanatics

• Doctor failed to take back up set of euthanatics (She never had before either). When the first attempt failed she had to leave the patient to get the second set. (Dismissed unconditionally) 
• Doctor failed to bring a reserve set of euthanatics as the package was too big for his case! After the first set failed he had to leave the patient to get a second set. He also neglected to give a pain killer before inducing coma. (Dismissed unconditionally) 
• Doctor failed to bring a second set of euthanatics and left the patient to get one when the first dose of sedative failed to produce a coma. (Dismissed unconditionally) 

Eligibility criteria not met

• End of Life clinic doctor went ahead despite views of patient’s neurologist and psychiatrist that further treatment options were available for a man with mild Parkinson’s and treatable anxiety and mood disorder (One year probation) 
• End of Life clinic doctor failed to get a proper psychiatric consultation before performing euthanasia on a48 year old man with depression, anxiety attacks and paranoid delusions. (Dismissed unconditionally) 
• In an Alzheimer’s case the doctor failed to get a consultant’s opinion and instead relied on a report from an earlier treating doctor. (One year probation) 

Independence of consultant

• Three cases involved a concern from the Review Committees that the consultant used by the doctor was not independent, being a doctor in the same practice. These cases were all dismissed unconditionally as the Board concluded that “Guidelines about independence of the consulting doctor are not sufficiently clear”. The new 2018 Code states explicitly that the consultant can’t work in the same practice as the doctor. 
• Doctor inserted an intravenous cannula before the consultant arrived to assess the case. This could have put improper pressure on the consultant in making an assessment. (Dismissed unconditionally). 

Valid request

• Patient was in and out of a coma after a cerebral haemorrhage. There had been an earlier request for euthanasia but the Review Committees found that alleged confirmation of the request by hand squeezes and nods was insufficient to establish a valid request. Also it was not possible to establish that the patient had unbearable suffering as she was mostly in a coma. (Dismissed unconditionally)