Dutch politicians are under pressure to hold “time to die” debate

The Dutch parliament is under mounting pressure to debate legalising assisted suicide for older people who are not dying but feel their life is over. A campaign by a group of prominent senior figures in Dutch society has raised 85 000 signatures in ten days—exceeding the 40 000 needed to trigger a parliamentary debate under a “citizens’ initiative” law.

The group, called Of One’s Own Free Will (Uit Vrije Wil), seeks to “legalise help with dying for older people who regard their life as complete, at their explicit request and under conditions of carefulness and verifiability.” The group includes former health minister Hedy d’Ancona, former European commissioner Frits Bolkestein, and professor in neurobiology at Amsterdam University, Dick Swaab (www.uitvrijewil.nu).

A “complete” life, it suggests, could be one in which physical decline has resulted in inescapable loss of personal dignity or one of complete dependence on others. But the Dutch Medical Association rejects the initiative claiming it meddles with careful legislation and practice surrounding euthanasia and assisted suicide.

Discussion in the Netherlands on a “suicide pill” for older people dates back to 1991 and a newspaper article by former Supreme Court judge, Huib Drion (BMJ 2004;328:1204).

Recent jurisprudence has stated that it is illegal to actively guide or direct a person to commit suicide. An exception is made for doctors who assist suicide under euthanasia laws. But a Supreme Court judgment in 2002 ruled that the patient must have a medically classifiable condition. Existential suffering is excluded.

The Free Will group argues its proposal is based on a fundamental principle of “self determination” that is “rooted in Dutch culture.” Any decision must not be impulsive but taken freely by a competent person, be well considered, authentic, consistent, and understandable. The law would be restricted to helping Dutch nationals older than 70 years.

Help would be offered by trained “care providers,” who would ensure that the suicide adheres to legal criteria and is carried out with expertise, care, and is verifiable. An independent second opinion would be needed, and the carer would ensure the drugs are taken and then report to a coroner.

Although a professional carer is needed to obtain the prescription drugs required, this could be a spiritual figure, psychologist, or palliative care nurse. “Helping elderly people die who are not terminally ill falls outside the professional domain of a doctor,” the group state.

The Dutch Medical Association fears that the initiative creates a second way to ending life. Patients judged not to meet the legal requirements for euthanasia or assisted suicide will simply by-pass their doctor. The Association’s policy director Dr Lode Wigersma warned: “Once it is legally permissible then you open the possibility of taking this alternative route to ending life and the whole careful construction of euthanasia practice as now established could be undermined.”

The initiative coincides with a campaign by the Dutch Right to Die Society (NVVL) for a humane alternative for existential suffering among the elderly. It claims at least 400 people aged over 60 years commit suicide each year.