1. The Dutch situation
Agnes Wolbert, NVVE

2. Outlines The nature of our law General developments
Better use of the law’s potential
‘Completed life’
Dementia and advanced directives
Recent developments
Third evaluation of the law
Group of activists discovered legal lethal powder
First prosecution in 15 years?

3. 1. The nature of our law Aimed at physicians Permission to help
No right to die
(The official name: Dutch law on Termination of life on request and assisted suicide)
The law formalized a practice in which physicians decided to use their discretion to end the suffering of their patients.
The goal of the law was to make this process transparant, to allow for oversight, and to prevent abuse.
Therefore, the Dutch law is in the first place designed to protect physicians from prosecution if they abide by the legal standards and procedures. Although the law does strengthen the position of the patiënt, this is not its primary goal. This also means that there is no right to die for patients and no right to self-determination. This in contrary to some other countries in which laws are being made now…

4. The requirements of due care mean that the physician:
holds the conviction that the request by the patient was voluntary and well-considered, 
holds the conviction that the patient's suffering was lasting and unbearable, 
has informed the patient about the situation he was in and about his prospects, 
and the patient hold the conviction that there was no other reasonable solution for the situation he was in, 
has consulted at least one other, independent physician who has seen the patient and has given his written opinion on the requirements of due care, referred to in parts a - d, and 
has terminated a life or assisted in a suicide with due care.
These are the so called due-care-criteria. I will not go deep into this.

5. 2. General developments Better use of the law’s potential
End of life clinic
Completed life
Commission ‘of the wise’
Politics
Dementia and advanced directives
In 2012 the NVVE founded the end of life clinic. This is not a real clinic, but only the name of a group of physicians and nurses who work in ‘ambulant teams’. These teams provide euthanasia when the general practicioner of the patient is not willing or capable to do so. These teams have no special rights; they are bound by the same rules as any other physician, which means the conditions as formulated in the Dutch euthanasialaw. The great advantage of these teams is that they have more knowledge and experience about euthanasia, compared to an average general practicioner. Therefore they are better equipped to act in difficult cases. Think of: euthanasia for people with psychiatric disorders, with dementia, or with a combination of small medical disorders (instead of one life-threatening disease like cancer). In the last years, the number of complex cases in which euthanasia is provided, has increased significantly. (According to some, this is not a good development. This might be one of the reasons why more critical reflection is heard in the public debate now.)
For some time, not only people who suffer from a severe medical disease ask for ‘a good death’, but also older people who suffer from life itself. They feel like their life is over, ‘completed’ and like death is forgetting them. Since there is a strong feeling in society that one person should have the right to decide about own life, the question arises why these old people cannot organise their own death in a good way. This means: with lethal medication (instead of throwing theirselves from buildings etc), and maybe with help from others, when they are too old to do it theirselves. This question is on the political agenda for some time:
In juli 2014 the government asked a commission of wise men (and women) to give advice on this topic, and to research some possible solutions.
In januari 2016 this commission came with its conclusion: ‘All the solutions have big disadvantages so better not doing it. Moreover: there is already space in the existing law for old people with several small medical problems, so why not use that space? We don’t think that there are many old people who suffer life, and who cannot rely on the law.’ The reactions on this advice were not so good: ‘If there was no problem, why would the commission be asked for a solution?’
In oktober 2016 the government came with its reaction: there should come a new law, especially meant to solve this problem
In december 2016 the progressive party D66 (also a strong power behind the euthanasialaw) came with a initiative bill, presented first to the people, not yet brought in in the parliamental debate
In 2017 national elections were held and now the formation is just ready. In the cabinet will be D66, but also two religious parties. The expectation is that this topic will be abandoned in the following years….. Misschien nog wat quotes uit het regeerakkoord over dit onderwerp.
Everyday more people suffer from dementia and that number will only increase the following years. People see the disease in their family and decide they dont want this for themselves. The NVVE sees (is dat zo?) more and more advanced directives in which people say they want euthanasia when they suffer from dementia. The law provides this possibility even when a person is not able to declare or explain its wish again: the advanced directive counts as a voluntary and well-considered request, which comes in place for the oral request at the moment itself. However, in practice this is difficult to do for physicians, they strongly prefer to hear a confirmation of the request before they will provide it. This problem is still discussed, and will never be fully answered. The NVVE stands for the possibilities the advanced directives give, and strives for more adaption of it by physicians.

6. First: some numbers KNMG, ‘Euthanasie in cijfers’
This picture gives a good view of the Dutch practice through the years.

7. 3. Recent developments Third evaluation
Group of autonomy fighters discovered lethal powder
First prosecution in 15 years?
New cabinet
Every five years the law is evaluated. The third evaluation was published last May. The main conclusions are:
The number of cases in which euthanasia is applied, has increased.
The number of cases in which euthanasia in cases of dementia is applied, has increased: (20……  2016: 141 cases, 48 bij slk, 3 bij 5 over 12)
The number of cases in which palliative sedation is applied has increased, more than euthanasia
The review system functions well. Some developments: evaluation of the review committees, standardization by a Code of practice
In 2013 a few NVVE members who are passionate about individual autonomy, founded the organisation “Cooperation Last Will”. The goal of this organisation is to provide individuals above the age of 18, with a possibility to end their own life, without the help of others.
In 2017 they discovered that a certain product, used in labs, would cause death, without severe pain or suffering.
At the 1st septembre of this year, the national television brought this news, which ofcourse lead to questions in parliament, and a lot of media attention.
Some weeks ago we heard that the Public Prosecution decided to look into the matter of a euthanasia case that was applied in 2016.
The review committees had labeled this case as ‘not according to the due care criteria’, and it was (amongst others) the criterium of a voluntary well-considered request that was not met. The reason for this thought lied in the fact that the advanced directive was not clear. The lady had written that she wanted euthanasia by the time that she decided the moment was there. By the time the euthanasia was applied, she was incompetent to found and declare her will. The physician did not know if this was ‘the moment’ she meant. Now the Public Prosecution is looking into the matter, what often results in a prosecution. That would be the first time in 15 years.
This week the four political parties which were negotiating a government agreement for the next 4 years, accomplished this job. That means that the next years we are governed by two parties whose base lies in Christianity. We will see if any further developments can be made in the field of self-determination at the end of life.