Where psychiatric euthanasia is definitely an option

Unlike in most other jurisdictions where medically facilitated deaths are legal, the euthanasia law in the Netherlands has no requirement that a patient be close to death. The law’s directives are few and broadly drawn. Aside from obtaining formal consent—a patient’s request must be “informed” and “voluntary and well considered”—the doctor must be “satisfied” that two conditions are met: The patient has “unbearable suffering, without prospect of improvement,” and there is “no reasonable alternative” to address it. The doctor must use the euthanasia medications properly, and she must consult an independent physician—though she is not bound by this outside consultant’s opinion. Indeed, as long as the patient is at least 16, no other person’s consent except the patient’s is mandatory. (Parents of 16- and 17-year-olds are involved in the discussion, but their permission is not required. Patients as young as 12 can seek euthanasia with parental consent. In about 10 cases since 2002, children ages 12 to 17 have received euthanasia; as far as I know, all were for physical illnesses.)

After the patient’s death, the doctors involved submit written reports, which are reviewed by one of five regional review committees consisting of a physician, a lawyer, and a bioethicist. These positions are not full-time jobs, but the five committees handle more than 6,500 cases a year. (In the United States, the per-capita equivalent would be 126,000.) Needless to say, the single physician on each committee cannot be a specialist on every disorder at issue. Over the years, only 0.18 percent of cases have been classified as “due care not met.” The doctor is virtually always right when it comes to euthanasia. Only one doctor has ever been prosecuted for violating the 2002 law.

Until about 2010, the controversial practice of psychiatric euthanasia was rare, despite being permitted since mid-1990s. Most Dutch psychiatrists—like most other doctors and the Dutch public—disapprove of psychiatric euthanasia. Still, there has been a steady increase, with 83 cases in 2017; the per-capita equivalent in the United States would be about 1,600 cases per year.