Euthanasia and assisted suicide in the Netherlands

Legal framework

During the early 20th century, euthanasia became a subject of debate among European physicians, philosophers, and legal scholars. In the Netherlands, however, the practice continued to be prohibited and was widely opposed by religious and medical groups.

In 1903, the Dutch Penal Code formally outlawed both euthanasia and assisted suicide under Articles 293 and 294, with violations carrying penalties of up to 12 years in prison.

In 1936, the Voluntary Euthanasia Legalisation Society (now Dignity in Dying) was founded in the United Kingdom and became one of the earliest advocacy organisations for legal reform.

The legal debate concerning euthanasia in the Netherlands began with the "Postma case" in 1973, concerning a physician who had facilitated the death of her mother following repeated explicit requests for euthanasia. While the physician was convicted, the court's judgment set out criteria when a doctor would not be required to keep a patient alive contrary to their will. This set of criteria was formalised in the course of a number of court cases during the 1980s.

The "Postma case" was prosecuted under Article 293 of the Dutch Criminal Code, which criminalises euthanasia (intentional termination of life at the patient’s request) unless strict legal exceptions apply. Although the act remained illegal, the court’s ruling introduced the idea that a physician might avoid punishment if acting out of necessity in response to unbearable and hopeless suffering. Following the case, discussion of euthanasia expanded within both the medical profession and public sphere. The Nederlandse Vereniging voor een Vrijwillig Levenseinde (NVVE), founded in 1973 shortly after the ruling, became an important advocacy organisation promoting the right to a voluntary end of life and supporting further legal reform. Its work, alongside evolving court decisions in the 1980s, contributed to the gradual formalisation of “due care” criteria that later shaped Dutch euthanasia law.

In 1981, the Rotterdam Court case involving psychiatrist Boudewijn Chabot was an important legal development in Dutch euthanasia law. The case considered whether physician-assisted death could be justified in situations of severe psychological suffering without a terminal physical illness. Although the physician was found to have acted improperly in some respects, the ruling recognised that unbearable psychological suffering could, under strict conditions, fall within euthanasia jurisprudence.

The case helped establish early judicial criteria, including that the patient must experience unbearable suffering (and, in many cases, be terminally ill), make a voluntary and repeated request, and that the physician must consult another independent doctor. These principles influenced later Dutch euthanasia law and the interpretation of “unbearable and hopeless suffering.”

In 1984, a key legal development was the Schoonheim case, the first euthanasia case reviewed by the Dutch Supreme Court. The case involved a physician who performed euthanasia on a 95-year-old patient suffering unbearably with no hope of recovery. The Court ruled that a physician who causes death may use “force majeure” (conflict of duty) as a defence when balancing the duty to preserve life with the duty to relieve suffering. It also stated that doctors who met these conditions would not automatically be convicted. The case became an important precedent in Dutch euthanasia law and helped shape the “due care” criteria later included in the 2002 euthanasia law.

Long-term trends in euthanasia and end-of-life decision-making in the Netherlands have been documented in successive national studies. The Remmelink Report, commissioned by the Dutch government and published in 1991 under the leadership of Attorney General Jan Remmelink, was the first comprehensive nationwide study of medical end-of-life practices. It examined physician behaviour across a range of decisions, including euthanasia, physician-assisted suicide, withdrawal of treatment, and the use of high-dose analgesia with potential life-shortening effects.

The report estimated that in 1990, out of approximately 130,000 deaths in the Netherlands, around 2,300 cases involved voluntary euthanasia and approximately 400 involved physician-assisted suicide. It also identified cases in which life-ending measures were performed without an explicit request from the patient, described in the report as “termination of life without explicit request.”These findings contributed to significant public and parliamentary debate and are frequently cited in discussions of the development of Dutch euthanasia law and subsequent regulatory safeguards.

Legislation (2002 Act)

Termination of Life on Request and Assisted Suicide (Review Procedures) Act was passed in April 2001 and took effect on 1 April 2002. It legalises euthanasia and physician-assisted suicide in very specific cases, under very specific circumstances. The law was proposed by Els Borst, the D66 minister of Health. The procedures codified in the law had been a convention of the Dutch medical community for over twenty years.

The law allows medical review board to suspend prosecution of doctors who performed euthanasia when each of the following conditions are fulfilled:

• the patient's suffering is unbearable with no prospect of improvement
• the patient's request for euthanasia must be voluntary and persist over time (the request cannot be granted when under the influence of others, psychological illness or drugs)
• the patient must be fully aware of his/her condition, prospects, and options
• there must be consultation with at least one other independent doctor who needs to confirm the conditions mentioned above
• the death must be carried out in a medically appropriate fashion by the doctor or patient, and the doctor must be present
• the patient is at least 12 years old (patients between 12 and 16 years of age require the consent of their parents)

The doctor must also report the cause of death to the municipal coroner in accordance with the relevant provisions of the Burial and Cremation Act. A regional review committee assesses whether a case of termination of life on request or assisted suicide complies with the due care criteria. Depending on its findings, the case will either be closed or, if the conditions are not met, brought to the attention of the Public Prosecutor. Finally, the legislation offers an explicit recognition of the validity of a written declaration of will of the patient regarding euthanasia (a "euthanasia directive"). Such declarations can be used when a patient is in a coma or otherwise unable to state if they wish to be euthanised.

The Dutch euthanasia framework places strong emphasis on procedural due process. Physicians must follow strict reporting and consultation requirements, including obtaining an independent medical opinion and submitting each case to a regional review committee. These safeguards are intended to ensure transparency, legal accountability, and compliance with the statutory due care criteria.

Euthanasia remains a criminal offense in cases not meeting the law's specific conditions, with the exception of several situations that are not subject to the restrictions of the law at all, because they are not considered euthanasia but normal medical practice:

• stopping or not starting a medically useless (futile) treatment
• stopping or not starting a treatment at the patient's request
• speeding up death as a side-effect of treatment necessary for alleviating serious suffering

Euthanasia of children under the age of 12 remains technically illegal; however, Dr. Eduard Verhagen has documented several cases and, together with colleagues and prosecutors, has developed a protocol to be followed in those cases. Prosecutors will refrain from pressing charges if this Groningen Protocol is followed.