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Euthanasia and physician-assisted suicide not meeting due care criteria in the Netherlands: a qualitative review of review committee judgements
  1. David Gibbes Miller,
  2. Scott Y H Kim
  1. Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
  1. Correspondence to Dr Scott Y H Kim;{at}


Objectives To assess how Dutch regional euthanasia review committees (RTE) apply the euthanasia and physician-assisted suicide (EAS) due care criteria in cases where the criteria are judged not to have been met (‘due care not met’ (DCNM)) and to evaluate how the criteria function to set limits in Dutch EAS practice.

Design A qualitative review using directed content analysis of DCNM cases in the Netherlands from 2012 to 2016 published on the RTE website ( as of 31 January 2017.

Results Of 33 DCNM cases identified (occurring 2012–2016), 32 cases (97%) were published online and included in the analysis. 22 cases (69%) violated only procedural criteria, relating to improper medication administration or inadequate physician consultation. 10 cases (31%) failed to meet substantive criteria, with the most common violation involving the no reasonable alternative (to EAS) criterion (seven cases). Most substantive cases involved controversial elements, such as EAS for psychiatric disorders or ‘tired of life’, in incapacitated patients or by physicians from advocacy organisations. Even in substantive criteria cases, the RTE’s focus was procedural. The cases were more about unorthodox, unprofessional or overconfident physician behaviours and not whether patients should have received EAS. However, in some cases, physicians knowingly pushed the limits of EAS law. Physicians from euthanasia advocacy organisations were over-represented in substantive criteria cases. Trained EAS consultants tended to agree with or facilitate EAS in DCNM cases. Physicians and families had difficulty applying ambiguous advance directives of incapacitated patients.

Conclusion As a retrospective review of physician self-reported data, the Dutch RTEs do not focus on whether patients should have received EAS, but instead primarily gauge whether doctors conducted EAS in a thorough, professional manner. To what extent this constitutes enforcement of strict safeguards, especially when cases contain controversial features, is not clear.

  • euthanasia
  • assisted suicide
  • netherlands
  • health policy
  • palliative care
  • review committees

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  • Contributors DGM and SYHK made substantial contributions to the design of the work and the acquisition, analysis and interpretation of data; drafting the work or revising it critically for important intellectual content; and final approval of the version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This research was supported in part by the Intramural Research Program of the National Institutes of Health Clinical Center. The study sponsor played no role in the conduct of this study. This research was conducted independently from the funders.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data analysed are currently publicly available.

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