Procedural due care criteria cases
| Case ID | Criteria not met | Patient characteristics | Judgement summary |
| 2012-30 | Consultation | A woman, 80–89 years old, with Parkinson’s disease, stroke, dysarthria and incontinence | GP did not find patient to meet unbearable suffering criterion. Patient turned to Foundation for Voluntary Life (SVL); consultant, also from SVL, was already involved in the case (previously reviewed patient’s file and discussed it with the physician), thus was not independent. Consultant also avoided the patient’s GP. |
| 2012-31 | Consultation | A woman, 80–89 years old, with rapidly progressing Alzheimer’s disease, pain and vision problems | GP conscientiously objected. EAS-providing physician inexperienced with EAS referred patient to an experienced SCEN consultant. Physician only evaluated the clinical status of patient, relied on consultant’s EAS judgement. Consultant guided physician through EAS and was present for physician exam of patient and during EAS implementation. RTE judged the consultant took over part of the physician’s role. |
| 2012-32 | Consultation | A woman, 60–70 years old, with rapidly progressing lung cancer | SCEN consultant and EAS physician in same practice. SCEN doctor did not find unbearable suffering and suggested another consultation, but the physician performed EAS to the SCEN consultant’s surprise. |
| 2012-38 | Medical care | A man, 60–70 years old, with oesophageal cancer | Physician used medications not permitted by the RTE for EAS. He had done this before in 2008 and had agreed to use the standard EAS drugs. |
| 2012-39 | Medical care | A woman, 60–70 years old, with breast cancer | Physician used less than half of the recommended dose of the coma-inducing agent and has a previous case in which he made the same error. |
| 2012-40 | Medical care | A man, 60–69 years old, with recent metastatic vertebral cancer, with paraplegia | Physician administered the barbiturate and the paralytic agent at the same time, rather than inducing the coma first. |
| 2013-103 | Consultation | A woman, 60–70 years old, with gastric cancer | Consultant was a direct colleague of the EAS physician. |
| 2013-104 | Consultation | A woman, 80–90 years old, with liver cancer | SCEN consultant and the physician were in the same partnership. |
| 2013-106 | Consultation | A man, 80–90 years old, with COPD, heart failure, renal insufficiency, osteoarthritis, diabetes and depression from wife’s death | Consultant found DCNM because the patient was grieving. A psychiatrist then found the patient depressed but competent. The consultation criterion was not met because of the long delay between the first consultation and the EAS. |
| 2013-107 | Medical care | A man, 70–80 years old, with mesothelioma | Physician used a benzodiazepine as a coma inducer instead of thiopental. |
| 2014-04 | Medical care | A woman, 70–80 years old, with metastatic lung cancer | Patient did not die after the physician administered the first set of EAS drugs and had to order another set from a pharmacist, which took 2 hours to arrive. |
| 2015-28 | Medical care | A man, 80–90 years old, with metastatic cancer | Physician used a low dose of the coma inducer and did not perform a coma check. |
| 2015-29 | Medical care | A woman, 40–50 years old, with leukaemia | Physician used a low dose of the coma inducer and did not perform a coma check. |
| 2015-81 | Medical care | A man, 70–80 years old, with multiple myeloma | Patient did not die after administration of meds, and physician left the patient to obtain backup meds, then administered the neuromuscular blocker without a second coma inducer, despite evidence that the patient was not in a full coma. |
| 2016-23 | Medical care | A man, 80–90 years old, with Alzheimer’s disease | The physician used a phenobarbital beverage instead of pentobarbital and at too low a dose; thus, had to be followed with intravenous EAS. |
| 2016-24 | Medical care | A man, 60–70 years old, with a distant stroke and a recent stroke, leaving him bedridden. | Physician injected a low dose intramuscularly (not intravenously, as required), because he did not want family to be uncomfortable at the sight of blood or an intravenous line. |
| 2016-37 | Medical care | A man, 60–70 years old, with lung cancer | Physician used a low dose of the coma inducer and did not perform a coma check. |
| 2016-45 | Consultation | A man, 70–80 years old, with sigmoid cancer | Consultant was a subordinate of the physician in the same department. |
| 2016-53 | Consultation | A man, 60–70 years old, with metastatic lung cancer | The SCEN consultant was contacted through the standard procedure but turned out to be in the same partnership as the physician. |
| 2016-57 | Medical care | A woman, 60–70 years old, with lung cancer | Physician used a low dose of the coma inducer and did not perform a coma check. |
| 2016-86 | Consultation | A man, 90–100 years old, with prostate cancer, osteoarthritis and frequent urinary tract infections | Physician told consultant that he intended to perform EAS even if the consultant found DCNM. Placed intravenous before the consultation, may have pressured consultant to find the criteria met. RTE judged that the consultation was not taken seriously. |
| 2016-87 | Medical care | A man, 80–90 years old, with prostate cancer and canal stenosis | The physician mixed up syringes and injected the neuromuscular blocker before the coma inducer. |
SCEN consultants were trained by the Support and Consultation on Euthanasia in the Netherlands (SCEN) organisation (see box 1).
COPD, chronic obstructive pulmonary disease; DCNM, due care not met; EAS, euthanasia and physician-assisted suicide; GP, general practitioner; RTE, regional euthanasia review committees.