Table 2

Procedural due care criteria cases

Case IDCriteria not metPatient characteristicsJudgement summary
2012-30ConsultationA woman, 80–89 years old, with Parkinson’s disease, stroke, dysarthria and incontinenceGP 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.
2012-31ConsultationA woman, 80–89 years old, with rapidly progressing Alzheimer’s disease, pain and vision problemsGP 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.
2012-32ConsultationA woman, 60–70 years old, with rapidly progressing lung cancerSCEN 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.
2012-38Medical careA man, 60–70 years old, with oesophageal cancerPhysician 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.
2012-39Medical careA woman, 60–70 years old, with breast cancerPhysician 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.
2012-40Medical careA man, 60–69 years old, with recent metastatic vertebral cancer, with paraplegiaPhysician administered the barbiturate and the paralytic agent at the same time, rather than inducing the coma first.
2013-103ConsultationA woman, 60–70 years old, with gastric cancerConsultant was a direct colleague of the EAS physician.
2013-104ConsultationA woman, 80–90 years old, with liver cancerSCEN consultant and the physician were in the same partnership.
2013-106ConsultationA man, 80–90 years old, with COPD, heart failure, renal insufficiency, osteoarthritis, diabetes and depression from wife’s deathConsultant 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.
2013-107Medical careA man, 70–80 years old, with mesotheliomaPhysician used a benzodiazepine as a coma inducer instead of thiopental.
2014-04Medical careA woman, 70–80 years old, with metastatic lung cancerPatient 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.
2015-28Medical careA man, 80–90 years old, with metastatic cancerPhysician used a low dose of the coma inducer and did not perform a coma check.
2015-29Medical careA woman, 40–50 years old, with leukaemiaPhysician used a low dose of the coma inducer and did not perform a coma check.
2015-81Medical careA man, 70–80 years old, with multiple myelomaPatient 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.
2016-23Medical careA man, 80–90 years old, with Alzheimer’s diseaseThe physician used a phenobarbital beverage instead of pentobarbital and at too low a dose; thus, had to be followed with intravenous EAS.
2016-24Medical careA 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.
2016-37Medical careA man, 60–70 years old, with lung cancerPhysician used a low dose of the coma inducer and did not perform a coma check.
2016-45ConsultationA man, 70–80 years old, with sigmoid cancerConsultant was a subordinate of the physician in the same department.
2016-53ConsultationA man, 60–70 years old, with metastatic lung cancerThe SCEN consultant was contacted through the standard procedure but turned out to be in the same partnership as the physician.
2016-57Medical careA woman, 60–70 years old, with lung cancerPhysician used a low dose of the coma inducer and did not perform a coma check.
2016-86ConsultationA man, 90–100 years old, with prostate cancer, osteoarthritis and frequent urinary tract infectionsPhysician 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.
2016-87Medical careA man, 80–90 years old, with prostate cancer and canal stenosisThe 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.