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If a patient suffers unbearably and when there is no prospect of improvement, some regard the termination of life of the patient as the only option to end the unendurable suffering as quickly as possible.

The Merriam Webster dictionary defines euthanasia as: "the act or practice of killing or permitting the death of hopelessly sick or injured individuals (as persons or domestic animals) in a relatively painless way for reasons of mercy" [1]. In case of euthanasia, the death of the patient is caused by a third party. Self-assisted suicide on the other hand is not caused by a third party, but by the patient him or herself after he or she has been provided with the lethal means to commit suicide.

Euthanasia is a highly debated subject. In most countries it is a punishable offence. Euthanasia can be volunary or non-voluntary. In case of voluntary euthanasia a patient asks a physician to practice euthanasia in order to end his or her life to stop the unbearable suffering. When a patient cannot decide for him or herself, or cannot make his or her wishes known to other people (such as is the case when a person is in coma, or a young child, senile, mentally disturbed, severely brain damaged or severely mentally retarded), euthanasia performed on such a person is considered non-voluntary [2]. Euthanasia is considered involuntary when a patient is against the practice of euthanasia on his or her behalf. [3]

Euthanasia is considered passive when common treatments necessary for the continuance of life are witheld from the patient. In case of active euthanasia, lethal substances or means are used by a physician to end the life of a patient. [4]

In most countries the practice of euthanasia is illegal. Only in Washington (USA), Oregon (USA), Monatana (USA), The Netherlands, Belgium and Luxemburg, there are laws which permit the practice of euthanasia and assisted suicide under certain circumstances and when specific guidelines are followed. [5]

The Netherlands is the first country to legalise the practice of euthanasia. Since 2002 the Dutch Criminal Code of The Netherlands includes grounds for immunity from criminal liability. However, there are strict boundaries. The law on euthanasia is incorporated in Article 293 and inArticle 294 of the Ducth Penal Code. Article 294 describes the sanctions for the violation of the criminal law as specified in article 293.

In article 293 reference is made to Article 2 of the Termination of Life on Request and Assisted Suicide Act (Euthanasia Act) In article 2 the due care conditions are given for a performance of euthanasia or assisted suicide permitted by Dutch law [6]:

- The patient suffers unbearably and there is no prospect of improvement.
- The patient's request for euthanasia is voluntary and persists over time. When the patient's request for euthanasia has been made under the influence of others, a psychological illness or drugs, the request can however not be granted.
- The patient has to be fully aware of his or her condition, prospects and options.
- At least one or more independent doctors need to be consulted to consider the possibility of euthanasia. The physician needs to give a written opinion in which he confirms the above mentioned due care conditions.
- The euthanasia performed by the doctor or the assisted suicide by the patient itself needs to be carried out with due medical care and attention. The doctor needs to be present when assisted suicide is performed.
- The patient must be at least 12 years old. Patients between 12 and 16 years old need the consent of their parents when they request euthanasia on their behalf.

Dutch physicians who terminate a life at the request of a patient are not punishable when they act in accordance with the Dutch Criminal Code and the procedures of the euthanasia review committee. [7] A physician who practiced euthanasia has to report the death by non-natural causes to the regional euthanasia review committee. [8].

According to section 2 of Article 293 of the Dutch Penal Code, it is not punishable for a physician to end a life at the explicit request of a patient when he follows the procedure provided by the law and he complies with the due care criteria for euthanasia. Patient and doctor must discuss any alternative treatment. The patient has to suffer unbearably without a prospect of improvement. As long as there are alternative treatments available, there is prospect of improvement. [9] Article 294 of the Ducth Penal Code describes the sanctions for the violation of the criminal law as specified in article 293.

The Dutch Ministry of Security and Justice does not allow people from other countries to come to The Netherlands in order to seek termination of life or assisted suicide because the Dutch legislation permits these actions under certain cicumstances. [10]

In February 2010, a group of Dutch academics and politicians which calls itself 'Out of Free Will' launched a petition in support of assisted suicide or euthanasia for Dutch citizens over 70 who feel tired of life. This petition supports modification of the Euthanasia Act in order to legalise euthanasia and assisted suicide when an elderly person above 70 years of age is tired of life even if the due care criteria of the absence of the prospect of improvement and unbearable suffering are not be met. Such a modification of the Euthanasia act would imply that persons above 70 years of age should have the right to professional medical help to have their lives terminated when they feel tired of life. [11] So far the Dutch Euthanasia Act has not been modified yet.

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[1] As quoted from The Merriam-Webster Dictionary.
[2] As quoted from What is non-voluntary euthanasia? ,
[3] As quoted from EuthanasiaWikipedia
[4] Ibid.
[5] See Euthanasia and Assisted Suicide: Frequently Asked Questions, International Task Force on Euthanasia and Assisted Suicide
[6] As quoted from Article 2 of the Termination of Life on Request and Assisted Suicide Act (Euthanasia Act), For an English version, see for example, Termination of Life on Request and Assisted Suicide (Review Procedures) Act, Right to Die (NVVE)
[7]See Euthanasia, Rijksoverheid
[8] Ibid.
[9] See, for example, FAQ – Euthanasia in the Netherlands, Radio Netherlands Worldwide
[10] See Page nine of the brochure of the Dutch Ministry of Welfare and Sport about the Euthanasia Act of 2002.
[11] See Ruim 40.000 mensen steunen hulp zelfdoding , NRC Handelsblad

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