Legal background, incidence and regulation of assisted dying the Netherlands

• Voluntary active euthanasia and PAS have been openly practised and, in effect, legal since the 1980s under guidelines developed in the courts and by the Royal Dutch Medical Association. According to an exception in the criminal code enacted in 2002, physicians who perform euthanasia or provide assistance in suicide commit no offence if they follow the guidelines for "due care".

• The guidelines require that:

• The patient must make a voluntary, informed and well-considered request.
• The patient must be facing unbearable and hopeless suffering, either currently or in the immediate future and with no outlook for improvement.
• The physician must agree with the patient that no reasonable alternative treatment that might reduce the suffering is available.
• The physician must consult with another, independent physician.
• The action must be performed with due care.
• The action must be reported to the appropriate authorities.
• Since 1998, five regional committees appointed by the Ministry of Justice review all reported cases. If they decide that the physician's behaviour met the requirements of due care, their decision is final.

Dutch law does not require that the patient be terminally ill but does require that the patient be facing "unbearable and hopeless suffering". Advance directives requesting euthanasia in the event that the patient becomes comatose or demented are also legal. Both before and after statutory legalization in the 2002 law, a physician has been protected from prosecution if the guidelines are met.

Legal background, incidence and regulation of assisted dying in Oregon

• The Oregon Death with Dignity Act was passed as a ballot initiative in 1994; implementation was delayed by a legal injunction and the measure was returned to the ballot by the legislature and passed again in 1997; the Act became law on October 27 of that year. A federal challenge to the ODDA was rejected by the US Supreme Court in 2006. Oregon is the only US state to legalize PAS (now referred to as utilisation of the ODDA). Euthanasia remains illegal.
• A total of 292 people have died under the ODDA in the 9 years since its enactment; this is approximately 0.15% of people who have died during this period.
• The Act allows terminally ill Oregon residents to obtain from their physicians a prescription for lethal medication for the purpose of ending their lives if the following conditions are met:
• The patient must be adult (18 years of age or' older) and a resident of Oregon.
• The patient must be capable (defined as able to make and communicate healthcare decisions).
• The prescribing physician and a consulting physician must confirm the diagnosis and prognosis.
• The patient must be diagnosed by two physicians as having a terminal illness (defined as 6 months or less to live).
• The patient must make two oral requests to his or her physician, separated by at least 15 days, and one witnessed written request.
• If either physician believes the patient's decision may be influenced by a mental disorder, the patient must be referred for a mental health evaluation.
• The patient must be informed by the prescribing physician of feasible alternatives, including comfort care, hospice care and pain control.
• The prescribing physician must request, but may not require, the patient to notify his or her next of kin of the request.
• The physician must report the prescription for lethal medication to the Oregon Department of Human Services (formerly the Oregon Health Division); and the Department must make available an annual statistical report of information collected under the Act.
• Pharmacies are required to report filling such prescriptions.
• Oregon's statute requires terminal illness but makes no reference to the patient's pain, symptoms or suffering. It does not indicate whether the prescribing physician must, may or may not be present at the patient's death. It stipulates that ending one's life under the Death with Dignity Act does not constitute suicide.

OREGON AND THE DEATH WITH DIGNITY ACT

• Who qualifies:
  • An adult, 18 years of age or older
  • A resident of Oregon—able to make and communicate health care decisions
  • Diagnosed with a terminal illness that will lead to death within six months
• The people who have used the Oregon law since 1997:
  • 292 people -- 157 men, 135 women
  • 97% white, 2% Asian
  • 46% married, 22% widowed, 25% divorced
  • 41% university degree or higher
  • 81% cancer, 8% amyotrophic lateral sclerosis
  • 87% feared losing autonomy and being less able to engage in activities making life enjoyable
  • 80% feared loss of dignity
  • 57% feared loss of bodily functions
  • 38% feared being a burden on family, friends and caregivers
  • 26% feared inadequate pain control or concern about it
  • 94% died at home, one person awakened after taking medication
  • Five minutes between ingestion and unconsciousness (median time), 25 minutes between ingestion and death (median time)
• To obtain a prescription for lethal medication:
  • The patient must make two verbal requests to his or her physician, separated by at least 15 days
  • The patient must give a written request to her doctor, signed in the presence of two witnesses
  • The prescribing physician and one consulting physician must confirm the diagnosis, prognosis and if the patient is competent
  • If either physicians believes the patient has a psychiatric or psychological disorder, the patient is referred for a psychological examination by law
• The drugs:
  • 47% take Secobarbital
  • 52% take Pentobarbital

Source: Oregon Department of Human Services. 6 November 2007