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Turning Points in the Conception and Regulation of Physician-Assisted Dying in the Netherlands

June 18, 2016
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Countries including the United States and Canada stand at a turning point, which manifests as spreading support and legalization of physician- assisted dying. The Netherlands, with its pioneering experiences of physician-assisted dying to which reference is often made, has gone through developments with more than one turning point. Firstly, physician-assisted dying attracted public attention and aspiration in the 70s. Secondly, physician-assisted dying became defined, its legislation initiated, and its practice tolerated around 1985. The tolerated practice of physician- assisted dying was provisionally formalized in 1994 and formally legalized in 2001. Regional Review Committees (RRCs) largely took over the controlling role of the Public Prosecutor and gained a leading role in the regulation of physician-assisted dying. Hereafter, the number of reported cases has risen to 3.8% of all deaths, but only 0.2% of the cases have been disapproved by the RRCs and none have led to legal prosecution. Thirdly, the justification of physician-assisted dying in the political and public debate has shifted from an appeal to a physician’s conflict of duties towards an appeal to a patient’s autonomy. Fourthly, in line with the increasingly valued autonomy of patients, cognitive and psychiatric disorders are increasingly regarded, also by the RRCs, as valid reasons for physician-assisted dying. Physician-assisted dying for those who are ‘weary of life’ or ‘tired of life’ is currently under discussion. Fifthly, the establishment of the End-of-Life Clinic in 2012, operating traveling teams for the provision of physician-assisted dying without means of palliative care, has uncoupled physician-assisted dying from the usual longstanding relationship between a physician and a patient. In conclusion, the long history in the Netherlands of tolerating and regulating physician-assisted dying has facilitated a normalization and expansion of its practice. By describing and clarifying the developments and their origins, we aim to inform other countries that are currently making decisions at earlier turning points.

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