Exercising due medical care
The physician must have exercised due medical care and attention in terminating the patient’s life or assisting in their suicide.
Proper administration of the correct substances: only by a physician
The requirement of due medical care has two aspects. First, the physician must administer the correct substances following the proper medical procedure. Second, it is the physician who must terminate the patient’s life. The physician is not permitted to let others, such as nursing staff, perform the procedure.
Performing euthanasia/assisting in suicide
In cases of euthanasia, or termination of life on request, the physician actively terminates the patient’s life by administering euthanatics, usually intravenously. In the case of assisted suicide, the physician gives a euthanatic to the patient, who then ingests it independently. The physician must remain present or in the immediate vicinity until the patient dies, as complications may occur. For example, the patient may vomit the potion back up or it may take a considerable time for death to ensue. In such cases, the physician may have to terminate the patient’s life after all. The physician must discuss this possibility beforehand with the patient and the patient’s family. The physician may not leave the euthanatic with the patient as this presents risks to the patient and to others.
KNMG/KNMP Guidelines for the Practice of Euthanasia and Physician-Assisted Suicide
In assessing whether a physician has exercised due medical care in terminating a patient’s life on request or assisting in suicide, the review committees refer in principle to the KNMG/KNMP Guidelines for the Practice of Euthanasia and Physician-Assisted Suicide of August 2012. The Guidelines advise physicians and pharmacists on practical and effective methods of performing euthanasia and assisting suicide. They list recommended substances, dosages, methods of administration and materials. The Guidelines replace Standards for Euthanasia published by the KNMG in 2007.
Request for additional information from the review committee
A review committee may ask the physician for additional information if, in the documents received:
- the physician has not stated the dosages of the substances administered, or has not stated it in milligrams;
- the physician has not administered the dosages recommended in the Guidelines;
- the physician has not stated how the substances were administered.
In cases of termination of life on request the physician must be sure that the patient is in a deep coma before administering the muscle relaxant. It is extremely important to use the coma-inducing substance recommended by the Guidelines in the correct dosage to ensure that the patient does not perceive the effects of the muscle relaxant. It is vital for the physician to establish the depth of coma before administering the muscle relaxant, for example by checking the corneal or eyelash reflex or by applying pain stimuli.