The physician must consult at least one other, independent physician, who must see the patient and give a written opinion on whether the statutory due care criteria have been fulfilled.
Ensuring a careful decision-making process
The purpose of consulting at least one other, independent physician is to ensure that the physician’s decision is reached as carefully as possible. It helps the physician establish whether the due care criteria have been met. The physician must take the independent physician’s opinion very seriously. If the independent physician’s advice is not followed, the physician will have to provide convincing arguments to justify this.
The independent physician must be independent of the attending physician and the patient. According to the Royal Dutch Medical Association (KNMG), this means that a member of the same medical practice or partnership, a registrar, or a physician who in some other way is in a relationship of dependence with the physician asking for the independent assessment cannot in principle be deemed to be independent. It is also important to avoid anything that might suggest that the physician is not independent. There must be no family or business relationship between the two physicians or, in principle, any broader cooperative relationship.
The independence of the independent physician in relation to the patient means there can be no family relationship or friendship between them, nor can the independent physician be treating the patient. To safeguard this independence, it is customary and advisable to contact a SCEN physician for an independent assessment through the SCEN organisation (Euthanasia in the Netherlands Support and Assessment Programme).
The independent physician must see the patient
To obtain a clear insight into the patient’s condition, the course of the disease and the patient’s situation, the independent physician must see the patient personally. The main rule is that the independent physician must be able to communicate with the patient, preferably in private. Nevertheless, it is possible to conceive of certain exceptional circumstances in which a personal conversation between the patient and the independent physician is not feasible: for example, a sudden and unexpected deterioration in the patient’s situation. The independent physician can ‘compensate’ for this by consulting other sources of information – the medical records and the advance directive – or by talking to other relevant persons.
Independent physician’s report
After visiting the patient, the independent physician must draw up a report. The report must say whether the independent physician believes that the physician has complied with the due care criteria and give reasons supporting this view. It is desirable for the independent physician to explicitly describe their relationship with the physician and the patient. The independent physician is responsible for the contents of this report, but the physician must ascertain whether it is of sufficient quality and whether the independent physician has given their opinion on whether the due care criteria have been fulfilled.
The independent physician’s opinion and written report are of great importance to the physician in reaching a decision. They also help the review committee obtain an insight into the case.
Limited validity of independent physician’s report
In certain circumstances considerable time may elapse between the independent physician’s visit and actual compliance with the patient’s request. This may mean that the physician has to consult the independent physician for a second time. It may be that a telephone call will suffice or the independent physician may have to visit the patient again, depending on the amount of time that has elapsed and whether the patient’s situation has changed.