No reasonable alternative

The physician must have come to the conclusion, together with the patient, that there is no reasonable alternative in the patient’s situation.

A shared decision-making process

The patient and the physician together come to a decision regarding euthanasia. It must be clear to both of them that termination of life on request or assisted suicide is the only reasonable way of relieving the patient’s suffering.

Patient may refuse treatment

The provision of good medical care, especially palliative care, is a key factor in end-of-life decisions. This does not mean that patients have to undergo every possible form of care or treatment. Patients are entitled to refuse care or treatment, including palliative options, for instance because the side-effects outweigh the positive effects for them. Or it may be that the patient cannot or does not wish to tolerate the (fear of) continuing loss of dignity, dependence or the absence of any prospects of improvement. Here too there may be no reasonable alternative.

Reasons for refusal

If treatment was refused, the review committee assesses whether there was a ‘reasonable alternative’ in the case in question. The physician’s report should explain the reasons why the patient found possible alternatives to be unreasonable or unacceptable.