Toetsingsprocedure Regionale Toetsingscommissies Euthanasie

A The physician performs euthanasia or assists in suicide

A physician who has performed euthanasia or assisted in suicide must always report it as death by unnatural causes to the municipal pathologist without delay.

When notifying the municipal pathologist the physician must enclose a detailed report. The report must explain why the physician believes the statutory due care criteria have been complied with. The review committees expect the physician to use the most recent version of the model notification form. The physician’s notification must include the report of the independent physician consulted and any other supplementary documents such as an advance directive, the physician’s notes or part of them, and/or letters from specialists.

The Act defines the physician as ‘the physician who, according to the notification, has terminated life on request or has provided assistance with suicide’. The basic principle is that the physician who actually terminated the patient’s life or assisted in the patient’s suicide is the one who signs the model notification form. This physician is considered by the committee to be the ‘notifying physician’.

The municipal pathologist performs an external examination of the body and ascertains how the patient died and what substances were used to terminate the patient’s life.

The municipal pathologist checks whether the necessary documents, including the reports of the physician and the independent physician, are enclosed and assembles any other supplementary documentation such as an advance directive, the physician’s notes and/or letters from specialists.

The municipal pathologist then contacts the public prosecutor who issues a declaration of no objection. At this point the registrar of births, deaths, marriages and registered partnerships gives permission for burial or cremation.

The municipal pathologist then sends the documents to the competent regional euthanasia review committee.

Once the review committee has received from the municipal pathologist the physician’s notification of euthanasia or assisted suicide and the accompanying documents, it registers all the relevant information.

Immediately after receiving a notification and reading all the documents submitted with it, the experienced secretary of the review committee makes a preliminary assessment of whether the notification is straightforward or not. A notification is considered straightforward if it can be established with a large degree of certainty on receipt of the documents (so at the beginning of the review procedure) that the statutory due care criteria have been complied with and the information submitted is so complete that it does not raise any further questions.

The secretary then draws up draft findings and sends them, together with the documents, to the committee members (a lawyer, a physician and an ethicist) for review.

E Review

Straightforward notifications are in principle reviewed digitally by the relevant committee. If a notification does raise questions with any of the committee members, it is referred to the monthly committee meeting where all non-straightforward notifications are discussed.

The review committee first assesses a notification on the basis of the documents received from the municipal pathologist. If the committee still has questions, it will generally put them in writing, inviting the physician to reply by email or fax in the interests of a speedy disposition of the case. In some cases, the committee may put questions by telephone.

At the monthly committee meetings the committee reviews all notifications which after registration and preliminary assessment by the experienced secretary have been classified as non-straightforward and are therefore in principle unsuitable for digital review. The meeting also reviews notifications that the committee, after an initial digital assessment, has decided raise questions and are therefore non-straightforward.

The review committee first assesses a notification on the basis of the documents received from the municipal pathologist. If the committee still has questions, it will generally put them in writing, asking the physician, in the interests of a speedy disposition of the case, to reply by email or fax. In some cases, the committee may put questions by telephone. It is also possible that the committee will invite the physician and/or independent physician to supplement their report in person.

If the committee is considering a finding that the physician did not act in accordance with the statutory due care criteria it is customary for the physician to be invited for an interview with the committee to provide further information.

E

The review committee issues its findings within six weeks of receipt of the notification. This period can be extended once for another six weeks if, for example, further information has to be obtained from the physician, the independent physician or the municipal pathologist, or if the committee invites the physician to provide supplementary information in an interview.

If the committee is considering finding that the physician did not act in accordance with the statutory due care criteria it is customary for the physician to be invited for an interview with the committee to provide further information regarding the case.

Due care criteria not complied with The finding ‘due care criteria not complied with’ means that in complying with the request for euthanasia or assisted suicide, the physician did not act in accordance with the due care criteria laid down in the Act. The committee is obliged to send its findings to the Board of Procurators General and the Health Care Inspectorate.

The finding ‘due criteria complied with’ means that in complying with the request for euthanasia or assisted suicide, the physician acted in accordance with the due care criteria laid down in the Act. This finding is definitive and the review procedure thus ends de facto.

If the review committee’s finding is that the due care criteria were complied with, the physician is immediately informed of this in writing and is sent the committee’s definitive findings.

(NB: The independent physician is not sent a copy of the committee’s findings. It is up to the physician to do so if desired.)

F.1

If the review committee’s finding is that the due care criteria were not complied with, it is obliged to pass its findings and the entire accompanying file on to the Board of Procurators General and the Health Care Inspectorate. The physician, the Board of Procurators General and the Health Care Inspectorate are therefore directly informed in writing of the finding.

G.1 Physician

The Board of Procurators General decides in accordance with its own powers and responsibility whether measures should be taken in respect of the physician and if so, which.

If the committee finds that the due care criteria were not complied with, it is obliged to provide the public prosecutor, on request, with all the information needed to assess the actions of the physician. The committee notifies the physician that it has supplied information to the public prosecutor.

G.2.1 (Suspended) decision not to bring charges (and possibly interview with physician)

G.2.2 Investigation by the Chief Public Prosecutor

G.2.2.1 No charges are brought
G.2.2.2 Criminal court

The Health Care Inspectorate decides in accordance with its own powers and responsibility whether measures should be taken in respect of the physician and if so, which.

G.3.1 Investigation (usually includes interview with physician)

G.3.1.1 Regional Healthcare Disciplinary Board

G.3.1.2 No further action