Review procedure in text
Notification of death by unnatural causes to pathologist
Euthanasia and assisted suicide are both unnatural causes of death. A physician who has performed euthanasia or assisted in suicide must always report it as death by unnatural causes to the municipal pathologist.
The notifying physician’s substantiated report
When notifying the municipal pathologist the physician must enclose a substantiated report, explaining why the physician believes the due care criteria have been complied with. The review committees expect the physician to use the most recent version of the model notification form available on the committees’ website. The questions it contains help notifying physicians make it clear to the review committee that they have complied with the due care criteria. To ensure legibility, the committees prefer the form to be filled in digitally.
One notifying physician
The law defines the physician as ‘the physician who, according to the notification, has terminated life on request or has provided assistance in 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 notification form. This physician is considered by the committee to be the ‘notifying physician’.
Municipal pathologist informs review committee
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 assembles and checks the necessary documents, including the reports of the physician and the independent physician, and 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.
Registration and preliminary assessment of notification
Once the review committee has received from the municipal pathologist the physician’s notification of euthanasia or assisted suicide, it registers all the relevant information. Immediately after receiving a notification and reading all the documents submitted with it, the experienced secretary of the relevant 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 questions.
The secretary then draws up draft findings and sends them to the committee members (a lawyer, a physician and an ethicist) for 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 it has any further questions, it will generally put them in writing, but physicians may also be contacted by telephone. The committee may also invite the physician and/or independent physician for an interview.
Finding: due care criteria complied with or not
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 case has thus been disposed of de facto.
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. These authorities decide in accordance with their own powers and responsibility whether measures should be taken in respect of the physician and if so, which.
After the review committee has issued its final decision the original file is kept for 15 years.