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Euthanasia and assisted suicide (EAS) was openly permitted but not technically legal in the Netherlands for decades. In 2002, it was formally legalised through the Termination of Life on Request and Assisted Suicide Review Procedures Act, subject to two main criteria: (1) the patient had to be capable of making voluntary decisions and (2) the patient had to experience unbearable suffering without prospect of improvement. Within the Netherlands, EAS has wide acceptance, and the public in general seems to favour a liberal interpretation of both of these requirements. Physicians are expected to use 'their own moral compass' to decide about personal participation, and it is generally possible and permissible to find a substitute physician if the patient meets the legally required criteria but the physician is not comfortable assisting. Over the years, multiple quantitative and qualitative studies have explored the Dutch practice of EAS, 1-3 but relatively little is known about the edges of what counts as meeting these criteria and how acceptable the practice is for physicians who participate. The study by Snijdewind et al gives a glimpse of these boundaries and suggests that at least sometimes the criteria are being stretched and adapted to meet the perceived needs of patients, and some participating physicians are relatively uncomfortable with some of the requests with which they are faced. 4 Just how rare or common these 'edgy' cases are within the larger practice of EAS in the Netherlands cannot be answered by this study, nor can it be ascertained how many physicians are becoming more or less comfortable with the practice over time since legalisation.
The physicians interviewed in this study came from two sources. First, they asked Support and Consultation for Euthanasia in the Netherlands physicians who have been specially trained to provide second opinions in EAS cases if they had experienced an 'unusually complex case'. Out of 103 such physicians who responded, nine were selected (by a process that was not clearly articulated in the paper) for an interview. Second, they selected 18 physicians out of 186 who participated in a national questionnaire who reported having 'experience with a complex case' of EAS and were willing to participate in an in-depth interview. Outside of experience with a complex case of EAS and some...