A recent evaluation survey shows a positive picture of the compliance with the Termination of Life on Request and Assisted Suicide (Review Procedures) Act (the Euthanasia Act) in the Netherlands. That is why minister Edith Schippers (Health, Welfare and Sport) and minister Ivo Opstelten (Security and Justice) see no reason for any changes in the policy on termination of life on request, assisted suicide and other medical treatment at the end of a person's life. Both ministers wrote this in a letter to the House earlier in 2013. This letter was discussed on Thursday 19 December during a debate between the ministers and the standing committee on Health, Welfare and Sport. The debate is to be continued on Thursday 20 March.

Due care
The purpose of the Euthanasia Act, which took effect in 2002, is to increase the caution with which life-ending acts are carried out by physicians. Moreover, the Euthanasia Act provides the legal framework for the justification of the termination of life. Key requirements are that the request is voluntary and well considered and that the patient's suffering is unbearable with no prospect of improvement. It is the physician's duty to assess the request for termination of life and to carry out the request with due care -- provided that the request meets the criteria -- after consultation of an independent medical practitioner.

Just like after the evaluation in 2007, the ministers have drawn the conclusion that the Euthanasia Act largely meets the goals of social control of termination of life by request, increased transparency and providing legal certainty to physicians. The evaluation revealed that physicians generally comply with the law.

Few changes
That is why the evaluation gives little reason for policy change. As far as policy change is necessary, this relates to the details, not to the headlines. The evaluation has already led to improvements in the so-called regional euthanasia review committees. It is the task of these committees to assess notifications from medical practitioners who claim to have assisted in termination of life in compliance with the law. In 2010, the average processing time of these notifications had risen to 111 days. In the first months of 2013, however, the processing time had been reduced to less than 80 days. This was achieved by increasing the staff and by adopting a more efficient working method.

End-of-life clinic
In their letter to the House both ministers also gave their opinion on the working method of the End-of-life clinic. The End-of-life clinic was established on 1 March 2012, in response to signals that some medical practitioners were not willing to comply with their patient's request for termination of life, even if the request met de requirements of due care laid down by law. Until early March 2013 all notifications by the physicians of the End-of-life clinic had been found to be in compliance with the requirements of due care. That is why the ministers do not deem it necessary to evaluate the working method of the clinic.

In the discussion about the euthanasia policy as well as in publications, the question of how to deal with a request for termination of life from a person suffering from dementia is often raised. In March 2013, Ms Edith Schippers, minister of Health, Welfare and Sport, stated her position on the matter in a letter to the House. Such a case demands an utmost complex consideration from the physician and that is why he has to get a proper picture of the patient, his convictions and the wishes he has expressed earlier. The advice from an independent consultant and a geriatrician, for example, can be of some importance, whereas information from relatives can also be helpful for the physician when forming a picture of the patient. Anyway, it is important that the patient's suffering is unbearable with no prospect of improvement and that the patient has made a statement -- preferably a written one -- before he or she was no longer capable of expressing his or her will.