“Existential” suffering not a justification for euthanasia

A legal test case has defined the limits within which doctors in the Netherlands, especially general practitioners, can agree to a patient's request for mercy killing.

The judgment draws a line between suffering of a medical nature—the result of a physical illness or mental condition on which doctors can act under the euthanasia law—and “existential” suffering, often associated with ageing, resulting from loneliness, emptiness, and fear of further decline. It accepted expert opinion that doctors had no expertise to judge such suffering.

Setting aside last year's acquittal, the court found GP Philip Sutorius guilty of helping an 86 year old man with no serious physical or mental illness to commit suicide. But it imposed no punishment, recognising that the GP had acted out of great concern for his patient.

The previous acquittal had accepted a broad interpretation of suffering “unbearably and hopelessly,” one of the criteria required to protect doctors against prosecution for euthanasia (BMJ 2000;321:1174). It accepted that Dr Sutorius's patient, former senator Edward Brongersma, had endured such suffering. He was obsessed with his physical decline and hopeless existence. He had spoken with Dr Sutorius on up to nine occasions of his wish to die.

But the appeal court accepted that the problems faced were not medical ones and that GPs had no expert experience in these questions. It believed Dr Sutorius had promised too soon to fulfil Mr Brongersma's wish to die, rather than seeking other solutions for his sense of life's pointlessness.

The public prosecution service had appealed the case to establish jurisprudence. It accepted that Dr Sutorius was a conscientious GP who acted with prudence and professionalism and had freely reported his actions but that he had gone beyond what was legally justifiable for a doctor.

The earlier so called “tired of life” judgment had caused unease within the medical profession and in political circles. It was seen as stretching the borders of euthanasia too far.

The Royal Dutch Medical Association (KNMG) agreed with last week's judgment in drawing a line as far as the role of the doctor was concerned with regard to physical and mental suffering. But it said there was still uncertainty over the doctor's role regarding existential suffering. This role was not excluded but fell outside the criteria of care for euthanasia. A special committee of the association, set up to look at tired of life cases, is currently considering this question.