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Being “tired of life” is not grounds for euthanasia

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7380.71/b (Published 11 January 2003) Cite this as: BMJ 2003;326:71
  1. Tony Sheldon
  1. Utrecht

    In a landmark decision the Dutch Supreme Court has ruled that doctors may not perform euthanasia or help with suicide unless the request comes from a patient suffering from a medically classifiable physical or psychiatric sickness or disorder. Simply being “tired of life” is no basis for doctors to act.

    In what the media have branded the “tired of life case,” the limits of euthanasia practice have been defined, after the case took two years to reach the highest court in the land. The decision has been welcomed by the Royal Dutch Medical Association for offering “clarity” in doctors' work. Voluntary euthanasia was decriminalised in the Netherlands in 2001.

    GP Philip Sutorius, who had helped an 86 year old patient die in the belief that the patient was suffering unbearably because of his obsession with his physical decline and hopeless existence, was initially acquitted in 2000. But an Amsterdam appeal court found him guilty of assisted suicide, a criminal act, in 2001 (BMJ 2001;323:1384). However, the court imposed no punishment, recognising that he had acted out of great concern for his patient.

    The Supreme Court has now dismissed his appeal against conviction, and the only legal option now for Dr Sutorius is an appeal to the European Court of Human Rights, although there is no indication that the GP intends to pursue this.

    In 1998 Dr Sutorius helped former senator Edward Brongersma to die, even though he had no serious physical or mental illness. Mr Brongersma had often spoken with Sutorius of his wish to die. He suffered from physical decline and struggled with his “pointless and empty existence.”

    The appeal court had accepted the argument that Mr Brongersma's suffering was not medical and that GPs therefore had no experience to judge such an issue.

    Dr Sutorius appealed to the Supreme Court in order to quash his conviction and clarify the position of doctors. The Supreme Court argued that last year's euthanasia law specifically did not cover such “tired of life situations.” Its decision underlines the earlier judgment that “unbearable and hopeless suffering,” a criterion laid down in the law on euthanasia, must be linked to a recognisable medical or psychiatric condition.

    While agreeing with the legal decision, the Royal Dutch Medical Association points out that a general debate on how doctors should respond to requests such as Brongersma's has already begun. It argues that doctors continue to struggle with these “complex questions,” which are often “in practice … a grey area.”

    The association has set up a committee to consider the issues and will report in the middle of 2003. Doctors and ethicists have already attacked the judgment, one branding it an “ugly historical mistake.” GPs, they argue, treat patients every day whose complaints cannot be linked to a classifiable disorder.


    Embedded Image

    Anti-euthanasia demonstrators protest outside the Dutch parliament, April 2001

    (Credit: AP PHOTO/SERGE LIGTENBERG)

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