Mental suffering as justification for

euthanasia in Netherlands
The Dutch Supreme Court this week recognised that euthanasia or assisted suicide could be
necessary for patients with mental suffering, and it ruled that doctors should consult a colleague
before reaching such a decision, as is the case for patients with unbearable physical suffering.
However, for patients with mental suffering, the Supreme Court says that the independent expert
should actually examine the patient. The judgment was made in the case against psychiatrist Dr
Boudewijn Chabot who assisted in the suicide of a 50-year-old divorced woman whose first son
had committed suicide and whose second son had died of cancer. Since last December Dutch law
excludes doctors from the criminal penalties for euthanasia and assisted suicide if they follow
guidelines established in 1984 and laid down in an appendix to the new euthanasia lawie, the
patient has to be suffering unbearably, has to be in the terminal phase of an illness, and has to
have expressed the wish to die more than once. When these criteria are met and when doctors
have consulted a colleague on the justification for euthanasia or assisted suicide in the case, the
courts will usually accept the "necessity" of the act. : Chabot’s patient could not cope with life.
She obtained his address through the Dutch Voluntary Euthanasia Society and he saw her for 24
hours in total. After consulting seven experts, he was convinced she had a genuine wish to die
and agreed to help her commit suicide. He provided her with the lethal preparation, which she
drank in his presence and that : of a friend and her general practitioner. [ Chabot then reported
the case to the judicial authorities, as required by law. : : The local and appeal courts had deemed
the circumstances exceptional and did not prosecute Chabot. The Attorney-General Leo Meijers
agreed that there was no distinction between mental and physical suffering and said that
Chabot’s action was justified even though the patient had not been terminally or physically ill.
However, the Solicitor General took the case to the Supreme Court as a test case for a legal
judgment to clarify the issue. The Supreme Court, arguing that the unbearability of the suffering
was "extra difficult" to determine objectively, found Chabot guilty but exempted him from any
penalty. The Court’s acceptance of mental suffering is in line with a report published by the
Royal Dutch Medical Assocation last November. Chabot’s lawyer, Mr E Sutorius was "very
happy" with the Supreme Court judgment-both for clarifying mental suffering as a justification
for assisted suicide and, by ruling that an independent expert had to see the patient, for
introducing an additional cautionary measure.

Marjanke Spanjer