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And What About the Pharmacist?

On the Position of the Provider of Lethal Drugs in Dutch Euthanasia Practice

Published online by Cambridge University Press:  02 June 2020

MARTIN BUIJSEN  and
WILMA GÖTTGENS
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Abstract

In the Netherlands, euthanasia has been decriminalized. Termination of life on request and assisted suicide are criminal offences under Dutch law; but if physicians comply with the due care requirements of the Euthanasia Act and report their actions in the manner prescribed by law, they will not be prosecuted. One of the requirements relates to the act of euthanasia itself. If this is to be performed with due medical care, the physician relies on the services of a pharmacist. However, the responsibilities of the pharmacist with respect to euthanasia are not laid down in law. At present, Dutch pharmacists have to make do with professional rules that do not offer adequate solutions for the problems that may arise when euthanasia is performed.

Keywords

euthanasiatermination of life on requestphysician-assisted suicidelethal drugspharmacistprofessional rulesprofessional standard
Type
Special Section: Death, Dilemmas, and Decisions
Information
Cambridge Quarterly of Healthcare Ethics , Volume 29 , Issue 3 , July 2020 , pp. 375 - 385
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Notes

1. In Dutch criminal law, two distinct acts are considered punishable: termination of life on request and assisted suicide. See Criminal Code, Sections 293 and 294. When a physician terminates the life of a patient on the latter’s request, he administers the lethal drugs. When he offers suicide assistance, the physician provides the lethal drugs and the patient takes the drugs himself. In the Netherlands, ‘euthanasia’ usually refers to termination of life on request by a physician. In this paper ‘euthanasia’ refers to both termination of life on request by a physician and physician-assisted suicide.

2. Oordeel 2016-85; available at https://www.euthanasiecommissie.nl/uitspraken-en-uitleg/o/onzorgvuldig/documenten/publicaties/oordelen/2016/niet-gehandeld-overeenkomstig-de-zorgvuldigheidseisen/oordeel-2016-85 (last accessed 12 Aug 2018).

3. See note 2, Oordeel 2016-85.

4. See note 2, Oordeel 2016-85, at 14.

5. Euthanasia Act, Section 2, paragraph 1, under f.

6. KNMG/KNMP. Richtlijn Uitvoering euthanasia en hulp bij zelfdoding [Guideline for performing euthanasia and assisted suicide]. Utrecht/The Hague: Royal Dutch Medical Association/Royal Dutch Pharmacists Association; 2012; available at https://www.knmp.nl/downloads/richtlijn-uitvoering-euthanasie-en-hulp-bij-zelfdoding.pdf (last accessed 12 Aug 2018). An English translation of the guideline can be found on the website as well.

7. Even for the most experienced doctors, things can sometimes go wrong. For this reason, the doctor is required to bring an extra set of intravenous euthanatic agents and materials for the preparation and administration of the agents. The emergency set does not have to be ready for use straight away. See note 6, KNMG/KNMP 2012, at 22.

8. See note 6, KNMG/KNMP 2012, at 9.

9. See note 6, KNMG/KNMP 2012, at 9.

10. See note 6, KNMG/KNMP 2012, Appendix IX.

11. See note 2, Oordeel 2016-85.

12. See Onwuteaka-Philipsen B. Derde evaluatie Wet toetsing levensbeëindiging op verzoek en hulp bij zelfdoding [Third evaluation study Euthanasia Act]. The Hague: ZonMw; 2017.

13. Criminal Code, Sections 293 and 294.

14. Criminal Code, Sections 293 and 294 jº Euthanasia Act, Section 2, and Burial Act, Section 7, paragraph 2.

15. Euthanasia Act, Section 9, paragraph 1, under a.

16. See note 2, Oordeel 2016-85.

17. According to the Euthanasia Act itself, the Act must be evaluated every five years and Parliament needs to be informed. Three evaluation studies have been conducted so far. No criminal proceedings have been reported. All studies are available at https://www.zonmw.nl/search/?=toetsing (last accessed 12 Aug 2018).

18. This number is the sum of all annually reported cases of euthanasia in which the legal due care requirements were not satisfied according to one of the regional euthanasia review committees. The annual reports are available at https://www.euthanasiecommissie.nl/de-toetsingscommissies/jaarverslagen (last accessed 12 Aug 2018).

19. See RTG Den Haag 24 July 2018 (ECLI:NL:TGZSGR:2018:33).

20. See for example the statement made by Royal Dutch Medical Association KNMG on 25 November 2015 in its weekly magazine Medisch Contact; available at https://www.medischcontact.nl/nieuws/federatienieuws/federatiebericht/knmg-euthanasie-is-bijzonder-medisch-handelen (last accessed 12 Aug 2018).

21. See Kamerstukken II, 1999-2000, 26 961, no. 6, at 33. [“Kamerstukken” is best translated as “Parliamentary Proceedings”].

22. These rulings are available at https://www.euthanasiecommissie.nl/uitspraken-en-uitleg (last accessed 12 Aug 2018).

23. Regionale toetsingscommissies euthanasie. Code of Practice. The Hague: Regionale toetsingscommissies euthanasie; 2015; available at https://euthanasiecommissie.nl/uitspraken/brochures/brochures/code-of-practice/1/code-of-practice (last accessed 12 Aug 2018).

24. Regionale toetsingscommissies euthanasie, EuthanasieCode 2018. The Hague: Regionale toetsingscommissies euthanasie; 2017; available at https://www.euthanasiecommissie.nl/uitspraken/brochures/brochures/euthanasiecode/2018/euthanasiecode2018 (last accessed 12 Aug 2018).

25. Civil Code Book 7, Sections 446–68.

26. Civil Code Book 3, Section 40, paragraph 2.

27. Civil Code Book 7, Section 446.

28. Civil Code Book 7, Section 468.

29. Civil Code Book 7, Section 453.

30. Buijsen M. Richtsnoeren voor artsen: Hun toepassing in de rechtspraak [Guidelines for doctors: Their application by the courts]. Tijdschrift voor Gezondheidsrecht 2000/1, at 19–33.

31. See Act on Professions in Individual Healthcare, Section 40, and Act on Quality, Complaints and Disputes in Care, Section 2, paragraph 2.

32. See note 30, Buijsen 2000.

33. See note 6, KNMG/KNMP 2012, at 11.

34. See note 6, KNMG/KNMP 2012, at 45.

35. Göttgens-Jansen W, Dees M, Leeuwen E van, Buijsen M, Horickx A. De stem van de apotheker in levenseindezorg. Onderzoek naar de taken en verantwoordelijkheden bij euthanasie en hulp bij zelfdoding [The voice of the pharmacist in end-of-life care. On the role and the responsibilities of the pharmacist involved in termination of life and assisted suicide]. Nijmegen: IQ Healthcare; 2017. This multidisciplinary study was commissioned by Royal Dutch Pharmacists’ Association (KNMP).

36. The research was partly historical and partly legal. In addition, researchers held in-depth interviews with 21 pharmacists. They also included and studied casuistry brought forward by trainee pharmacists. Finally, they analyzed 3,223 questionnaires filled out by physicians and pharmacists after euthanasia had been carried out. Physicians and pharmacists are required to do so according to the guideline Performing euthanasia and assisted suicide. See note 35, Göttgens-Jansen 2017.

37. See note 35, Göttgens-Jansen 2017, at 45.

38. See note 35, Göttgens-Jansen 2017, at 45.

39. Physicians associated with the so-called End-of-Life Clinic can be called upon by patients whose doctors are unwilling to grant requests for euthanasia, for whatever reason. These physicians do not have a treatment relationship with the patients who contact them. They do not object to euthanasia as such, but they do have to meet the requirements of the Euthanasia Act, as all doctors do. See https://www.levenseindekliniek.nl (last accessed 12 Aug 2018).

40. See note 35, Göttgens-Jansen et al. 2017, at 46.

41. See note 35, Göttgens-Jansen et al. 2017, at 46.

42. See note 35, Göttgens-Jansen et al. 2017, at 46.

43. See note 35, Göttgens-Jansen et al. 2017, at 46.

44. See note 35, Göttgens-Jansen et al. 2017, at 46.

45. See note 35, Göttgens-Jansen et al. 2017, at 46–7.

46. See note 35, Göttgens-Jansen et al. 2017, at 47–8.

47. See note 35, Göttgens-Jansen et al. 2017, at 48–9.

48. See note 12, Onwuteaka-Philipsen 2017.

49. See note 35, Göttgens-Jansen et al. 2017, at 49–50.