Abstract
BackgroundThe Netherlands, Belgium, and Luxembourg have adopted laws decriminalizing euthanasia under strict conditions of prudent practice. These laws stipulate, among other things, that the attending physician should consult an independent colleague to judge whether the substantive criteria of due care have been met. In this context initiatives were taken in the Netherlands and Belgium to establish specialized services providing such consultants: Support and Consultation for Euthanasia in the Netherlands (SCEN) and Life End Information Forum (LEIF) in Belgium. The aim of this study is to describe and compare these initiatives.MethodsWe studied and compared relevant documents concerning the Dutch and Belgian consultation service (e.g. articles of bye-laws, inventories of activities, training books, consultation protocols).ResultsIn both countries, the consultation services are delivered by trained physicians who can be consulted in cases of a request for euthanasia and who offer support and information to attending physicians. The context in which the two organisations were founded, as well as the way they are organised and regulated, is different in each country. By providing information on all end-of-life care matters, the Belgian LEIF seems to have a broader consultation role than the Dutch SCEN. SCEN on the other hand has a longer history, is more regulated and organised on a larger scale and receives more government funding than LEIF. The number of training hours for physicians is equal. However, SCEN-training puts more emphasis on the consultation report, whereas LEIF-training primarily emphasizes the ethical framework of end-of-life decisions.ConclusionIn case of a request for euthanasia, in the Netherlands as well as in Belgium similar consultation services by independent qualified physicians have been developed. In countries where legalising physician-assisted death is being contemplated, the development of such a consultation provision could also be considered in order to safeguard the practice of euthanasia (as it can provide safeguards to adequate performance of euthanasia and assisted suicide).
Highlights
The Netherlands, Belgium, and Luxembourg have adopted laws decriminalizing euthanasia under strict conditions of prudent practice
This paper aims to describe such specialized health services as established in the Netherlands ('Support and Consultation on Euthanasia in the Netherlands', i.e. SCEN) [12] and in Belgium ('Life End Information Forum', i.e. LEIF) [13]
Information on the Life End Information Forum in Flanders was acquired through the LEIF website [21], the bye-laws, the LEIF magazine [22], publications concerning LEIF [13,23,24] and the training folders the physicians receive while undergoing training
Summary
The Netherlands, Belgium, and Luxembourg have adopted laws decriminalizing euthanasia under strict conditions of prudent practice. The procedural criteria consist of mandatory notification of the euthanasia case to the official review committee [7], and consultation of a colleague by the attending physician, hereafter called the consultant, who is independent or impartial from both the patient and the attending physician [4,5], and competent to judge the patient's condition This consultant must read the medical file and examine the patient in order to judge whether the substantive criteria have been met, i.e. judge the serious and incurable nature of the condition, ascertain that the patient's physical or psychological suffering is constant, unbearable, and without prospect of improvement, and that the patient's request was voluntary, well-considered, and repeated (in Belgium and Luxembourg the law only prescribes this in patients not expected to die in the near future). The consultant must make a written report regarding his or her conclusions
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