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Human rights/the Netherlands

Media Loft editor-in-chief Victoria Hoogland on what euthanasia is in the Netherlands and what to do about children, mentally ill or dementia patients

28.04.2023

The Netherlands is preparing to legalize child euthanasia by including in the law the possibility of a lethal procedure for children from 1 to 12 years old.

Media Loft Editor-in-Chief Victoria Hoogland talks about the most controversial law in the Netherlands and how it is enforced.

“I thought for a long time whether I should talk about it, but in the end I decided to do it. I’ll get straight to the point: in a maximum of 10 days I will no longer be.”

These words are written by Noah Pothoven, a seventeen-year-old girl who passed away voluntarily, refusing food and medicine. She was not terminally ill - at least not in the normal definition of the word. But she did not want to live and eventually achieved her goal.

Noa was born in 2001 in the Netherlands. She was sexually harassed for the first time at the age of 11. At 14 she was raped by two men. She refused, citing her age, indicating that they could consider the request only after she turned 21.

Noa suffered from depression, post-traumatic stress disorder and feelings of guilt, which eventually led to anorexia. She was admitted to hospitals and specialist centres about twenty times, including forcibly. She spent several days in a medical coma. She lived for almost a year eating through a tube. She attempted suicide. After reading one of her suicide notes, Noah's mother learned the reasons for her daughter's severe emotional and mental state.

In an attempt to make sense of everything that was happening to her, the girl wrote and published a book - "To Win or Learn", which made her famous. At seventeen, the young Dutch girl sent a request to doctors asking for euthanasia. She was refused, citing her age, indicating that they could consider the request after her 21st birthday.

“We are in despair, we don’t know what to do,” the girl’s parents cried in one of the interviews, “which clinic, which doctor can help us? Noah feels hopeless. She doesn't want to live anymore..."

On June 2, 2019, Noah Pothoven passed away, refusing food, water and medicines.

The girl refused food and water, and her parents and doctors eventually agreed not to force her to take food and liquid.

“After many years of fighting, the war is over. Now I have stopped eating and drinking, and after many conversations and discussions, it was decided to release me, because my suffering is unbearable,” Potkhoven wrote in her last post.


Noah Pothoven
Photo: Marc Pluim

Contrary to media reports that spread unverified information about Noah's passing, the girl did not undergo euthanasia in the full sense of the word, as she died not from a dose of a lethal drug, but by her own will stopped eating.

Pope Francis reacted to Noah's death this way: “Euthanasia and assisted suicide is a defeat for everyone. We are called on to never leave those who suffer, to never give up, but to care and love in order to give them hope.”

In 2001, the Netherlands once again made history, this time as the first country in the world to legalize euthanasia.

Despite the fierce opposition of the Catholic and Protestant churches, the famous law "termination of life on request and assisted suicide" was passed, largely due to the active lobbying of the then Minister of Health Els Borst.

Alas, her own story is rather tragic. She was certainly a very controversial figure, the author of the famous feminist saying "Politics is too important to be left to men", the initiator of discussions on the most sensitive topics, including not only euthanasia, but also organ donation, genetic research of abortive material, legalization of marijuana .

A year after the adoption of the famous law, Els Borst retired, although she did not quit public activity.

In 2014, Borst was killed in her own garage by a crazy fanatic. The man - a fierce opponent of euthanasia, whose name was not disclosed - said that he acted at the behest of "divine providence." 41 stab wounds were counted on the woman's body.


Els Borst
Photo: Marcel Antonisse

The arguments against euthanasia are clear - it turns out that it implies a violation of the Hippocratic oath, does not exclude the risk of abuse and runs counter to many religious beliefs. And if many Protestant movements still allow a discussion about palliative sedation in order to alleviate the suffering of the patient (but not to end life), then the Catholic Church is unequivocal: euthanasia is unacceptable, because our soul belongs to the Lord, and only He decides when a person’s earthly path should come to an end.

The website of the Dutch government explains that end of life can take the form of either euthanasia, when a doctor injects a dose of a lethal drug, or assisted suicide, in which case the patient receives the "medicine" themself and uses it for its intended purpose.

Euthanasia should not be confused with a situation where a person notifies others in advance that they do not want to be resuscitated in the event of, say, cardiac arrest.

The decision can be conveyed in three ways:

  • Order a medallion with the appropriate inscription from the Dutch Patients' Federation.
  • Complete and sign the application and send it to your family doctor.
  • Get a tattoo that says "do not resuscitate!".

All these three ways are equal; doctors have no right to ignore them. But from the point of view of the law, refusal of resuscitation is not euthanasia.

Palliative sedation, when a terminally ill patient is unconscious until the end of their days due to the action of drugs (for example, morphine), is also not considered euthanasia - after all, death does not occur from a lethal injection, but from an illness, which is the key point here.

Let's go back to the 2001 law "Termination of Life on Request and Assisted Suicide." It spells out six fundamental criteria very clearly.

  1. The decision must be voluntary. The doctor must make sure that this is the sincere desire of the patient.
  2. The patient's suffering is unbearable and cannot be alleviated.
  3. The patient is fully informed about his medical situation.
  4. The absence of an alternative designed to make life easier for the patient.
  5. The consultation of another doctor is required.
  6. Full medical support of the procedure.

"It is contrary to human nature itself, says my friend Annamik. - Besides, euthanasia goes against all laws of medicine. Who determines that the life of a person, even one suffering from pain or severe dementia, is less valuable than mine or yours? How can a doctor be armed with a lethal injection and be allowed to kill a patient, shortening their life path?"

In 2021, euthanasia accounted for 4.5% of total deaths in the Netherlands. In other words, 7,666 people died voluntarily due to unbearable suffering that could not be alleviated. In general, about half of the Dutch support the law and consider it fair.

The request procedure itself looks simple, but can be significantly drawn out (depending on the patient's condition and the opinion of his doctor). Contrary to popular belief, obtaining permission for euthanasia is not easy - most applications are rejected. Only one or two percent of all cases involve mentally ill patients. The remaining ninety-nine are still at the terminal stage of a serious illness, implying unbearable physical suffering.

First of all, the patient must fill out an appropriate application, where he states his request. The doctor is obliged to consider it in terms of the above six points and give his assessment. The cornerstone here is precisely the presence of "unbearable and hopeless suffering." If the family doctor agrees with the request, he will consult another independent specialist who must give his verdict. And only if they are unanimous in their opinion, will a positive decision be made.

In each region of the country there are special commissions, where medical workers, lawyers, and ethicists work. Their purpose is to supervise and check the activities of physicians in order to faithfully follow the 2001 law. These commissions pay close attention to and approve every euthanasia application. If the doctor's actions are found to be illegal, the punishment could be up to 12 years in prison for euthanasia and 3 years for assisted suicide. Since the responsibility of the medical worker is huge here, each such request is weighed very carefully by the doctors.

In January 2018, 29-year-old Dutch woman Aurelia Brouwers passed away voluntarily. This case resonated with the public because the woman suffered from a mental illness.


Aurelia Brouwers
Photo: RTL Nieuws, Sander Paulus

“I am 29 years old and I have decided to leave voluntarily. I made this decision because I have many mental problems, I suffer unbearably and without hope. Every breath I take is torture, she said. I have been suffering from depression since I was twelve years old. The doctors said that I suffer from borderline personality disorder. Then other diagnoses followed - attachment disorder, chronic depression, anxiety, psychosis, I also hear voices."

Aurelia's doctors did not approve her request for euthanasia, so she went to the famous Levenseindekliniek - "End of Life Clinic" - in The Hague. This is something like a “last resort” where patients are sent if they are denied euthanasia by their own doctor.

Jorden is the husband of my close friend. A cheerful father of five children, the youngest of which is just over a year old, and an incorrigible optimist. He lives in the center of Amsterdam, loves his beautiful wife and enjoys taking care of the kids.

“The first time I thought about death was when I was 19 years old when I saw how other cultures say goodbye to those facing death during one of my trips to Indonesia, he says. - And I thought then, if we are celebrating the birth of a new life, why not celebrate its end as well?

Yes, I wholeheartedly support euthanasia. A sober look at the end of my journey makes me extraordinarily happy, because thanks to this I appreciate every minute even more and the beautiful world I see around me seems fuller and brighter.

Moreover, I believe that our law should be more liberal, because today a huge number of people who are truly suffering cannot enjoy the right to appropriate care, although they want it. It is because I have made death a part of my future that I love life so much.”

It must be understood that the topic of death in the Netherlands is not a taboo. Most of the Dutch have a special "funeral insurance", which will, once having been issued save a person’s family from the financial and organizational difficulties associated with their death. The topic of death is openly discussed with children; parents explain to them quite clearly and precisely why they will never see an elderly relative or friend again.

Of course, the content of such conversations depends on the religious views of the parents, but it is not customary to avoid them altogether.

This is yet another example of the famous candor of the Dutch: death is part of life, and it would be cowardly to ignore it.

And if a child dying of cancer wants to discuss their own farewell ceremony with their parents, then all their wishes will be heard, recorded and respected.

My friend and colleague Richard, being an only child and with the absence of a mother, was forced to organize euthanasia for his own father. His father insisted on this for many months, while suffering from a serious illness. Richard was sure that if his father took his medications on schedule and followed the advice of doctors, there would be no talk of "unbearable suffering". But the man, being in his right mind, stubbornly stood his ground, repeating that he wanted to leave on the chosen day instead of suffering from excruciating pain for several hours when the next attack came. “Ik had genoeg, Rich” (“I’ve had enough”), he repeated to his son and again and again called the family doctor, demanding that the procedure be started. He was only sixty-seven years old.

Richard's father got what he wanted, he passed away without suffering on a clear summer’s day. Richard was with his father for the last hours, rocking him like a child, and realizing that he was no longer destined to wake up - and that this was his own choice.

After the funeral, Richard quit his job and still suffers from severe depression. I visited him several times and I myself could hardly control my emotions, seeing how a grown man silently cries for days on end in his lonely apartment. He never could forgive his father for his voluntary departure.

Child euthanasia also exists here. It can be requested from the age of twelve. For patients under the age of sixteen, parental consent is required. After the age of sixteen, formal parental consent is no longer required, but their opinion is undoubtedly taken into account in the decision-making process of a doctor. From the age of eighteen, young people no longer need any parental consent when requesting euthanasia. But of course, compliance with the six conditions is mandatory.

In April 2023, the Minister of Health of the Netherlands, Ernst Kaupers, announced that within a year, terminally ill children from one to twelve years old will also have the opportunity to die.

This concerns only a very small group of children, approximately 5-10 per year, who are terminally ill and for whom palliative care options are insufficient to alleviate their suffering.

In the media, I periodically see speculation on this topic and the usual rhetoric that goes hand in hand with it. I will say briefly - you should not think that a civilized democratic country has suddenly gone crazy and now allows every teenager with depression or some kind of imaginary illness to just legally kill themselves. We are talking about the unbearable suffering of a terminally ill child and the deep grief of their parents. This is a choice that no person in the world should ever have to make, because it is a painful road straight to hell. And God forbid the venom-spitting journalists never have to suffer it for themselves.


Photo: rtlnieuws.nl

In 2019, 17 couples received approval for couples' euthanasia. “It's becoming more and more common,” the Live in the Netherlands project says in a related article on its website. “According to experts from the Euthanasia Center of Expertise, this is still an exception and only happens if each of the spouses meets the six conditions (terminally ill, there is no other way to reduce suffering, and so on).”

Perhaps the most difficult situations are when the patient suffers from a severe form of dementia. In this case, if such a statement was made by the patient while still in their right mind, it can also be considered after the fact, that is, after the condition worsened. But such cases are very ambiguous and often, despite the desire of the patient, the opinion of their family and even the consent of the doctor, the result is a refusal.

Many thanks to Media Loft journalists and Anastasia Hasanbeik for fact-checking.

Victoria Hoogland, journalist and writer, has lived in the Netherlands for 10 years and is the author of:

"Dutch children sleep through the night" (foreword by  famous Ukrainian pediatrician Dr Komarovsky) - AST 2020
"Madame Amsterdam" (a collection of stories about the Netherlands) - AST 2022