Patient Autonomy and the Defence of Medical Necessity: Five Dutch Euthanasia Cases


  • Barney Sneiderman
  • Marja Verhoef



In the Netherlands, physicians are allowed to practice euthanasia pursuant to medico-legal guidelines established by the Dutch Supreme Court. The Court has in effect carved out a defence of medical necessity for physicians who would otherwise be convicted of Penal Code offences that are likewise found in the Canadian Criminal Code. The Dutch euthanasia policy, or EAS (euthanasia and assisted suicide), applies to both consensual lethal injection and assisted-suicide scenarios. The Dutch policy is grounded in the bio-ethical principles of patient autonomy and beneficence. The law stipulates that the request for death must be the voluntary choice of a mentally competent patient whose suffering is unbearable and irremediable. This article discusses the application of these principles in the context of five Dutch EAS cases. The cases illustrate how a commitment to autonomy/beneficence can lead to a broadening of the patient-centred criteria which would justify a physician in taking active steps to end life.