Euthanasia

"Existential" suffering not a justification for euthanasia

Tony Sheldon, Utrecht

A legal test case has defined the limits within which doctors in the Netherlands, especially general practitioners, can agree to a patient's request for mercy killing.

The judgment draws a line between suffering of a medical naturethe result of a physical illness or mental condition on which doctors can act under the euthanasia lawand "existential" suffering, often associated with ageing, resulting from loneliness, emptiness, and fear of further decline. It accepted expert opinion that doctors had no expertise to judge such suffering.

Setting aside last year's acquittal, the court found GP Philip Sutorius guilty of helping an 86 year old man with no serious physical or mental illness to commit suicide. But it imposed no punishment, recognising that the GP had acted out of great concern for his patient.

The previous acquittal had accepted a broad interpretation of suffering "unbearably and hopelessly," one of the criteria required to protect doctors against prosecution for euthanasia (BMJ 2000;321:1174). It accepted that Dr Sutorius's patient, former senator Edward Brongersma, had endured such suffering. He was obsessed with his physical decline and hopeless existence. He had spoken with Dr Sutorius on up to nine occasions of his wish to die.

But the appeal court accepted that the problems faced were not medical ones and that GPs had no expert experience in these questions. It believed Dr Sutorius had promised too soon to fulfil Mr Brongersma's wish to die, rather than seeking other solutions for