According to article 7:488 of the Dutch Civil Code, physicians are required to inform patients about the intended examination, the proposed treatment and the developments concerning the examination, treatment and the health status. Subsequently, article 7:450 of the Dutch Civil Code requires a physician to ask the patient's permission for all medical treatments. Without the permission of the patient, a physician is not allowed to carry out medical treatments. The patient has the right to refuse treatment, but also to withdraw a previously given permission.1
With the ageing of the population, the increasing possibilities of prolonging life and the increasing need for self-determination in the Western world, written advance directives become increasingly important. As people age, the chances are higher that the patient is no longer able to give verbal permission for treatment, e.g. when the patient suffers from dementia. In these cases, a previously completed advance directive can be used to determine which treatments the patient prefers. A distinction is made between negative and positive advance directives.
In negative advance directives the patient refuses to give permission for certain medical treatments. For example, a patient can indicate that he or she does not want to be resuscitated after a cardiac arrest. According to article 7:450 sub 3 of the Dutch Civil Code, negative advance directives, which were completed when the patient was mentally competent, have to be followed by healthcare professionals and the respresentatives of the patient. The content of the advance directive should be clear, with no room for interpretation. Moreover, the advance directive should include the patient's name, the date and the signature of the patient.
In a positive advance directive, the patient gives permission for certain medical treatments. It can also contain a request for a certain treatment, for example a request for euthanasia. In the so-called euthanasia declarations the patient indicates under which circumstances he or she wishes euthanasia. It is recommended that the patient consults his or her physician when drafting the euthanasia declaration, in order for the physician to assess whether or not the patient's request was well-considered and voluntarily. Furtermore, it is important that the patient clearly describes his or her interpretation of hopeless and unbearable suffering. Such a declaration is no guarantee that euthanasia will actually be performed, since there is no right to euthanasia. However, the declaration can clarify the patient's wishes and expecations, wich the physician can take into account.2
1. H.J.J. Leenen e.a., Handboek Gezondheidsrecht, Den Haag: Boom Juridische Uitgevers 2014, p. 375.
2. Regionale Toetsingscommissies Euthanasie, Code of Practice, Den Haag 2016, p. 23-24.