The Dutch Termination of Life on Request and Assisted Suicide Act (WTL) applies to all patient groups, including patients with a psychiatric illness. According to the WTL, hopeless and unbearable suffering is required before euthanasia can be performed. In the "Chabot" case, the Dutch Supreme Court stated that the origin of the patient's suffering is not the determining factor, but its unbearableness. This means that psychological suffering can be regarded as hopeless and unbearable suffering as well within the context of the WTL. Another important requirement from the WTL is that the patient has to be mentally competent. From the Chabot case can be concluded that a patient with a psychiatric illness may be mentally competent as well, but that extra caution is required to rule out that decision-making abilities are affected by the psychiatric illness.1
To properly assess the patient's request for euthanasia or assisted suicide, the physician needs to follow the guidelines set out by the Dutch Association for Psychiatry. First, the request should be seen as a request for help. Furthermore, the request must be made known to the physician and to third parties repeatedly over a period of several months before it can be considered sustainable. Finally, it is recommended that the request of a patient with a psychiatric illness will be assessed twice by an independent physician, including one pshychiatrist.2
1. Hoge Raad 21 juni 1994, NJ 1994/656.
2. Regionale Toetsingscommissies Euthanasie, Code of Practice, Den Haag 2016, p. 26.