In the case of the 84-year-old woman, the Life’s End Clinic doctor administered a fatal injection just one month after meeting her for the first time.

Seniors in the Netherlands who do not have a terminal illness are eligible for euthanasia. That is the clear message of a new code of practice for euthanasia, which is being sent to every general practitioner in the Netherlands. The normal degenerative conditions that accompany old age are reason enough now for assisted suicide. The only considerations are that the senior says his or her suffering is unbearable and that there is no reasonable prospect of improvement. The senior could still be years away from natural death.

“If a patient wants to receive euthanasia his suffering must be of a medical nature. But he is not required to have a life-threatening condition. An accumulation of old-age complains—such as sight problems, hearing problems, osteoporosis, arthritis, balance problems, cognitive decline— can cause unbearable suffering with no prospect of improvement,” says the code of practice. “It is the sum of one or more of these conditions and the accompanying complaints that can cause a suffering that—together with the medical history, biography, personality, values, and pain threshold of the patient—can be experienced by that patient as unbearable with no prospect for improvement.”

The code of practice acknowledges that the decision to administer euthanasia in such cases can be subjective. “The unbearability of the suffering is sometimes difficult to determine because the experience of suffering is deeply personal. What one patient can still find bearable is unbearable for another patient. The primary consideration is the experience of the individual patient, in light of his personal and medical history, personality, values, and physical and emotional strength,” says the code of practice. “The doctor should place himself not only in the situation but also in the perspective of the patient.”

The code of practice is issued by the regional committees that oversee how doctors carry out euthanasia in the Netherlands. They review every reported instance of euthanasia to make sure the doctor followed the law. The code of practice is intended to help doctors understand how they will be evaluated. Last year, the committees reviewed 6,585 reported cases of euthanasia and found 12 instances where a doctor had acted negligently.

The new code of practice is an update of the first one that was issued in 2015. The update is important because the Dutch Ministry of Justice recently opened criminal investigations into five instances where doctors were found negligent.

Euthanasia was legalized in the Netherlands in 2002, and the intention of the lawmakers was for the Ministry of Justice to look into these types of cases. However, up to now, the ministry had never done this. Public criticism of their inaction began to mount. Thus, the ministry finally reversed course and announced its first-ever criminal investigation in September 2017, followed by four more investigations announced in March. It is still unknown whether any of these will result in charges being filed.

Dutch doctors who administer euthanasia will probably read the new code of practice carefully. For the first time, being ruled negligent by the oversight committee could land them in serious legal trouble.

One of the Ministry of Justice’s investigations concerns an 84-year-old woman who was euthanized on the basis of an “accumulation of old-age complaints.” She did not have a terminal illness. She refused to use a walker and declined some of the treatments her GP offered, but she was in despair over her growing frailty and the loss of her independence. Her GP refused her request for euthanasia, so she contacted the Life’s End Clinic in The Hague.

The Life’s End Clinic calls itself an “expertise center for complex euthanasia requests.” They have a network of doctors who may be willing to administer euthanasia after a patient’s GP has declined. Even in the Netherlands, their work is controversial. Much of the criticism centers on the fact that their doctors do not have a pre-existing treatment relationship with the patient.

In the case of the 84-year-old woman, the Life’s End Clinic doctor administered a fatal injection just one month after meeting her for the first time. The oversight committee found the doctor negligent, and she is now under criminal investigation. She is also under investigation for a second finding of negligence for the way she euthanized a patient with advanced Alzheimer’s.

Last year, lawmakers in the Netherlands proposed the “Completed Life Bill” that would make any person age 75 or over eligible for euthanasia. The person could be perfectly healthy. That bill was put on the back burner in a political compromise.

The current Dutch government is a coalition of four political parties: two that support the Completed Life Bill, and two that oppose it. The parties agreed to commission a study into the matter, which will take at least 18 months to complete. However, as the code of practice clearly states, seniors without a terminal illness are already eligible for euthanasia. In the end, the Completed Life Bill may turn out to be redundant.