Paperwork, tick boxes and review committees. No one but the doctor is watching until after the patient is dead.

The heavy bureaucracy built into assisted suicide and euthanasia laws are supposed to keep people safe – to ensure that they are making a competent, uncoerced decision to die.

All of this is in the hands of the primary medical professional until after the patient has died, and a review committee reviews that everything has been done according to the law.

But what if something went wrong? What if the patient was coerced? Or what if they weren’t competent to make the decision to die? A review committee can’t bring the patient back, and, internationally, they have even been reluctant to punish doctors who get it wrong. Across both the Netherlands and Belgium, despite review committees questioning the judgment of medical professionals in dozens of euthanasia deaths, only two cases against a doctor have been handed over for judicial review.

And that’s when all the paperwork has been filed and the doctor has reported that a euthanasia death has occurred. In the Netherlands, at least 23% of euthanasia deaths aren’t reported despite being required by law. In the Flanders region of Belgium, that percentage jumps to nearly 50%.



The End of Life Choice Bill proposes that a doctor submits paperwork to a Registrar, who would be responsible for checking that the process has been complied with before the death goes ahead. However, because the doctor-patient relationship is based on confidentiality, the Registrar would need to take doctors at their word. It would be up to doctors to report whether they followed all the requirements. If they cut corners, the only witness may be the dead victim.

Sources: B D Onwuteaka-Philipsen et al., “Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey,” in Lancet (2012) 380(9845): 908-915; T Smets, J Bilsen, J Cohen, et al., “Reporting of euthanasia in medical practice in Flanders, Belgium: cross sectional analysis of reported and unreported cases,” BMJ (2010) 341:c5174.