The following Fact Sheet has been prepared by the South Australian Voluntary Euthanasia Society (SAVES). For further information visit their website:


South Australian Voluntary Euthanasia Society

SAVES Fact Sheet No.22

Physician-Assisted Suicide in Dutch Psychiatric Practice


  1. In 1994, the Dutch Supreme Court ruled that in exceptional instances, physician assisted suicide (PAS) might be justifiable for patients with unbearable mental suffering but no physical illness.

  2. A comprehensive government supported survey of end-of-life decision making in Dutch psychiatric practice was carried out in 1996 and reported in the New England Journal of Medicine 19 June 1997. (See Groenewood JH, van der Maas PJ, et al. Physician-assisted death in psychiatric practice in the Netherlands. N Engl J Med 1997;336:1795-801.)

  3. The annual number of explicit and persistent requests for PAS in psychiatric practice was estimated to be around 320. (In the Netherlands (population about 15 million) the estimated total number of patients receiving mental health care is about 400,000, with the number of psychiatric patients in institutions about 26,000. In all Dutch medical practice (not just psychiatric), the annual number of requests for euthanasia or PAS is estimated as around 9700 of which about 3600 (37%) are acceded to.)

  4. Physician-assisted suicide in Dutch psychiatric practice is extremely rare. The estimated annual number of psychiatric patients actually assisted to die was between 2 and 5, ie less than 2% of the requests. At least half of these, it is estimated, would also have had a serious physical disease, often in a terminal phase.

  5. In its 1994 decision, the Dutch Supreme Court stated that:

    • the absence of a medical illness means that extreme care should be applied in assessing the seriousness of suffering and the prospect for successful treatment;

    • if the patient deliberately refuses a realistic alternative to alleviate suffering, assistance to suicide is not justified;

    • an independent expert must be consulted on all aspects of the case and must have examined the patient before giving an opinion.

    The study shows that Dutch psychiatrists fully support the spirit of the Supreme Court's concerns.

  6. Only 19% of respondents to the survey thought that consultation with at least one psychiatrist should be mandatory when voluntary euthanasia or PAS is considered because of physical suffering.

The concluding paragraph on the report of the study reads:

In Dutch psychiatry, there is a rather liberal attitude towards PAS in psychiatric patients but a very reluctant practice. Consultation of a psychiatrist about requests for euthanasia or PAS because of medical diseases is relatively rare and perhaps should occur more often, although most Dutch psychiatrists think that the primary care giver should decide whether psychiatric assessment is necessary.[emphasis added]

Further information contact SAVES at:

Or contact: Hon Secretary, SAVES, PO Box 2151, Kent Town, SA 5071, Australia - Fax + 61 8 8265 2287