 I'm pleased to see such an excellent audience for this Vahedin Delancey lecture. The Vahedin Delancey lectures are funded by a trust in Jersey in memory of Baron Vahedin Delancey, who was an extraordinary man who was at various stages in his career, a doctor, a dentist, a barrister, anartcollector, a rich man and a public benefactor. And with his wealth he caused the to be created a fund to sponsor studies in and interest in medical legal matters. And the Jersey Foundation generously gave Cambridge some money to fund mainly periodic public lectures on medical legal themes. Since I've been involved in organising them, which I have intermittently since 2003, we've had a series of them on different themes. I won't give you a list of all of them, but the first one that I organised with Anjir Jumapadain's help was from Elizabeth Butler Sloss, who was president of the family division who talked about recent cases on life and death in the courts. And the last one we had, which I regret to say, was as long ago as November 2011, was Professor Peter Lachman, who talked about the effect upon the pre-availability of new medicines of tort liability of those who supply them. The lectures have been a little intermittent, but there we envisage them being a more regular picture because the faculty is in the process of creating a centre for medical law, life sciences and ethics, on the basis of a generous gift from two benefactors who also generously endowed a parallel centre in Hong Kong University. And we have one person in post and another shortly to be appointed. And we envisage that this future centre will probably take under its wing the arrangement of these lectures. The subject today, as you all well know, is euthanasia and assisted dying in the Netherlands. And to talk to us about it, we have the distinguished Dutch criminal lawyer, Lester Paul Nalis, from the Erasmus University of Rotterdam, who is part of an official commission which has been created in the Netherlands to investigate the present law and to consider discussions about, consider possible further reforms to it in one direction or another. This is topical as a subject to have heard at lecture in England because there are proposals and discussions to change the law here. For the benefit of those of you who are law students, let me remind you and for the benefit of those of you who aren't, let me tell you what the law in this country currently says. Suicide, as throughout in Western Europe, was regarded as a crime, part of a package of crimes that existed because the behaviour was morally condemned by the church. As far as the person who took his or her life was concerned, that meant here that the body was denied Christian burial and was actually desecrated by being buried at the crossroads with a stake through its heart. It was one time that the suicide's goods were forfeit to the crown. The person who committed suicide couldn't be brought before the courts, obviously. But genuine criminal liability was created for attempting to commit suicide and people who tried and failed therefore got prosecuted and sometimes sent to prison. And those who helped people taking it suicide were regarded as complicit in murder and therefore accessorised to murder and therefore liable to the death sentence which occasionally was actually carried out, though usually not. In 1961 suicide was, in turn, commas, if I may so put it, decriminalised on the recommendation of the Criminal Law Revision Committee, Professor Glangor Williams, by very distinguished predecessor, was part of this body. And I heard him sarcastically say, contrary to predictions, half the population did not immediately take coaches to beachy head and jump over. But there was great resistance to decriminalising suicide and, as part of the package, there was created a new offence punishable with up to 14 years imprisonment of aiding the vetting councillor for procuring suicide, which is still enforced. This harsh law is softened as before and threw out an English criminal law by two things. One of them is the discretion to prosecute. There's not a duty in the authorities to prosecute. The Director of Public Prosecutions has a discretion as to whether to prosecute. And secondly, in a case which ends up before a jury, what we call jury equity, that's to say juries give unreasoned verdicts, which could be unreasoned verdicts of acquittal. And sometimes juries acquit just because they've been sorry for the defendant and they don't like the law. And by those two devices the law contrives to be not as severe as it appears to be. It was nevertheless challenged recently in the courts by various people who either were helpless and people who wanted to end their lives who were either already completely helpless and not able to do it and wanted somebody to help them take their lives or who were suffering from degenerative illnesses which they thought would put them in that position. And the best known one was Debbie Purdy, who was described in the newspapers as scoring a victory in a case decided by the House of Lords in 2009. Her victory consisted of getting House of Lords to say the Director of Public Prosecutions should at least issue guidelines indicating when he would or wouldn't prosecute people for complicity and suicide, which he then did. The victory didn't do her any good, however, because if you saw the notice in the newspapers about her death at the end of last year, you'd see that she brought about her end by starving herself to death. This being the only method open to her to end her life without possibly creating criminal liability for somebody who helped her. There is before the House of Lords in its legislative capacity an assisted dying bill at the moment, which would make it lawful for people who are terminally ill to make declarations that they wish to die. And if these declarations were made then medical professionals would be allowed to prescribe them medicines that would bring their life to an end and if necessary help them to ingest it. Pretty narrow. This bill has been introduced before and not got through the House of Lords. It's halfway through its committee stage at the moment and one of the people behind it told me last week that it won't make its final stages in the House of Lords. This parliamentary session, it will all die when Parliament's dissolved prior to the general election and they'll have to start all over again. So quite likely, likely previous edited attempts it won't succeed. What are the reasons for the resistance? Well the main reason for resistance is ultimately a religious one. Life is a gift from God and it's a sin to reject it. But utilitarian reasons against changing the law are also put forward. A prominent one being the slippery slope argument. The slippery slope argument goes like this. If we create any legislative dent in the principle of the sanctity of life we won't be able to stop the country sliding from permitting those who wish to die to be helped to die through to causing people to be killed who don't want to die. And by the time we've got there the result will be the state will be deciding what useless citizens can be got rid of and it will be like Nazi Germany purging society of its useless elements. And slippery slopeers are want to point to countries where the law has been relaxed usually saying and that's what happens. Look it's just going to be like that here in this country if we change the law. And among the countries where the rules have been relaxed is the Netherlands and sometimes the Netherlands is invoked as a shocking example of how it would all go wrong if we changed the law here. So it's particularly appropriate that we have Professor Nades here who's an expert on the subject who can tell us what is actually happening in the Netherlands. Just a word if I may on my own position and referring back to the first Behadent of Lancet lecture which I was involved in organising what we had by the name Elizabeth Butler Snoss who as the president of the family division had just decided a case called involving Ms B maybe this case is no few. Ms B was a woman who suffered some terrible blood clot in the in the towards the neck which had paralyzed her from the neck down in consequence of which she was only alive by being kicked on a ventilator. And she said I don't wish to continue to live like this please turn the ventilator off and the hospital said no we can't that would be being complicit in your suicide. And it went to the High Court and Dame Elizabeth said you can't treat people against their wish artificial ventilation is medical treatment she can insist on it being stopped and so it was stopped and she died. And Elizabeth Snoss said to me in discussion before the lecture I went to the hospital and I interviewed Ms B she was wholly sane, wholly rational what she wanted to do would not have been consistent with my religious beliefs I'm a practicing Christian I would have thought it was wrong. But interestingly enough Ms B was a practicing Christian too and she'd reconciled it with her beliefs and I didn't think that it was at all appropriate for the law to force her to do something which wasn't in accordance with her religious beliefs. And I am sympathetic he was to say to what David Elizabeth Butler sloss said. That's rather a long introduction. Having delayed the start may I invite Professor Davis to deliver this lecture over to you. Thank you very much. Dear colleague let me first of all say thank you to the foundation and the faculty for having me here this afternoon and especially thanks to all who organized the trip for me to come here. I keep where she there and the other persons involved in the organization. Thank you very much. And of course thank you very much for attending this this lecture. I'm a foreigner. My English is not. Well I'm not a native speaker English apologize for that. I'm speaking to you at the end of the afternoon. There must be nicer things to do than having him to attend the lecture and of course in a good university as is in mind also. Now all things all kinds of lectures etc. So thank you very much for having making time and opportunity to be here this afternoon. And of course I'm very great and all not in a way to stand here in the tradition of my fellow Dutchman Baron Cornelius von Verhaeden de Lonsey. He was born in 1889 and he studied medicine at Leiden University in the Netherlands. There are people from Rotterdam University who say you are not allowed to mention the name Leiden University. Just say some university in the Netherlands nevertheless. He's from Leiden University in the Netherlands before he got his medical degree in in England during the First World War. I couldn't find I looked for it. I couldn't find whether he served at the front as a doctor in the British Army Army. If he had I have no doubt he would have been confronted with questions on euthanasia there. What I'm going to do with you I'm going to provide you an overview of some headlines of the state of affairs in the Netherlands hoping to give you some views and some points of discussions about the situation in the Netherlands. Partly it's typical Dutch situation so I'm not sure whether it would be useful the actual law situation in the Netherlands for the English situation and the English discussion but that's up to you. I'm going to outline a little bit the law as it stands. How did we get there? There is a certain development before the actual situation that is very relevant. I say something about some discussions about the termination of life on request and assisted suicide acts concerning these acts and I'm going to say something about discussions that go beyond that. I gave you some materials. I hope you have it before you with some legal text. I'm going to refer to that. It would be wise if you can read it with us together. It may help you to understand a little bit better the situation in the Netherlands. The actual situation in the Netherlands can best be described if we take three key moments in history. The first being the provisions of the criminal code, the actual criminal code, which came into force in 1886. The second key moment is a Supreme Court decision dated in November 1984 and the third is of course the moment that the termination of life on request and assisted suicide act got into force that is the first April of the year 2002. That's all the main things I want to address on this point of the historical development. I gave you the text of 1886 and I gave you the text of the actual text of the provisions of article 293 and 294 of the Dutch criminal code. It's worthwhile to mention that I think you know where Britain has a common law approach in the Netherlands, the continent as a more civil law approach. The written law in the code is more important than the jurisprudence although as I said one of the key moments is a Supreme Court decision. So the difference might be not that as big as you can say that it would be on theoretical grounds. I gave you the 293 provision from 1886 and the text from the actual situation. This is 294 and I have made some remarks concerning a comparison of the text of 1886 and the text now because if you can see if you compare these two texts you can find a lot of common elements that has been decided in 1886 and that still are very relevant for the actual situation in the Netherlands. That's my text. I'm going to make a few remarks on these points that are common to the text of 1886 and the actual text. First of all, article 293, 1886, euthanasia is a separate crime. It's not manslaughter. It's not murder. It's a separate crime. So a physician who commits euthanasia does not commit a murder. He's not charged with a murder case. It will not threaten lifetime or death penalty even. There's a separate crime. There is a separate provision because the legislator thought that being it a crime against life but all requests of the victim, it would be wise to have the maximum sanctions lowered from 15 years manslaughter to 12 years in the case of euthanasia. As we turn to section 294, you see different things. 294, that's suicide. Suicide as such is not a criminal act. It wasn't in 1886 and it still is not. But assisting suicide is a crime as euthanasia is a crime both in the view of the legislature both crimes underlying the same penal provision, the same interest that is the respect for the life of another person. That's the reason why euthanasia and assisted suicide both are in the criminal law. There's no distinction on this point. Even under the review procedures act there is still no distinction between these two crimes. But in the end you will see that in the actual discussion the point is coming up whether we should not make a bigger legal distinction between euthanasia on one side and assisted suicide on the other. On the other hand you can see that there is a huge difference in maximum sanction. Euthanasia is more or less manslaughter in a lighter version. Manslaughter, maximum imprisonment 12 years, euthanasia, sorry 15 years, euthanasia 12 years. On assisting suicide it was in 1886 and it is still maximum imprisonment 3 years which is very low in the Dutch perspective. It for instance means that pretrial detention is not possible into the crime of assisting suicide and there should be a minimum maximum sanction of 4 years. So it's really a different crime assisting suicide. It's seen as a different crime, it's treated as a different crime, not being a crime as such. Both are under criminal law provisions but the severness of the crime is seen completely different. And you can see this distinct view on another element in the definition of article 294. There is this element, you can see in the text, that assisting suicide is only a criminal offence if suicide follows. Without suicide there is no criminal offence under article 294 which means that a doctor who is convinced that his patient can be put at ease by saying yes I'll give you the drugs, I'll put you the medicine really, if you want to end your life I'll help you by giving the drugs. And if there are some cases, if he is convinced that exactly giving her the possibility, giving him the possibility, that would reassure his or her patient that he will not take the medicine, there are cases where people say I'm quite at ease, I can take my drugs, I know they are there, that's enough. Maybe I'll do it tomorrow and tomorrow it seems that they say well maybe next week or maybe next month. That doctor that provides that doctor in that insurance is not criminal because article 294 says it's only criminal when the suicide follows. So that's some remarks on the legal provision. As I said there are some legal provisions that go back on decisions of the legislature ever since 1886 and they have never been disputed since they are still headlines of the actual system. Then again what happened, what brought us to the actual situation, the actual agenda, that's where we get to this Supreme Court decision of November 84. There you have to understand a little bit of Dutch society based on a very intensive and comprehensive debate being conducted in literature, in media, in politics. It can be concluded that somewhere in the late 70s, so before this decision, late 70s, early 80s of the last century, there was a certain consensus in the Netherlands about the desirability of decriminalising euthanasia and assistant suicide in certain cases of exceptional medical suffering. There was an agreement in society. The subject was debated by a variety of interest groups and professional groups and in terms of legal development it was of particular interest that some legal lawyers, former members of the Supreme Court, if you google on the name entity I can hardly ask you to pronounce that in the same way as I do. And the name Drion is very famous, very, very big lawyers with a great influence and they made a case stating that euthanasia and assistant suicide should be acceptable in certain circumstances. That was really very important. But precisely because of the extensive and comprehensive nature of the debate there was very little agreement about the cases or situations to which decriminalisation should apply, the way in which this decriminalisation should be provided for by law and who should have the authority to decide or to carry out euthanasia in the cases. So the world consensus, yes we should change the law but the question and what are we going to do then, that there was no consensus on that. And although there was a certain support in society for an exemption from criminal liability with respect to euthanasia and assistant suicide there was for a long time no parliamentary majority for the change of law. You must know that we live in, well, let me put it in a sophisticated way. We have a system of coalition government and ever since the Second World War it was in a way inevitable that the Christian Democrats were in the government and of course they brought all agreements on these kind of law. It happened that it was seen as a miracle that they were outside of the government in the 80s and the 90s so that was the moment that the Socialist Party and the Liberal Party formed a majority and they tried and with success tried to change the law on euthanasia. Given the political impasse at that moment it was not surprising as such that the Supreme Court looked for ways within the existing system of codified criminal law and criminal procedural law in which it could end the punishability of euthanasia and assistant suicide in certain cases. We accept from, as I said, we have a civil law system but we accept from our Supreme Court that in certain cases where there is a certain majority in society and where there is an impasse in the legislative, the legislative can't decide. There is a certain room for the Supreme Court even in the civil law approach within the system and within the structures and within the wording of the actual court to try and interpret the criminal court, the wording of the code into the direction that would be acceptable for society. That would mean more or less a change in law. This was not the first, it was the first decision on the topic of euthanasia and assisting suicide but by far it was not the first decision in that direction. The Supreme Court has a certain room for maneuver within certain structures to changing and they took up this point. I saw that the legislature was not ready to decide, there was a lot of discussion but more or less there was consensus in society and that's where they found a solution. The ruling passed by the Supreme Court in November of 1984 is the case in which the court provided scope for non-punishable euthanasia and assisted suicide. Its formulation of the exception is based on the written general ground for exception in section 40 of the Dutch criminal code. It's in your text. Any person who commits an offence under the compulsion of an irresistible force shall not be criminally liable. This provision is interpreted as including the justification defense of necessity. That's the key word of the case of the Supreme Court. Necessity. Being a situation in which a person has to choose between conflicting duties and the court ruled that if the person in such a situation obeys the most important one and violates by doing so the criminal law his act can be justified and in this formulation the principles of subsidiarity and proportionality are applied. The court found concerning euthanasia and assisting suicide the court found that a medical doctor and only a medical doctor acting in such a conflict of duty situation and based on objective medical opinion and on medical ethical principles may justifiable opt for euthanasia if there is a conflict of duties between on one hand the duty to comply with. The law and refrain from performing acts that end the life of another person and on the other hand the duty to prevent in accordance with medical ethics and based on objective medical opinions unbearable medical suffering on the part of the patient. So they created a justification necessity and seeing a conflict of duties the doctor having to prevent his patient from unbearable suffering but within standards of medical profession and on the basis of principle and accepted principles of medical ethics. I just have to take my power point presentation. This is the ground for the court found for the exception for criminal liability for euthanasia in the context of a duty medical duty of conflict situation available to a medical doctor for an act that in itself remains a criminal offence. But the system is it is a criminal offence but there is a justification called necessity. I leave out the details of the court rulings. It led to a system with a lot of jurisprudence and it was elaborated by the Supreme Court and by the lower court in all kind of directions. But I leave that out because the the the approach that the court choose in this situation leaving euthanasia and assisting suicide within the criminal law leaving it an offence not decriminalizing it in taking it out of the criminal code but leaving it there and creating a justification that was exactly the system but in another way elaborated that was accepted by the legislature in this review procedures act in 2002. The main articles are again in your in your text and the impunity is structured as follows. As follows under the new sections, 293 and 294 of the people of the people of the people code, with the needs here and assistance suicide remains, as I said, in the criminal code. So the main element in the Dutch system still is both are criminal offenses and the main control system in the Dutch system again is the criminal system. That's the starting point. The Revial Procedures Act did not alter this qualification. Nevertheless, the legislator created a special ground for justification. They did not lean as the Supreme Court did on the general justification of this defence. They created a separate specially for the articles 293 and 294 created ground for immunity. The legislator abandoned the approach based on necessity as a general justification of law. Formulation of the ground for exception for criminal liability in the penal code. That's especially article 293 paragraph 2. That's the key point where it's all about, it's in your text. You can see there that there are three distinct conditions. First of all, the exception is only there for a doctor. No one else can address this defence. It's only created for a doctor. That's in accordance with the Supreme Court and we only allow an exception on the basis of medical norms and in accordance with principles of medical assets. The second one is that the penal code makes clear that if a doctor wishes successfully to invoke the ground for exception from criminal liability, he must report his act of euthanasia or assistance suicide to the municipal forensic pathologist. The doctor must report that's an essential criteria. He must be open and that might lead to the assessment of what he did as being no longer an offence on the article 293 and 294. The third element in this paragraph 293 section 2 is that the doctor must meet the requirements of due care set out in the review procedures act. I want to go into that act in the moment with you. So there you have it. There you have the system, a special arrangement in the criminal code referring to a special act. What are the requirements of due care under the review procedures act to which the penal code refers? Well, there are more or less obvious and you can find them in article 2 of the review procedures act. I just read them out, but you can see them reached and the doctor should reach the firm conclusion that the patient had made a voluntary and well considered request. Decision of the doctor on a well informed request. The doctor has reached the firm conclusion that the patient was experiencing unbearable suffering and there was no prospect. There is no prospect of improvement in this situation. There you have the two key elements voluntarily request in the situation of unbearable suffering with no prospect of improvement in the situation. And then you get more or less certain criteria that are more or less a little bit more procedural that the doctor has to inform the patient. He has to consult another doctor and he has of course he has to carry out the euthanasia and the assistant suicide within due medical care and attention. But there is a big difference in the situation after the act and that is of course the way in which the act of the doctor is assessed. Before the act there was an option in criminal law, there was a justification but the only instance that could say that there was a justification was the criminal court. So the doctor had to be prosecuted and then the court had to say yes in this case the justification of necessity is there. And that of course is a big problem because the doctor has to go to court he has to be prosecuted he will be in open trial he will be charged etc. So the review procedure act did not alter in a way the substantial criteria that the Supreme Court accepted in the 1984 decision. But in essence they changed the way in which the act of the doctor is assessed. In the new act you can find this multidisciplinary assessment committee they will say they will teach they will review the act of the doctor. They will conclude whether the doctor did upheld the criteria of article 2 of the act. As they found as this committee multidisciplinary there is a lawyer in it we are always there as a lawyer. Of course it has to be because it is a justification under criminal law a lawyer a doctor and an expert on medical ethics. These three form in all cases this review committee we have five regional committees. If the committee says yes we think that in a certain case the doctor met with all the criteria then the case is over. The public prosecutor will not be informed theoretically the public prosecutor could prosecute a doctor because it is the policy of the criminal act so it is not a binding decision. The committee says in all of you this was in according to the law but there has never been a doctor prosecuted in the case that the criteria were upheld. In the other situation if the assessment the review committee says well we think in this case not all the criteria are upheld then they leave it to that. They don't give an opinion whether there should be prosecution. They leave that to the prosecutor's seat. The case is handed over to the prosecutor's seat and then the prosecutor's seat has to decide whether it is a case to prosecute or not. It depends I say something about that in short notice it more or less depends the decision depends on exactly on what criteria the review committee thought that the doctor did not upheld the criteria of law. So that's the system within the criminal law system we have more or less a review committee being if you want more or less a front office for the prosecutor's seat they made the first outside public prosecutor and they made the first assessment and if they found that the doctor upheld the law then it's death then we leave it to them. That's the system that we now have it's completely based on an act of a doctor in accordance to medical ethics to medical standards assessed by a committee so that's very limited and it still is a provision under criminal law. We trust doctors to do so doctors except this system they found that they think there are cases where they can make the decision to go all the way with the patient in euthanasia or in assisting suicide. They have developed their standard norms for this situation and I think that's very important they accept from each other that other doctors do not have the same opinion the whole system is based not absolutely not on the right of a patient but it's all based on what we allow doctors to do in accordance with their standards and the law always says the doctor can act the doctor may do it. I think assist in suicide and within doctors there is room for one doctor to say yes in this situation I think it would be possible to help a patient to suicide where another doctor says no for me for personal reason or for medical reasons whatever I'm not so far yet so there is within our system our health system the doctors have taken up this point the complete approach. On doctors and ready to report cases of euthanasia and assisting suicide it's well it's more or less working because that of course is the big question does it work I would say in a way yes in a way it would and that's not that's not too bad as as such. First of all doctors do report I think that's the main success of the gut system and the main element of the system as a criminal lawyer one could ask questions but it's typical the pragmatic Dutch approach that we don't ask difficult questions as long as there's no necessity for it so we'll leave the question there there are some research there are some surveys I gave you the English. The English summary of some in in in the text you see my email address on the first side if you have any questions I'm to a certain extent ready to answer them the awesome surveys on which we can more or less reliable conclude that up to in 80% 80% of cases of euthanasia and assisting suicide they really are. Reported by doctors which is very high and it's rather high over the year so there's a success so the key point we trust doctors to report cases yes that's a success nevertheless there is a gray area a gray area between euthanasia and palliative sedation. There are cases where it's not clear palliative sedation is accepted as normal medical treatment there's no problem there's nothing to report there is no criminal offense whatsoever and of course the problem is there that doctors can define cases can see cases can accept cases or can even not with this immediately. Bad thoughts but can see what we lawyers would see as euthanasia they could see as palliative sedation and the difference is somewhere there where doctors say well in cases of palliative sedation I'm not I'm not looking I'm not I'm not I'm not I'm not killing my patient I'm not looking for his death I try to help him. And yes the result may be that he dies a week earlier something like that but that's not what I'm aiming at I'm aiming at release of pain well yes of course but there are of course cases where we criminal lawyers would see that as intentionally killing another which might be as it is a request a form of euthanasia. So there is a gray area and in my view the gray area is a little bit awesome figures figures are not not not not clear but there might be some 2% of all dying cases where there is something unclear whether is this normal medical treatment called palliative sedation or is this a criminal act called euthanasia or assisted suicide. So there is a certain problem and we point there in the year 2010 the committees where is the no in the between 2007 and 2011 so for four years out of a total of 13,918 13,911. 18 cases they reviewed this committee there were exactly 36 handed over to the public prosecutor as being cases where the committee said we don't think that all the criteria were met there so that is very few is that a success. Yes. Nevertheless, one might come to the conclusion that report that doctors seem to report more or less. Well excellent cases. The best case clear cases where there is no discussion 36 cases out of 13,900. You could you could see there is a discussion do these committees assess review strict enough. We accepted so far that as I said euthanasia and assisted suicide still under criminal law. The prosecutor can prosecute even when the committee says this is in accordance with the law if the prosecutor says yes but but you reach that conclusion in an interpretation of the law interpretation of the criteria that we do not accept then the doctor might be prosecuted. We did not have any cases of that so there is more or less and there is more or less the success of this law being accepted. Nevertheless, in these 36 cases none of them has led to criminal and 36 when the committee says the criteria were not upheld were not met out of these 36. No one was prosecuted. No case was prosecuted. No doctor was prosecuted. That makes me a little bit suspicious as a criminal lawyer to put it mildly. Of course, as I said, if you look to these criteria you can see two more or less substantial criteria requests and suffering and in these 36 cases there are a lot where the last criteria is not upheld. The last criteria is the way in which the euthanasia and assisted suicide is committed. Well that of course is not immediately a criteria that leads to the conclusion that if it's not met out of the series of parents and it's not only substantial level. Nevertheless, there have been cases where a doctor did not consult, as is one of the criteria, did not consult a second doctor and still the prosecution saw now ground for prosecution. As an England, the prosecution or prosecutor does not have to prosecute. There is room for manoeuvre. Nevertheless, as I said, let me put it very, very, a little bit in this way carefully. Out of 36 cases where the criteria were not met, no prosecution that makes me suspicious. I would really like to know more about what happened in these cases. I'm going to do some research in the next years. I'll be back in a few years. There's not a reason to do that, which I'll come to that later. One could conclude in general that it works, the system works for what I could say the standard case. What we could say the standard case. The standard case is a mature patient, heavily suffering cancer from a medical source, a medical disease, which does not affect him mentally. He knows mentally what he's doing, he's capable of making his own decisions, and he is suffering in a way that can be recognized by the doctor, by others in his surroundings as unbearable and without any perspective. That's the standard case. That's the majority of cases in which, by far the majority, some 85%, that are this standard case where people got euthanasia and normally have the expectation of life less than a month. So it's really cancer not affecting the mental capacity in the end version and then euthanasia is a way of preventing further suffering. That's the big majority of cases in the Netherlands, therefore we have a modality that is accepted within the Netherlands because the prosecution has a huge discretion, we accept this system of having some acts under the criminal law, but exactly because it's a criminal law, exactly because the procuracy has a possibility to deal with that, we don't actually apply criminal law as long as certain criteria are of health. If I look in this audience, it's dangerous to say it this way, I see people of different age, some of you, I won't conclude which category, but some of you must admit in the Netherlands and know something about what a Dutch coffee shop is about. A coffee shop is everything else than coffee. If you want a cup of coffee, don't go to the coffee. This complete system is based on the same principle. Everything that is happening in the coffee shop is under criminal law, it's explicitly kept as a criminal offence, nevertheless that means we could apply criminal law, but we don't, the prosecutor doesn't, as long as a coffee shop owner met certain criteria, which of course is different than these from butaneasia, there are criteria like... The criteria there are no hard drugs, no minors, take care that the neighbors do not get annoyed, no alcohol, etc. So a coffee shop is an ongoing criminal offence, but it's more or less tolerated. There's the Dutch approach, exactly the same, more or less exactly the same. We take that approach, that's the machinery that we take for euthanilia, but within this machinery it's only the doctor that has the possibility to apply for acts of euthanasia and assisted suicide that is not a criminal. So the standard case, we handle the standard case, but of course that leads to a lot of discussion about the not standard case. We should be a little bit reluctant, you will hear a lot of discussions of the Netherlands, that is this picture of in the Netherlands, we had some people, I'm not sure, I thought they were from America, and they had made a stock order, a simple apple, and they asked them for well over 80, I had saved in the Netherlands, but they stopped there, they had given the Netherlands more, etc. Well that's not the case. There was some discussion, as I said, standard case. There's no discussion about that, and that makes out of, that makes some 85%, something like that, of the cases. What are the categories outside the standard case? Well first of all I won't say too much about it, but if you read section 2 paragraph 2 of the Act, then you can see there are some lines about the advanced directive, and if you read that you can of course imagine that that gives some problems. How far does such an advanced directive go, and how far may, and you see there the same construction, if there is an advanced directive, it says the doctor may use that directive, he may act upon that directive, but that directive is only one of the criteria. The doctor should be convinced that all the criteria are met in the situation. Well that's an unclear situation, there you have this compromise idea again in our Act, that's an unclear situation that we are discussing at the time. The other one is minus, of course as such, minus cannot request suicide or euthanasia without, well the section is that between 12 and 16 years, a minor cannot ask for euthanasia and a 16 suicide result at the decision of the parents, the parents can decide. The rock case is now where doctor said we have seen minus 15, 14 years from their cancer, in a way more mature to bear their suffering, to handle their suffering than their parents. The rock case is where doctor said the patient is taking his suffering, his cancer, his death, the parents are in the situation of complete denial, we can't discuss it with them, but they say no, we don't want to talk about it with them, that's a problem. And we have a case where parents are forced and where one says yes and the other says that's why I said no, if the other said no. So there are some cases coming up with the doctor saying I've seen the patient is a minor, but in a way he handles this situation by far more mature than some parents. There were some reports that this was one of the problems. Then the case of others done medical doctors. As I said, the whole system is based on a decision, the only justification possible is a decision of a doctor. We had a case where a man doctor assisted his mother in suicide. That's a criminal offence, there's no justification, the act is not applicable. So the prosecutor prosecuted him, and the court said yes, it's a criminal offence, there's no reason for any sanction. Saying we recognize here that it was a dress and we recognize here that this is a criminal offence. But in the circumstances of this case, we accept more or less the assistance of this son, the careful assistance of this son, in helping his mother. Of course that will lead to more discussion. If the court says here you have, and you hear the echo of the court decision from 1984, courts see discussion in society, and courts try to help to find a solution. A solution here might be yes, it's a criminal, but no reason for sanction. Of course in the next case, the prosecutor has to think three times before he prosecutes. The end might be yes, it's a criminal, but no sanction. And then again the last version of discussion, then we go beyond the scope of the medical approach. Actual system accepted in society, let me stress that again, standard case, then we accept there is a discussion and not the picture as we are going to kill everybody etc. There is a discussion, nothing more yet, about what is known as completed life. People who just have the feeling my life is completed. I'm not suffering from something medical as such, but my life is completed. Let me add one word on the first bullet here, the scope of lasting and bearable suffering, the case of dementia, people who suffer from somatic suffering, but who are mentally disturbed in a way, it has never been excluded, that might be suffering in the meaning of the act. Also mentally suffering, suffering from mentally disorder, can be to suffering as mentioned in the act. As you see in the act there is no limitation of suffering to cases of only somatic suffering. There are only very few cases, all of them are assessed as being within the scope of the world, and there are some in the jurisprudence of the review committees. There are some lines of more cautiousness, more careful decisions, if a patient is claiming euthanasia or assisting suicide, suffering, not from a somatic disease, but from mentally disorder, we are more connected in that, but it is as such possible, it was not excluded by the court in 1884, and it is not excluded in the actual law. Nevertheless, there still has to be a medical ground for the suffering, and the case of completed life is the discussion about what would be behind medical grounds, what would be the situation that people just say, I am not suffering, but my life is completed. I have just had, my life is over, but my body is still there, that's it. Well, there is discussion, and there is this committee where I have the honour to be a member of. There is discussion, and the instruction to the committee is, the committee will carry out the aforementioned study into legal possibilities with respect to assisting an individual who considers his or her life to have run its course in committing suicide, and we also analyse the social dilemmas in this context. The study's core focus will be on how the wish of a growing group of people in the Netherlands to have a greater right of self-determination in terms of the assistance to be received when they have made an end-of-life decision can be met in practice. At the same time, it is of paramount importance that abuse is prevented so that people feel free and feel safe. So here you have the related approach. We are talking about it, and you see the key word here, self-determination. The system in the Netherlands still is very, well, let me say it positively, based on the darkness decision, there is no right to use media, there is no right to assist in suicide, there is no right to self-determination in law, there are possibilities for a doctor based on medical standards, that's the actual situation. If we would go and accept this concept of complete life, then basically the only reason can be, of course, the right of self-determination, which would be a huge step, not only in a change, but not only in a change in the underlying theory of why we accept euthanasia and assisting suicide in certain cases, but of course in the bill, I made it a little bit clearer, and it will change the complete system of control and criminal law control because that is all based on a doctor's decision now and the doctor is the only one who can call for justification, and the first criteria is he has to report these cases. How are we going to set up such a system of acceptance and reporting if the decision as such is in the line of self-determination, based on self-determination and not on other grounds? They haven't seen for the first time, as I said in the beginning, but we have treated so far euthanasia and assisting suicide, always together, both are crime, both are under this active criteria, and I didn't say here for the first time people argue that if we would go to the concept of complete life, then it might be for the first time better to make a written distinguish between these crimes and allow only assisting suicide in cases of complete life. The committee is still discussing and thinking, not on the one hand, because all of the members is for the one and wrong, and you are very much wrong. But we will continue to discuss the report in the expected in the second half of this year and I can guarantee you that at least a summary in English if not the complete report can be translated. That of course is a question of money and that's always a very sensitive topic in the Netherlands. I hope to make clear that in a way we have more or less typical Dutch provisions coming from an accepted discussion and accepted situation in the Netherlands. The act is a success for the standard case which nevertheless make out 85%, something 80-85% of all cases. So it is a big success. It is seriously debated for other cases. So far there are people who say mentally suffering from mental disorder this is very very complicated. There is a sort of call for do we not go too far. Others say no we don't go far enough. But this case of completed life should be made possible. Again I underline we are only discussing that there is not a majority consensus on this point of completed life in society as it was before the Supreme Court ruling in 1984. Well, the big question is in how far can we do we want to keep up the actual system based on the decision of a doctor, based on a medical decision controlled over the system of being a medical decision with an obligation for the doctor or other cases. Maybe we move I don't know more to a right on self-determination if we go in that direction that would mean a complete different system that alone would take some time and consideration. Maybe there will be a bigger distinction between euthanasia and assisting suicide. I know that I gave you a lot of information about the Dutch situation maybe you can rethink it over again the risk and if you go to the internet a lot of literature in English about the Dutch situation nevertheless I hope to have to give you some overview and even illuminate a little bit that we have a rather strict system under criminal law. You cannot come to the Netherlands have an intake interview at the clinic at 2 o'clock in the afternoon at 3 o'clock That's absolutely not out of the question now doctor will do that. Thank you very much.