Active and Passive Euthanasia are Different; Here’s How

After the death of a Dutch teenager was misreported as a case of euthanasia, questions on the law have resurfaced.

Among the most relevant, diverse and heated discussions of all times is the debate on euthanasia (the will to die in peace). Deliberations on the issue have been wide-ranging; covering the moral, ethical and financial implications of the law and how different countries choose to interpret it.

The tragic death of a 17-year-old girl, Noa Pothoven, after years of depression and ‘unbearable pain’ caused by traumatic experiences in her past, caught the world’s attention for multiple reasons. Widely covered by major news publications, it was claimed that the teenager, who had been raped and molested as a child, had chosen to die by refusing to eat, drink or take her medication, and that she was allowed to do so by the country’s euthanasia law.

Apparently, they had all gotten it wrong. Politico Europe correspondent Naomi O’Leary posted a series of tweets saying that Pothoven had died by suicide, not euthanasia, and the spread of wrong facts was “infuriating.” She tweeted that she had spoken to Paul Bolwerk, a Dutch reporter who was covering the story for their local newspaper DeGelderlander, who confirmed that Pothoven had been severely ill with anorexia and other conditions for some time.

Without telling her parents, she sought and was refused euthanasia.

The confusion, then, was that if her family and doctors had complied to her decision of not eating, and decided not to force-feed her, could it be termed as passive euthanasia? And if yes, is this form of euthanasia recognized in Netherlands?

We break it down for you.

What is Active and Passive Euthanasia?

To begin with, let’s make it clear that the way euthanasia is understood and interpreted across the world varies in its intricacies.

Euthanasia is defined as the painless killing of a patient suffering from an incurable disease or an irreversible coma.

Writing for FIT, Dr Ashwini Setya explained the difference between active and passive euthanasia:

• In active Euthanasia a poisonous / toxic substance is administered to bring death which may even be an overdose of a prescribed drug. Active euthanasia is illegal in most jurisdictions. Dying person actually dies from something other than the disease.
• On the other hand, passive Euthanasia is caused by withdrawing the life support system or omission of medical care. It is refraining from the action that would delay death, thereby allowing natural death to occur. So the death is caused by disease and not external factors.

Euthanasia in Netherlands

According to Royal Dutch Medicine Organisation, “Euthanasia is defined as the active termination of life at a patient’s voluntary and well-informed request. Physician-assisted suicide (PAS) also comes under this definition.”

However, it is subject to strict conditions.

There is no right to euthanasia for patients in the Netherlands and physicians are not under any obligation to perform euthanasia.

Euthanasia is still a punishable offence under the Dutch Penal Code, and is only permissible if the relevant due care criteria are met, as laid down in Dutch legislation. These criteria include a “voluntary and well-considered request from the patient, unbearable suffering without any prospect of improvement, and the lack of a reasonable alternative.”

The Guardian reports that as per available figures, 4 percent of all deaths in Netherlands were from euthanasia, wherein most of them had been suffering from incurable cancer, neurological disorders or cardiovascular disease. Notably, only one was under 18.

The patient must also have been fully informed of their condition, prospects and choices, another independent doctor must agree with the request, and a doctor must be present when the procedure is performed, either by the doctor or the patient.  

For children aged between 12 and 16, the consent of parents is required.

Considering these facts and the latest updates in Noa Pothoven’s case, her death may not be considered a case of euthanasia as it was neither active termination of her life by a physician, nor a physician-assisted-suicide.

The report by journalist Naomi O’Leary after her conversation with the Dutch correspondent stated, “This is a deeply contentious area of medicine and ethics, and norms differ around the world, but the answer is no.”

(This is a developing story and will be updated as fresh details emerge)