Non-punishable assistance in intentionally ending one’s own life outside the Termination of life on request and assisted suicide review procedures Act

This thesis primarily focusses on non-punishable assistance in intentionally ending one’s own life outside the Dutch Euthanasia law (the Termination of life on request and assisted suicide review procedures Act). It starts with the historical and legal background of assisting someone who intentionally ends one’s own life in the Netherlands. Dutch case law has clarified that assistance in intentionally ending one’s own life is not punishable when this assistance is limited to (1) having conversations about the wish to end life, (2) offering moral support (including being present on the condition that no active assistance has been offered), and (3) providing general information about methods to end one’s own life. Several Dutch right-to-die organisation offer this non-punishable assistance in the form of non-directive counselling. The aims of this thesis are (1) to clarify which people seek such non-punishable assistance; (2) to clarify how seeking such assistance is related to seeking physician assistance in dying; (3) to clarify how counselees experience the assistance they received; (4) to describe the number and the characteristics of people who have intentionally ended their own life after receiving such assistance; and (5) to describe the characteristics of the counselling they received. Furthermore, this thesis gives an estimate of the number of people who intentionally ended their own life in the Netherlands, and describes their characteristics. The results are derived from a nationwide mortality-follow back study among physicians, a cross-sectional study amongst counsellors working with right-to-die organisation Foundation de Einder, and an in-depth interview study with counselees who sought assistance from these counsellors. The main findings are interpreted in relation to three overarching themes: (1) the terminology for assistance in dying, (2) physician involvement with people intentionally ending their own life, and (3) the practice of assistance in intentionally ending one’s own life outside the Dutch law on physician assistance in dying. The thesis concludes with several implications and recommendations for further research, practice, and policy