In June 1994 the Supreme Court of the Netherlands delivered its judgment in the Chabot case.(155) The case involved the prosecution of a psychiatrist who had assisted the suicide of one of his patients. The patient, Ms B, was not suffering from any physical illness. She was a 50 year old woman who had a 20 year history of depression. Her very unhappy personal life, including a violent marriage and the death of one of her sons by suicide and of the other from cancer, had resulted in her abandoning any wish to go on living. Psychiatric treatment had not helped her and she had made at least one attempt at committing suicide. For several years she had made it known to other people - including her sister, friends and her family doctor - that she wished to die, 'but in a humane way which would not confront others involuntarily with her suicide'.(156) In 1991 Ms B approached the Dutch Federation for Voluntary Euthanasia who referred her to the defendant, Dr Chabot. He concluded that she was not suffering from a psychiatric illness or a major depressive episode, but rather that she had an adjustment disorder 'consisting of a depressed mood, without psychotic signs' arising from bereavement. Her condition was in principle treatable but the chance of success was small. Dr Chabot tried to persuade Ms B to accept some form of therapy but she refused. She asked him instead to assist her suicide.
Dr Chabot was of the opinion that Ms B was experiencing intense, long-term psychic suffering with no prospect of improvement. He was also of the opinion that her explicit and clearly expressed request for assistance with suicide was well-considered, and based on understanding of her situation and the consequences of her decision. He further believed that her rejection of therapy was well-considered. He consulted seven independent experts(157) who all agreed with his assessment of Ms B's situation. None of the doctors consulted by Dr Chabot examined Ms B.
In September 1991, Dr Chabot helped Ms B commit suicide by prescribing a lethal dose of drugs. She took these drugs in the presence of Dr Chabot, a general practitioner and a friend. Dr Chabot reported her death to the local coroner as death by physician-assisted suicide. He was prosecuted under Article 294 of the Penal Code. In April 1993 the District Court in Assen applied the defence of necessity and found him not guilty of this offence. The Court of Appeals in Leeuwarden upheld the trial court's decision in September 1993. The Dutch Supreme Court, however, overturned the rulings of the lower courts. It concluded that the defence of necessity should have been rejected in this case and accordingly found Dr Chabot guilty as charged.
In the course of its judgment the Supreme Court stated the following:
the necessity defence is not limited to cases where the patient is in the terminal phase of an illness of somatic (physical) origin.
the necessity defence can also apply where a patient's suffering is entirely of a non-somatic origin (ie is mental suffering only, rather than suffering due to physical pain). A psychiatric patient's wish to die therefore can be legally considered the result of a competent and voluntary judgement.(158) Further, the suffering of a psychiatric patient can be legally considered 'lacking any prospect for improvement' if the patient has refused a realistic therapeutic alternative.
the courts must approach cases where the necessity defence is said to be based on non-somatic suffering 'with exceptional care'. Accordingly, the defence cannot be invoked in these cases unless the patient has been examined by an independent colleague/medical expert.(159)
Dr Chabot was convicted under Article 294, therefore, not because the defence of necessity could not apply in a situation where a patient's suffering was of the kind experienced by Ms B. Rather it was because he had not ensured that Ms B was actually examined by another doctor before he assisted her suicide.
Despite finding Dr Chabot guilty, in view of 'the person of the defendant and the circumstances in which the offence was committed', the Supreme Court declined to impose any punishment. In February 1995, however, Dr Chabot was reprimanded by a Medical Disciplinary Tribunal which concluded that his behaviour had 'undermined confidence in the medical profession'.(160)
In September 1994 the Dutch government revised its prosecutorial guidelines to reflect the holdings of the Supreme Court. If a patient has a psychiatric disorder, the guidelines now require the doctor who receives the request for physician-assisted suicide or active voluntary euthanasia to have the patient examined by at least two other doctors, one of whom must be a psychiatrist. The government also responded to the Supreme Court's ruling by dropping 11 of 15 pending prosecutions in relation to cases where the patient was not in the 'terminal phase' of a somatic illness.(161)
Like many other developments in the Netherlands relating to the regulation of the practice of euthanasia, the Chabot case has been used to found arguments that lead to opposing conclusions. Some commentators view the case as evidence that once the law begins to allow doctors to perform physician-assisted suicide and active voluntary euthanasia, even in strictly and narrowly defined circumstances, the categories of patients who may be legally euthanased will inevitably expand. Thus, it is claimed, the Chabot case is 'another step down the slippery slope' towards a situation where euthanasia is tolerated and practised in an (even more) unacceptably wide range of circumstances, including situations where the patient has not requested death.
Other commentators acknowledge that the Chabot case raises the real possibility that Dutch courts may in the future 'hold assistance with suicide justifiable in several categories of cases in which the person concerned is not "sick" at all (eg the case of very elderly persons who are incapacitated in various ways and simply "tired of life")' and that '[f]rom there it is only a small additional step to the case in which the person concerned is not suffering at all at the time the request is made but, in anticipation of coming deterioration, wants to be in a position to choose the time of death in advance of becoming incapacitated and dependent'.(162) They reject the claim, however, that such developments necessarily will result in an increase in the incidence of involuntary euthanasia. Some commentators also describe the Chabot case as a development that tightens the restrictions on the practice of euthanasia in the Netherlands. They argue that the Supreme Court's ruling clarifies the circumstances in which it is not acceptable (as well as the circumstances in which it is acceptable) for a doctor to help a psychiatric patient commit suicide.
