Although euthanasia is widely practised in the Netherlands it remains technically illegal. It is not allowed by statute, but the law accepts a standard defence from doctors that have adhered to official guidelines. These hinge on voluntariness of the request and unrelievableness of the suffering. It is not a condition that the patient is terminally ill or that the suffering is physical. "Euthanasia is popularly taken to mean any form of termination of life by a doctor. The definition under Dutch law, however, is narrower. It means the termination of life by a doctor at the express wish of a patient. The request to the doctor must be voluntary, explicit and carefully considered and it must have been made repeatedly. Also, the patient's suffering must be completely unbearable and without any prospect of future improvement. Pain relief administered by a doctor may shorten a patient's life. As is the case in other countries, this is seen as a normal medical decision in terminal care and not as euthanasia." .
Doctors will not be prosecuted if they have met the substantive requirements published by the Royal Dutch Medical Association in 1984. These are that the patient makes a voluntary request, the request must be well considered, the wish for death is durable, the patient is in unacceptable suffering, and the physician has consulted a colleague who agrees with the proposed course of action.
The Royal Dutch Medical Association and the Ministry of Justice in 1990 agreed a notification procedure with the following elements, subsequently laid down in regulations under the Burial Act. The physician performing the euthanasia or assisted suicide does not issue a declaration of natural death, but informs the local medical examiner of the circumstances by filling in an extensive questionnaire. The medical examiner reports to the district attorney, the district attorney then decides whether or not a prosecution should be instituted.
