No one wants to imagine that war, social disruption, or a cyberattack could affect the Netherlands. Yet, there is legislation in place that governs what must be done in such situations. But what is expected of healthcare providers when society is in chaos? And who even knows these rules? Martin Buijsen, Professor of Health Law at Erasmus School of Law, delved into Dutch legislation at the request of Medisch Contact and stumbled upon an unknown but important law.
Responsible care in times of crisis
Even in times of crisis, doctors are expected to act according to their oath and the professional standards established within their field. These professional standards apply not only to doctors but also to other healthcare providers such as dentists and nurses. These professions each have their own professional norms. "The Wet op de beroepen in de individuele gezondheidszorg (Healthcare Professionals Act) – the Wet BIG for short – states that doctors and other BIG-registered healthcare providers must provide responsible care under all circumstances," explains Buijsen. "This applies even when war breaks out or society collapses." This principle is also assumed in the Wet op de geneeskundige behandelingsovereenkomst (Medical Treatment Agreement Act – Wgbo), although there will usually be no formal treatment agreement in such situations. However, according to Buijsen, in certain scenarios, like war, it does not matter that there is no legal treatment relationship between healthcare provider and patient. Ultimately, he says, the key issue is that those who need care must receive it.
Special times, special laws
If extraordinary circumstances occur in the Netherlands, the government can declare a state of emergency. Under the Coördinatiewet uitzonderingstoestanden (Coordination Act on Exceptional Situations - Cwu), emergency laws can be enacted in situations such as war, social disruption, and disasters. "The government must declare the state of exception, and the Dutch Parliament must decide on its duration. These laws regulate the tasks and powers of the government, provinces, and municipalities in such a situation. Furthermore, it regulates which fundamental rights can be restricted, and so on," says Buijsen. Based on the Cwu, limited emergencies and full-scale emergencies can be declared. Once the Cwu is in effect, other emergency laws may also come into force.
The unknown Emergency Law for Healthcare Providers
In his search for answers for Medisch Contact, Buijsen came across a surprisingly unknown law. He says, "What I did not know is that with the declaration of a state of emergency in extraordinary circumstances, the Noodwet Geneeskundigen (Emergency Law for Healthcare Providers) can also come into effect. I think very few health law experts have ever heard of this law. And I wonder how many doctors are familiar with it themselves. It is an old law from 1971 that was amended in 2021. The emergency law allows healthcare providers to be 'mobilised,' so to speak." But the law is broader than just doctors. Other healthcare providers – from pharmacists to midwives – can also be called upon. And it does not stop there. Even students and retirees without an active BIG registration can be obligated to provide care in emergency situations.
Calling upon healthcare providers
Under the Noodwet Geneeskundigen, healthcare providers can be ordered to continue working in crises and keep their practice open. It is also possible that healthcare providers could be forbidden from leaving the country. "But you could also be instructed to work outside of your usual location – for example, in an affected area. You could then be required to provide care that normally would not fall within your job description," Buijsen states. As an example, he cites a psychiatrist who must treat war injuries. Buijsen continues: "The law does not go into detail, but the possibilities for imposing far-reaching obligations on doctors – once the state of emergency is declared and it is determined which parts of the emergency law apply – are indeed significant."
What if a healthcare provider says 'no'?
Refusing such obligations is not without consequences. The law provides for criminal penalties: depending on the severity of the violation, a fine or imprisonment may apply. Buijsen explains: "There is a progression in the severity or duration of the punishment. A prison sentence can be imposed for one month, three months, or a year." Additionally, professional disciplinary law remains in force. According to Buijsen, the second disciplinary standard would certainly apply. This standard concerns acting in violation of what a proper professional should do. Violating this standard can lead to a warning, reprimand, fine, suspension, or even the loss of the right to practice the profession. Thus, a healthcare provider who refuses to provide care could face criminal consequences and jeopardise their career.
The law offers protection and regulates what is expected of healthcare providers in times of crisis, but let us hope we never actually have to rely on emergency legislation.
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Want to read the full article from Medisch Contact? Read it here (in Dutch).
