The decision by doctors at Maastricht UMC+ to end treatment for three-year-old Yasmin Ansam Mohamed has sparked strong emotions. Yasmin suffers from a severe genetic disorder, has been on a ventilator since February, and, according to her doctors, has no prospect of recovery. In late June, a court ruled that the hospital had acted with due care. Nevertheless, public reactions followed, including threats directed at the hospital. What does health law say about such difficult decisions? Martin Buijsen, Professor of Health Law at Erasmus School of Law, discussed the case in both NRC and De Limburger. In the latter, he states: "Ultimately, there is little one can do but accept it, if the ethical code prescribes that treatment must stop."
What does medically futile mean?
When doctors decide to stop a treatment, this is never done lightly. It must first be determined whether further treatment is medically meaningful. According to Buijsen, this assessment lies with the physician. In De Limburger, he explains: "As a patient, you have a right to treatment. However, only insofar as that treatment is meaningful. You cannot demand interventions that achieve nothing. Medical ethics dictate that treatment must cease in such cases. And yes, the doctor may decide this unilaterally."
Medical ethics are based on professional guidelines specific to each medical discipline. Buijsen explains that each field establishes its own standards, which are laid down in codes of conduct. These norms are embedded in the Dutch Medical Treatment Agreement Act (WGBO), which outlines not only patients' rights, but also a doctor's right to refuse treatment.
In Yasmin's case, doctors concluded that no treatment options remained that could offer a prospect of recovery or even a minimal level of functioning. The ventilator served only to prolong her life artificially, but without any medical perspective. Based on this, the doctors decided to cease treatment.
Clashing beliefs
Yasmin's parents disagreed with the decision made by Maastricht UMC+. In court, they appealed to their freedom of religion, arguing that ending treatment is unacceptable while the heart is still beating. However, according to Buijsen, this freedom is legally limited in scope: "Freedom of religion is generally a defensive right. Healthcare and medical practice do not infringe upon that freedom. If patients refuse treatment for religious reasons, even if that treatment is life-saving, doctors must respect that, provided, of course, that the patient is deemed mentally competent."
Mentally competent
A person must be deemed mentally competent to independently decide on a medical treatment. This means they can understand the doctor's information and grasp the consequences of their decision. Everyone is presumed competent unless proven otherwise. Competence is also context-specific: someone might be able to make daily life decisions but be unable to understand the implications of a complex medical procedure. If someone is not competent, a legal representative makes the decision. In the case of children, this is usually the parents.
It is different when a patient or family requests treatment on religious grounds. Buijsen clarifies: "If patients request a particular treatment for religious reasons, it will only be provided if it aligns with the professional standards of the healthcare provider. Those standards are decisive. In this case, further treatment was deemed medically futile. The professional standard then prescribes that treatment be stopped. Religious arguments cannot compel doctors to act against their professional judgement."
In NRC, Buijsen highlights the importance of intercultural communication in hospitals. Spiritual counsellors who share the patient's cultural background, he says, can play a key role in bridging cultural divides. "It helps if someone at the hospital can empathise with the patient's and family's cultural framework."
Treatment abroad and crowdfunding
The court ruled that Maastricht UMC+'s decision to stop Yasmin's treatment was made carefully and in line with professional standards. Following the ruling, supporters raised nearly €150,000 through crowdfunding for a possible treatment in Egypt. Yasmin's parents were grateful for the gesture but ultimately decided not to pursue this option. What if they had chosen treatment in Turkey? "That decision lies, in principle, with the parents, but it cannot be carried out without the hospital's cooperation. If transporting the child to such a clinic, or staying there, would cause her further suffering, the hospital certainly has legal grounds to intervene," Buijsen explains.
In other words, while parents may pursue alternative options, the hospital is not obliged to cooperate, especially if doing so worsens the child's condition.
Grief and powerlessness
Although the legal and ethical frameworks are firmly in place, these remain incredibly painful decisions in practice. Buijsen remarks: "This is a tragic case. Nevertheless, healthcare and medicine, however advanced, cannot solve every medical problem. Doctors, too, are often powerless in the face of severe suffering. What needs to be done in such cases may be clear, but it is, of course, far from easy. Clear communication is of the utmost importance."
