Ethical Expertise Before and After Medically Assisted Dying: The Informal and Formal Role of the Ethicist in the Netherlands.

Although we have a long-standing and well-institutionalized practice of medical aid in dying (MAID) in the Netherlands, it is insufficiently clarified which goals ethicists should pursue in the context of assisted dying, and which competencies they need to fulfil their role(s). We sought to contribute to this clarification. We argue that both in anticipation and in evaluation of MAID, ethicists fulfil a role that is highly valuable to good MAID practice, and complementary to that of other professionals. Whereas the involvement of the ethicist preceding MAID, for instance, to provide ethics support in the case of complex decision-making, is elective in the Netherlands, the participation of ethicists in evaluating performed MAID cases is obligatory, as they are required members of the interdisciplinary regional review committees that judge every case of MAID. We discuss some misconceptions and less-than-optimal performances of both these roles of the ethicist, then focus on how these roles should be perceived, and which kinds of ethics expertise are necessary for ethicists to make a valuable contribution to good MAID practice.