So as not to be misunderstood, let me say at the outset that suicide is always wrong, gravely evil, that "assisted suicide" is murder, and that it would not make everything okay if euthanasia and assisted suicide were confined to "those who really want it and are competent and rational," "those who are terminally ill," "those who have met stringent criteria" or any of the other bromides we hear. The "safeguards" don't make it all right, period. If someone sat before me and told me, in the calmest terms, that he wanted to kill himself because he was going to die of cancer in six months, that he had weighed all the options, and that he was willing and able to go through any necessary mental evaluation or other evaluation to show that he was under no constraint or coercion, to jump through a variety of bureaucratic hoops, in order to obtain a "peaceful and dignified death" for himself, it would still be absolutely wrong to cooperate, and such a person should still be prevented from murdering himself.
Nonetheless, the fact of the matter is that assisted suicide is never, ever confined to such cases. Wesley J. Smith has reported countless times where the news media have distorted actual practice, stating that some law allows "only the terminally ill" to commit suicide when this is not true, stating that "strict safeguards" will be in place, when in fact they will not be, and so forth.
We need to remember this, partly for rhetorical and political reasons and partly to keep our own minds clear about what it means in a society to turn healers into killers and to make death an end in itself.
This has already been made abundantly clear in Europe, particularly in Holland and Belgium, where babies are killed, children can "request" suicide, and the elderly are euthanized without request. In Oregon--vaunted as an example of moderation in assisted suicide laws--doctors are required by the law to falsify medical accounts, patients can easily go doctor shopping to find one (including a doctor who does not know their case well) willing to help make them dead, and state health care plans not-so-subtly have encouraged suicide by covering death but not treatment.
So any alleged safeguards are a lot of baloney, and the reason for this is that, once death is counted as treatment, it devours a culture's sense that there should be a preference for life over death, which in turn makes safeguards seem discriminatory and pointless.
A recent example of this dynamic in Holland connects it with the issue of medical conscience.
Milou de Moor, a patient with lupus, wanted to be made dead. Under Holland's protocols, her local GP was supposed to approve of her being euthanized. That's one of those "safeguards," presumably to bring into the decision-making process a doctor who knew the patient in a holistic fashion. (Another article says that the approval of the doctor was not strictly required, but the fact that the other doctors refused to carry out the euthanasia without the GP's approval gives the strong impression that they, at least, did not consider themselves "covered" without it.)
Milou was going to be killed by a neurologist at the University Hospital in Ghent (Belgium) who had been treating her for some time for her lupus. But the local GP refused to sign off. Her reasons for hesitation are given nowhere in any of the articles I have found. They merely state that she had wavered on the matter, sometimes seeming to approve but ultimately unwilling to concur. One is left to conjecture that the GP thought Milou was too young to die, that the doctor felt squeamish about signing off on death for someone who was not actively dying, that she thought Milou could be treated or helped for her suicidal ideation. Who knows?
The upshot was that Milou, at only 19, hung herself from a tree in an orchard, and her family has gone on a professional vendetta against the GP who prevented her from being made dead in a doctor's office instead. Because being bumped off by someone in a white coat using a lethal injection is dignified, but hanging from an apple tree is icky, or something.
The parents have made a complaint against the GP, and a disciplinary board will decide whether to launch a case against the doctor.
The success of such a complaint would mean, in practice, that GPs would be expected to rubber-stamp suicide demands. The notion of independent judgement and checks and balances would be the merest illusion. Doctors would have to fear, justifiably, that even hesitating to approve a euthanasia could get them in trouble. Death now, death fast, death at all costs. Death is the good decision, death is the better decision. Hurry up and make people dead or they might do it themselves messily, and that's the only thing we really feel horrified about.
So much for safeguards. In such a climate, suppose that a doctor suspected coercion? Suppose that the doctor did not think that the patient understood the nature of the request, or was not of sound mind? It is entirely plausible that a doctor could nonetheless face exhausting and career-destroying investigation and/or discipline for exercising medical judgement in such a case. The prima facie case, it appears, must be pro-death.
Oh, by the way: No, I don't think doctors in Holland just have to "do their job [of making patients dead] or quit."