AN OUTSIDER’S VIEW OF THE DUTCH EUTHANASIA POLICY AND PRACTICE

Eubios journal of Asian and international bioethics: EJAIB

Why has the law on euthanasia in the Netherlands caused such an upheaval both at home and abroad? In this paper I explore some bioethical issues in the decriminalisation of euthanasia in the Netherlands. The regulatory role of legal and state institutions in the process of decision-making by patients, physicians and other people concerned plays a central role in these discussions. I argue, first, that the limited scope of the Dutch legislation on euthanasia cannot be a solution to end-of-life issues in general, and, second, that it is inadequate as a model for dealing with problems related to 'death-on-request' abroad. Moreover, the confusion around the meaning of the term euthanasia would make its adaptation in other institutional environments capricious. Legal changes in the Netherlands was accompanied by cultural changes, expressed in the use of terms such as individual autonomy and personal choice. In the last section of this article I argue that the social and political environment may be crucial in defining the meaning of free choice. The contending views on the decriminalisation of euthanasia seem to develop as a reaction to change in medical technology in a particular socio-political environment rather than from a unique cultural ethic.

BMJ, 1994

The practice of euthanasia in the Netherlands is often used as an argument in debates outside the Netherlands-hence a clear description of the Dutch situation is important. This article summarises recent data and discusses conceptual issues and relevant characteristics of the system of health care. Special emphasis is put on regulation, including relevant data on notification and prosecution. Besides the practice of euthanasia the Dutch are confronted with the gaps in reporting of cases to the public prosecutor and the existence of cases of ending a life without an explicit request. Nevertheless, the "Dutch experiment" need not inevitably lead down the slippery slope because of the visibility and openness of this part of medical practice. This will lead to increased awareness, more safeguards, and improvement of medical decisions concerning the end oflife.

The author is most grateful to Evert van Leeuwen and Martine Bouman for facilitating the research and to the interviewees for their kind cooperation. He also thanks the editors and referees of ISSUES IN LAW & MEDICINE for their instructive and constructive comments. SUMMARY: ... The Dutch experience has influenced the debate on euthanasia and death with dignity around the globe, especially with regard to whether physician-assisted suicide and euthanasia should be legitimized or legalized. ... This article reports the main findings of my interviews and provides detailed accounts of the way in which some of the Netherlands' leading experts perceive the policy and practice of euthanasia in their country. ... There were 8900 explicit requests for euthanasia or assisted suicide in the Netherlands in 1990, and 9700 in 1995. ... Griffiths estimated that 10% of physicians in the Netherlands oppose the practice of euthanasia on principle, and a further 6% would not perform euthanasia themselves, but refer patients who ask for it to another doctor. ... Some interviewees think that the major problem in the practice of euthanasia in the Netherlands is low level of reporting. ... He testifies from his experience as a member of one regional committee that of three hundred to four hundred cases examined, there was only one case in which a physician was not careful enough in the euthanasia procedure. ... The media invited him to debate on euthanasia issues only because they needed to depict 'the other side,' not because they were really interested in exploring the antieuthanasia arguments. ... Notwithstanding, many interviewees were quite content with the Guidelines. ...

Journal of Medical Ethics, 1994

In the Netherlands the government's proposalfor the legal regulation of euthanasia, assisted suicide and the termination of a patient's life without request has been approved by Parliament. The defence of this proposal is to a large extent based on a specific interpretation of data about the practice of euthanasia in that country, published in 1991 (the Remmelink Report). This paper discusses both the interpretation of the data and the new law. On the basis of that and other data, the author concludes that many cases of euthanasia, assisted suicide and termination of a patient's life without request remain unnotified and therefore unreviewed by the legal authorities. It is argued that the new law will not guarantee an improvement to this situation. In short, the new law will not protect effectively the lives ofpatients, and must, therefore, be open to ethical and legal objection.

Mich. St. U. Det. CLJ Int'l L., 2001

320 MSU-DCL Journal ofInternational Law [10:319 a survey among a random sample of family doctors, showing that in 22% of cases the request was made only once.3 The rate of record keeping4 and written requests5 in euthanasia cases improved during the 1990s, but the situation is ...

Notre Dame JL Ethics & Pub. Pol'y, 1995

408 NOTRE DAME JOURNAL OF LAW, ETHICS & PUBLIC POLICY [Vol. 9 euthanasia such as newborns or those with advanced senile dementia). Arguments for voluntary euthanasia rest on the judg-ment that some lives are not "worth" living. Doctors are not automata who ...

Journal of Law and Society, 1998

Journal of Bioethical Inquiry, 2009

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physicianassisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of lifeterminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life.

Description: The book offers a comprehensive survey and analysis of much of the empirical medical data, law, and ethics regarding end-of-life issues. It includes analysis of data from a variety of sources: ethical, medical and legal in the Netherlands. Each of the chapters offers a fresh insight on pertinent questions concerning end-of-life dilemmas. Methodology: An interdisciplinary study in ethics, medicine and law that incorporates the relevant theories and case studies with the findings of interviews conducted in dozens of hospitals and research centers in the Netherlands.

My essay opens with some personal words about my acquaintance with Ivan Šegota. I proceed by explaining the methodology of my research on euthanasia in the Netherlands. I then detail the major findings and end with guidelines for physician-assisted suicide (PAS). My research in the Netherlands made me change my mind: from supporter of euthanasia I became an ardent opposer of this practice. I think, however, that physicians should not turn a deaf ear to patients at the end of life, who suffer miserably and request to die. Therefore, PAS is suggested. To prevent potential abuse, we need to devise very careful guidelines which, I believe, are suitable for democracies as we enter the 21 st Century, an era of highly developed technology which brings a lot of good but, in the field of medicine, might prolong patient's life unnecessarily. At the center of guidelines is the patient, and the underlying values of treatment are respect for the patient and her autonomy, beneficence, non-maleficence and compassion.