Euthanasia in the Netherlands: sliding down the slippery slope? (original) (raw)
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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.
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.
End-of-Life Practices in the Netherlands under the Euthanasia Act
New England Journal of Medicine, 2007
Background In 2002, an act regulating the ending of life by a physician at the request of a patient with unbearable suffering came into effect in the Netherlands. In 2005, we performed a follow-up study of euthanasia, physician-assisted suicide, and other end-of-life practices. Methods We mailed questionnaires to physicians attending 6860 deaths that were identified from death certificates. The response rate was 77.8%. Results In 2005, of all deaths in the Netherlands, 1.7% were the result of euthanasia and 0.1% were the result of physician-assisted suicide. These percentages were significantly lower than those in 2001, when 2.6% of all deaths resulted from euthanasia and 0.2% from assisted suicide. Of all deaths, 0.4% were the result of the ending of life without an explicit request by the patient. Continuous deep sedation was used in conjunction with possible hastening of death in 7.1% of all deaths in 2005, significantly increased from 5.6% in 2001. In 73.9% of all cases of euthanasia or assisted suicide in 2005, life was ended with the use of neuromuscular relaxants or barbiturates; opioids were used in 16.2% of cases. In 2005, 80.2% of all cases of euthanasia or assisted suicide were reported. Physicians were most likely to report their end-oflife practices if they considered them to be an act of euthanasia or assisted suicide, which was rarely true when opioids were used. Conclusions The Dutch Euthanasia Act was followed by a modest decrease in the rates of euthanasia and physician-assisted suicide. The decrease may have resulted from the increased application of other end-of-life care interventions, such as palliative sedation.
Euthanasia in the Netherlands: The Legal Framework
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 ...
The limitations of the Dutch concept of euthanasia
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.
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.
Euthanasia in the Netherlands: The Policy and Practice of Mercy Killing
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.
New Developments In Dutch Legislation Concerning Euthanasia and Physician-Assisted Suicide
Journal of Medicine and …, 2001
Dutch euthanasia and physician-assisted suicide stand on the eve of important legal changes. In the summer of 1999, a new government bill concerning euthanasia and physician-assisted suicide was sent to Parliament for discussion. This bill legally embodies a ground for exemption from punishment for physicians who conduct euthanasia or physician-assisted suicide and comply with certain requirements. On November 28, 2000, the Dutch parliament approved an adapted version of this bill. Since the approval by the Dutch Senate can be regarded as a formality, it is expected that the bill will come into force in the course of this year (2001). In this paper we discuss these new developments.
Euthanasia and Palliative Care In the Netherlands: An Analysis of the Latest Developments
Health Care Analysis, 2004
This article discusses the latest developments regarding euthanasia and palliative care in the Netherlands. On the one hand, a legally codified practice of euthanasia has been established. On the other hand, there has been a strong development of palliative care. The combination of these simultaneous processes seems to be rather unique. This contribution first focuses on these remarkable developments. Subsequently, the analysis concentrates on the question of how these new developments have influenced the ethical debate.