Euthanasia in the Netherlands

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Euthanasia in the Netherlands

• The Policy and Practice of Mercy Killing
• Raphael Cohen-Almagor

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Preliminaries Comparative Law
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Part A Background

• 1. The Two Research Reports of 1990 and 1995 and
  Their Interpretations
• 2. The Practice of Euthanasia and the Legal
  Framework

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Part B Fieldwork

• 3. The Methodology

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Phase I The Interviews

• 4. Why the Netherlands?
• 5. Views on the Practice of Euthanasia

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6. Worrisome Data

• Some of the most worrisome data in the two Dutch
  studies are concerned with the hastening of death
  without the explicit request of patients. There
  were 1000 cases (0.8) without explicit and
  persistent request in 1990, and 900 cases (0.7)
  in 1995. What is your opinion?

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7. The Remmelink Contention and the British
Criticism

• The Remmelink Commission held that actively
  ending life when the vital functions have started
  failing is indisputably normal medical practice.
  Is this correct? What is your opinion?
• In its memorandum before the House of Lords, the
  BMA held that in regard to Holland, all seem to
  agree that the so-called rules of careful conduct
  (official guidelines for euthanasia) are
  disregarded in some cases. Breaches of rules
  range from the practice of involuntary euthanasia
  to failure to consult another practitioner before
  carrying out euthanasia and to certifying the
  cause of death as natural. I asked my
  interviewees Do you agree?

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• 8. Should Physicians Suggest Euthanasia to Their
  Patients?

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9. Breaches of the Guidelines

• The physician practicing euthanasia is required
  to consult a colleague in regard to the hopeless
  condition of the patient. Who decides who the
  second doctor will be?
• What happens in small rural villages where it
  might be difficult to find an independent
  colleague to consult.

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Lack of Reporting

• Record-keeping and written requests of euthanasia
  cases have improved considerably since 1990
  there are now written requests in about 60 and
  written record-keeping in some 85 of all cases
  of euthanasia. The reporting rate for euthanasia
  was 18 in 1990, and by 1995 it had risen to 41.
  The trend is reassuring, but a situation in which
  less than half of all cases are reported is
  unacceptable from the point of view of effective
  control.
• What do you think?
• How can the reporting rate be improved?

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10. On Palliative Care and the Dutch Culture

• It has been argued that the policy and practice
  of euthanasia is the result of undeveloped
  palliative care. What do you think?
• I also mentioned the fact that there are only a
  few hospices in the Netherlands.

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Culture of Death

• Daniel Callahan argues that there is a culture
  of death in the Netherlands.
• What do you think?
• I intentionally refrained from explaining the
  term culture of death. I wanted to see whether
  the interviewees have different ideas on what
  would constitute such a culture.

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• 11. On Legislation and the Chabot Case

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Phase II Interviewees General Comments

• Preliminaries
• General Comments

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Phase III Updates

• Preliminaries
• On the New Act
• On the Work of the Regional Committees
• Further Concerns

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Part C Conclusions

• Preliminaries
• Suggestions for Improvement

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• Since November 1990, prosecution is unlikely if a
  doctor complies with the Guidelines set out in
  the non-prosecution agreement between the Dutch
  Ministry of Justice and the Royal Dutch Medical
  Association.
• These Guidelines are based on the criteria
  established in court decisions relating to the
  conditions under which a doctor can successfully
  invoke the defense of necessity.

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The substantive requirements are as follows

• The request for euthanasia or physician-assisted
  suicide must be made by the patient and must be
  free and voluntary.
• The patients request must be well considered,
  durable and consistent.

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• The patients situation must entail unbearable
  suffering with no prospect of improvement and no
  alternative to end the suffering.
• The patient need not be terminally ill to
  satisfy this requirement and the suffering need
  not necessarily be physical.
• Euthanasia must be a last resort.

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The procedural requirements are as follows

• No doctor is required to perform euthanasia, but
  those opposed on principle must make this
  position known to the patient early on and help
  the patient to get in touch with a colleague who
  has no such moral objections.
• Doctors taking part in euthanasia should
  preferably and whenever possible have patients
  administer the fatal drug themselves, rather than
  have a doctor apply an injection or intravenous
  drip.

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• A doctor must perform the euthanasia.
• Before the doctor assists the patient, the doctor
  must consult a second independent doctor who has
  no professional or family relationship with
  either the patient or doctor.
• Since the 1991 Chabot case, patients with a
  psychiatric disorder must be examined by at least
  two other doctors, one of whom must be a
  psychiatrist.

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• The doctor must keep a full written record of the
  case.
• The death must be reported to the prosecutorial
  authorities as a case of euthanasia or
  physician-assisted suicide and not as a case of
  death by natural causes.
• Since the legalization of the new law, cases
  of euthanasia and PAS are reported to the
  regional committees instead of the prosecutorial
  authorities.