Euthanasia, Ethics, and Public Policy: An Argument against Legalisation

By John Keown | Go to book overview

10
Breach of the guidelines

In how many cases of VAE was there a 'free and voluntary' request which was 'well-considered, durable and persistent'? In how many was there 'intolerable' suffering for which VAE was a 'last resort'? In how many did the doctor consult with another doctor and subsequently report to the authorities?1 The Survey contained telling evidence also about the extent to which Dutch doctors did, and did not, comply with the guidelines. This chapter will summarise that evidence, which betrays widespread noncompliance with the guidelines, not least the practice of NVAE.


An explicit request

An 'entirely free and voluntary' request which was 'well considered,
durable and persistent'?

Doctors stated that in the 2,700 cases of VAE and PAS there was an 'explicit request'2 in 96%; which was 'wholly made by the patient'3 in 99% of cases and 'repeated'4 in 94%; and that in 100% of cases the patient had a 'good insight'5 into his disease and its prognosis. Oddly, no specific question was put about the voluntariness of the request and there is no evidence of any mechanism which could have guaranteed that the request was voluntary. Moreover, the request was purely oral in 60% of cases6 and, when made to a GP in cases where a nurse was caring for the patient, the GP more often

____________________
1
Ninety-eight per cent of doctors stated that they were aware of the 'rules of due care' formulated by the KNMG, the Health Council and the government. When asked what they were, 89% mentioned consultation; 66% the need for a seriously considered request; 42% a voluntary request; 37% 'unacceptable' suffering, and 18% a long-standing desire to die (Survey, 95–6, table 9.1). By contrast, when shown fourteen guidelines and asked to rank them in importance, 98% mentioned voluntariness and only 67% consultation (ibid., table 9.2).
2
Ibid., 50, table 5.15.
3
Ibid.
4
Ibid.
5
Ibid.
6
Ibid., 43.

-103-

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Euthanasia, Ethics, and Public Policy: An Argument against Legalisation
Table of contents

Table of contents

  • Title Page *
  • Contents vii
  • Preface xi
  • Foreword xiii
  • Acknowledgments xv
  • Table of Cases xvi
  • Abbreviations xviii
  • Introduction 1
  • Part I - Definitions 7
  • 1 - 'Voluntary Euthanasia' 9
  • 2 - Intended V. Foreseen Life-Shortening 18
  • 3 - 'Physician-Assisted Suicide' 31
  • Part II - The Ethical Debate: Human Life, Autonomy, Legal Hypocrisy, and the Slippery Slope 37
  • 4 - The Value of Human Life 39
  • 5 - The Value of Autonomy 52
  • 6 - Legal Hypocrisy? 58
  • 7 - The Slippery Slope Arguments 70
  • Part III - The Dutch Experience: Controlling Vae? Condoning Nvae? 81
  • 8 - The Guidelines 83
  • 9 - The First Survey: the Incidence of 'Euthanasia' 91
  • 10 - Breach of the Guidelines 103
  • 11 - The Slide Towards Nvae 115
  • 12 - The Second Survey 125
  • 13 - The Dutch in Denial? 136
  • Part IV - Australia and the United States 151
  • 14 - The Northern Territory: Rotti 153
  • 15 - Oregon: the Death with Dignity Act 167
  • Part V - Expert Opinion 181
  • 16 - Expert Committees 183
  • 17 - Supreme Courts 191
  • 18 - Medical Associations 208
  • Part VI - Passive Euthanasia: Withholding/withdrawing Treatment and Tube-Feeding with Intent to Kill 215
  • 19 - The Tony Bland Case 217
  • 20 - Beyond Bland: the Bma Guidance on Withholding/withdrawing Medical Treatment 239
  • 21 - The Winterton Bill 260
  • Conclusions 273
  • Afterword: the Diane Pretty Case 282
  • Bibliography 292
  • Index 303
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