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

By John Keown | Go to book overview

11
The slide towards NVAE

The Remmelink Report

The Survey revealed that the Dutch system of regulation had failed to prevent major non-compliance with the guidelines. Nor is this surprising: the system could never realistically hope to detect doctors who ignored the guidelines since it essentially relied on them to expose their own non-compliance. It is therefore puzzling that the Remmelink Commission should have concluded that the 'medical actions and decision process concerning the end of life are of high quality'.1 No less puzzling, given the failure of a large majority of doctors to report cases, was Professor Van der Maas's observation that the Survey showed that doctors were 'prepared to account for their decisions'.2

Moreover, the Remmelink Report's narrow categories of 'euthanasia' and 'intentional killing without request' may have suggested to those who had not considered it before a neat way of side-stepping the reporting procedure. A doctor might end life not by intentionally administering a lethal drug, which the guidelines would require to be reported, but by an overdose of morphine or by withdrawing treatment, and then claim (in the most unlikely event of being challenged) that this was not 'euthanasia' but 'normal medical practice'.

Even though later statistics have indicated, as we shall see in the next chapter, a significant increase in the number of cases reported (for example, 1,303 were reported in 1993),3 it was always likely, because of the

____________________
1
Outline, 6. Remarkably, Van der Maas also regarded them as of 'good quality' (Survey, 199).
2
Survey, 205.
3
Jaaverslag Openbaar Ministerie 1993 (1994) Appendix 1, table 'Number of reported cases of euthanasia and assisted suicide'. Although this number was almost three times the number for 1990, it is 15 fewer than for 1992. The table also indicated that only 14 cases were prosecuted in 1993. In a dozen of these cases the prosecution was brought because the patient had not been terminally ill. After the decision of the Supreme Court in the case of Dr Chabot that a terminal illness was not required to justify VAE, the prosecution in these cases was discontinued.

-115-

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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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