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

By John Keown | Go to book overview

13
The Dutch in denial?

The increasing body of evidence which has emerged from the Netherlands over the past fifteen or so years, not least the wealth of data produced by the two surveys, shows that the guidelines have been extensively breached and that there has been a marked lack of control by the authorities. Yet the disturbing reality of inadequate control still seems lost on many. As we saw in the Introduction to this book, even one of the Justices of the US Supreme Court who was referred to the leading exposés of Dutch practice nevertheless thought that the picture from the Netherlands was still unclear and that further evidence was needed.1 Why such hesitation given the mass of disturbing evidence already in the public domain?

One reason is that the Dutch (and non-Dutch) supporters of VAE have often, not surprisingly, placed a misleadingly benign interpretation on the evidence. They have persistently sought to portray the Dutch experience in the best possible light, denying or at least downplaying its negative aspects. This is predictable but not productive and has inevitably served to muddy the waters. In particular, anyone who had uncritically read the benign interpretation of the data either by Professor Van der Maas or by the Remmelink Commission could be forgiven for thinking that VAE was under effective control.


Van der Maas and Remmelink

As we have seen, Van der Maas concluded that his surveys showed that decision-making by Dutch doctors was of high quality and that they were prepared to account for their conduct. His lack of criticism of the widespread breaches of the guidelines was remarkable and contrasts with his readiness to criticise those who identified a higher incidence of

____________________
1
See p. 4.

-136-

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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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