The Report of the Dutch Governmental Committee on Euthanasia
On January 17, 1990, the then newly formed coalition government of the Netherlands appointed the Committee to Investigate the Medical Practice Concerning Euthanasia. The committee, chaired by the Attorney General of the Supreme Court, Prof. J. Remmelink, commissioned the Institute for Social Health Care of the Erasmus University in Rotterdam to conduct a nationwide survey. On June 14, 1990, the Second Chamber of Parliament rejected the motion that would restrict the subject of the committee's investigation of euthanasia to explicit patient requests. Instead, the chamber approved the committee's plan to investigate both euthanasia with the patient's request and the various forms of termination of life without the patient's request. (1)
Three studies were conducted. In the retrospective study, more than four hundred physicians were interviewed about their opinions on and the practice of euthanasia. Then, during a six month period, the same physicians were asked to record and report their actions in cases with a fatal outcome (the prospective study). In the third part of the survey, a representative sample of deaths was taken from the register at the Central Statistical Office, and the physicians who had been involved in the care of the deceased were asked to provide information.
For years an often heated, but mostly inconclusive, debate on euthanasia in the Netherlands has taken place. The critics allege that euthanasia has been carried out on a very large scale, that involuntary euthanasia has been widely practiced, and that many irregularities have occurred, while the defenders of euthanasia reject these allegations. Due to this situation, the result of the study ordered by the Remmelink committee were awaited with great anticipation.
The committee released its report on September 10, 1991. (2) It immediately became clear that the report contains the most valuable, extensive, and reliable information on euthanasia in the Netherlands to date. It also became clear that the report conveys two very different messages: a reassuring one, expressed in the conclusions and comments of the committee, and a very alarming one, contained in the report's data and findings.
Euthanasia: The Annual Number of Cases
The report contains all the information needed to establish the annual number of cases of euthanasia in the Netherlands. Obviously, varying totals can be obtained from the available data by adopting different definitions of euthanasia. There are good reasons to adopt a descriptive definition such as the one given by Joseph Fletcher(3) because it includes all essential forms of euthanasia.
The findings published in the report indicate that annually 25,306 cases of euthanasia (as defined by Fletcher) occur in the Netherlands. This number includes 2,300 cases of active voluntary euthanasia,(4) 400 cases of physician-assisted suicide,(5) and 1,000 cases of active involuntary euthanasia.(6) There were 5,800 cases in which life-prolonging treatment was withdrawn or withheld upon request of the patient,(7) and 4,756, or 82% of these patients died.(8)
Of the 25,000 cases in which life-prolonging treatment was withdrawn or withheld without a request of the patient,(9) 8,750 cases, or 35%, were done with the intent to terminate life.(10) Of the 22,500 patients who died of overdoses of morphine,(11) 8,100 cases, or 36%, were done with the intent to terminate life.(12) The 25,306 cases of euthanasia constitute 19.4% of the 130,000 deaths that occur in the Netherlands each year.(13)
The committee's conclusion that only 2,300 cases of euthanasia occur every year was reached by assuming that only active termination of life upon request of the patient deserves the name of euthanasia. Thus, the committee adopted a normative definition that expresses an opinion on what euthanasia should be. Other forms of euthanasia, involving 23,006 cases a year, were excluded. …