Euthanasia in the Netherlands: Distinguishing Facts from Fiction

Article excerpt

Euthanasia in The Netherlands: Distinguishing Facts from Fiction

As far as active, voluntary euthanasia is concerned, the Dutch sometimes feel like members of an extra-terrestrial species, being the subject of others' wild guesses and morbid fantasies. The American lay and medical press abound with inaccurate accounts. For example, one author writes: "In The Netherlands, where euthanasia is tolerated, there's evidence that patients are avoiding health care facilities because of this fear" (of being sneaked upon by a doctor). Another writes that "there is clear evidence that active voluntary euthanasia has been clinically extended (in The Netherlands) to include involuntary active euthanasia at family request, and secret involuntary active euthanasia by both physicians and nurses."

The "evidence" alluded to simply does not exist. In fact, there is a growing demand in The Netherlands for health care facilities such as nursing homes to the extent that parliament recently stressed the need of providing more funds to curtail waiting lists. Apart from that, euthanasia "at home" is much more common than euthanasia in a health care facility. Moreover, the extensive jurisprudence on euthanasia shows that virtually all of the doctors brought to trial for performing euthanasia, or whose case was investigated by a public prosecutor, appeared to have followed the generally accepted rules of practice (see below). There has been one case of nurses ending the life of a comatose patient on the request of the family. They were tried and found guilty.

What, then, are the facts concerning the practice of euthanasia in The Netherlands? Since the early 1970s, euthanasia has been hotly debated in our country. Most of its supporters and opponents have now reached agreement on what "euthanasia" means, based on the definition employed by the State Commission on Euthanasia in 1985: Euthanasia is the deliberate action to terminate life, by someone other than, and on request of, the patient concerned.

Euthanasia is thus distinct from requested nontreatment; giving assistance to east dying that unintentionally shortens life; and discontinuing or omitting medically useless treatment. The confusing term "passive euthanasia" has been dropped in official documents. "Euthanasia" is by definition active and voluntary.

Euthanasia is a criminal offense under article 293 of the Penal Code of the Netherlands: Any person who terminates the life of another person at the latter's express and earnest request is liable to a term of imprisonment not exceeding twelve years. this article construes terminating life on request as manslaughter or murder, subject to the mitigating circumstance of the request. In the absence of a patient request the perpetrator renders him or herself guilty of manslaughter or murder. Moreover, the present government has not adopted a longstanding proposal to legalize euthanasia. Instead, it has decided that physicians who terminate life on request of the patient will not be punished only if they invoke a defense of force majeure and have satisfied the criteria discussed below, and then only on condition that the court accepts this defense. Such possible immunity from prosecution applies only to doctors.(2).

Thus, doctors practicing euthanasia do so in violation of the law. In practice, however, they will not be prosecuted if they appear to have followed strict guidelines. Three tiers of the Dutch judicial system--district courts, appeal courts, and the Supreme Court--have handed down judgments in which these guidelines are precisely defined. They have been affirmed and elaborated upon by the Royal Dutch Medical Association (KNMG), the State Commission on Euthanasia, and the Dutch government.(3)

In brief, these conditions require, among other things, that there be an explicit and repeated request by the patient that leaves no reason for doubt concerning his desire to die; that the mental or physical suffering of the patient must be very severe with no prospect of relief; that the patient's decision be well-informed, free, and enduring; that all options for other care have been exhausted or refused by the patient; and that the doctor consult another physician (in addition, he may decide to consult nurses, pastors, and others). …

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