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

By John Keown | Go to book overview

9
The first Survey: the incidence of 'euthanasia'

Since the Dutch Supreme Court declared VAE lawful in 1984, a substantial body of empirical data has emerged concerning its practice. Much of this data has helpfully been generated by the Dutch themselves in the form of two major surveys. The first survey examined practice in 1990; the second practice in 1995. This chapter will consider the incidence of VAE and of other forms of intentional life-shortening (in particular NVAE and PE or passive euthanasia) in 1990.


The Remmelink Report and the Van der Maas Survey

The Dutch coalition government which assumed office in 1989 decided to appoint a commission to report on the 'extent and nature of medical euthanasia practice'.1 A commission under the chairmanship of the Attorney-General, Professor Remmelink, was appointed on 17 January 1990 by the Minister of Justice and the State Secretary for Welfare, Health and Culture and charged to report on the practice by physicians of 'performing an act or omission to terminate [the] life of a patient, with or without an explicit and serious request of the patient to this end'.2 The Commission asked P. J. van der Maas, Professor of Public Health and Social Medicine at the Erasmus University, to carry out a survey which would produce qualitative and quantitative information. The Commission and Van der Maas agreed that the survey should embrace all medical decisions affecting the end of life so that VAE could be seen within that broader context. Their umbrella term 'Medical Decisions concerning the End of Life' ('MDELs') included 'all decisions by physicians concerning courses of action aimed at hastening the end of life of the patient or courses

____________________
1
Medische beslissingen rond het levenseinde. Het onderzoekvoor de Commissie onderzoe kmed is che praktijk inzake euthanasie (1991) (hereafter 'Survey') 3.
2
Ibid., 4.

-91-

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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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