Euthanasia in the Netherlands

By Admiraal, Pieter V. | Free Inquiry, Winter 1996 | Go to article overview

Euthanasia in the Netherlands

Admiraal, Pieter V., Free Inquiry

In an opinion poll, carried out in 1993 in The Netherlands, one of the questions asked was: "Do you think that Someone always has the right to have his life terminated when he is in an unacceptable position without any prospect?" The outcome was clear: 78% said "yes," 10% said "no," and 12% had no opinion. When divided into separate groups by religion, the percentage of those who agreed was 93% for those who professed no religious faith, 74% for Roman Catholics, 60% for members of the Reformed church, and 48% for other religions.

In 1991 van der Maas published the results of an investigation, performed at the request of the Ministry of Justice, concerning euthanasia and other medical decisions about the end of life. Dependent on the region in The Netherlands, 40 to 60% of doctors admitted to having carried out euthanasia.

The official definition of euthanasia appears in the Report of the Dutch Government Commission on Euthanasia, published in 1985. Euthanasia is "a deliberate termination of an individual's life at that individual's request by another. Or, in medical practice, the active and deliberate termination of a patient's life, on that patient's request, by a doctor." Article 293 of the Dutch Criminal Code says: "Anyone who takes the life of another on that person's express and serious request will be punished with a prison sentence of a maximum of twelve years." So, active euthanasia, despite the fact that it is practiced on a relatively wide scale in The Netherlands, remains a criminal offense. How are we to reconcile this apparent contradiction?

In 1972 the Royal Dutch Medical Association issued a provisional statement on euthanasia. In its view:

. . . legally euthanasia should remain a crime, but if a physician after having considered all the aspects of the case, shortens the life of a patient who is incurably ill and in the process of dying, the court will have to judge whether there was a conflict of duties which could justify the act of the physician.

Over recent years jurisprudence in The Netherlands has developed to the extent that the legal view now is that, although euthanasia is not a part of regular or routine medical care, a physician will be judged guilty but not culpable if he or she performs euthanasia or assists suicide in the correct way. This legal decision is based on the concept of the state of emergency within which the physician acts. This state is thought to be applicable because the physician is confronted with conflicting obligations towards the patient as a caregiver and health professional, and towards the law as a civilian. Professional obligations force him or her to act against the formal statements of the law, but in accordance with principles developed in medical ethics and in congruence with the explicit wish of the patient.

The current position is that most doctors practicing euthanasia are not prosecuted if they have met the substantive requirements published by the Royal Dutch Medical Association:

1. The patient makes a voluntary request.

2. The request must be well considered.

3. The wish for death is durable.

4. The patient is in unacceptable suffering.

5. The physician has consulted with a colleague who agrees.

In 1990 the Association and the Ministry of Justice agreed upon a notification procedure that contains the following elements:

* The physician performing euthanasia or assisted suicide does not issue a declaration of a natural death, but informs the local medical examiner of the circumstances by filling in an extensive questionnaire.

* The medical examiner reports to the district attorney.

* The district attorney then decides whether or not a prosecution should be instituted.

This notification procedure has been laid down in regulations under the Burial Act and acquired formal legal status in 1994.

It should be noticed that, in common with other jurisdictions, the following practices in respect of terminally ill patients are not regarded as euthanasia, but rather as good and acceptable medical practice: stopping senseless or futile treatment; stopping or not commencing treatment on request of the patient; using analgesic medication in high doses to alleviate suffering even when this may shorten life (the principle of double effect). …

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