Chapter XX: Dutch Government-Ordered Surveys of Euthanasia
Fenigsen, Richard, Fenigsen, Ryszard, Issues in Law & Medicine
In 1990, the government-appointed committee on euthanasia, chaired by professor J. Remmelink, commissioned the Institute for Social Health Care of the Erasmus University in Rotterdam to conduct a nationwide survey. While the project was discussed in the parliament, a Liberal representative, Mr. Jacob Kohnstamm, introduced a motion that would restrict the investigation to euthanasia on the patient's explicit request. On June 14, 1990, the Second Chamber of the Parliament rejected this motion, and approved the committee's plan, strongly supported by the Minister of Justice, professor Ernst Hirsch-Ballin, to investigate both euthanasia upon patient's request and the various forms of termination of life without the patient's request. Immunity from prosecution and total anonymity were granted to all doctors participating in the study.
Three studies were conducted. In the retrospective study, more than four hundred physicians were interviewed about their opinions on, and their 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 death certificates 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. National estimates were obtained by weighed extrapolation of the findings.
When the committee released their report, (199) it immediately became clear that it contained the most valuable, extensive, and reliable information on euthanasia in the Netherlands to date. The data on active euthanasia are shown in Table 1.
The total of 11,800 persons who died of active euthanasia in 1990 is nine percent of all deaths in the country. As estimated by attending physicians, most patients who underwent active euthanasia would soon die anyway; however, in about one-third of the cases euthanasia shortened the patients' lives by one to six months, or even by more than six months. (200)
The great majority (80%) of patients who underwent active euthanasia upon their request suffered from various forms of cancer. In cases of involuntary euthanasia the percentage of cancer patients was lower. Most of the remaining patients suffered from heart or lung disease or a disease of the nervous system.
In the year 1990, physicians rejected 6,700 requests for euthanasia. In the Committee's opinion, this indicated that such requests were seriously considered and not too easily granted. (201) This conclusion is open to doubt. A later government-ordered study found that if requests for euthanasia were not granted, in half the cases this was simply due to the fact the patients died before euthanasia could be carried out. (202) Another study showed that when the requests for euthanasia were granted, euthanasia was carried out on the day of request in 59 percent of cases, and within one hour after the request in 11% of cases, (203) which suggests rather hasty decision making.
"Passive Euthanasia." Life-prolonging treatment was withdrawn or withheld with consent of the patients in 5,800 cases, (205) and without patients' consent or knowledge in 25,000 cases. (206) Ninety-eight percent of physicians working in nursing homes have withheld or withdrawn lifeprolonging treatment without patients' consent. (207)
More Information on Active Involuntary Euthanasia. Fifty-nine percent of physicians viewed active euthanasia without the patient's request as "conceivable, " (208) and 27% have actually performed such acts. (209) The latter figure was lower than 41% found in 1989 study. (210) Among the 1,000 patients whose lives were actively terminated without their request there were 140 conscious, fully competent persons. (211) Some physicians proceeded to active involuntary euthanasia even though they believed that other courses of action were still possible. …