An Outsider's View of Dutch Euthanasia Policy and Practice
Cohen-Almagor, Raphael, Issues in Law & Medicine
ABSTRACT: This article provides a critical analysis of Dutch euthanasia policy and practice. The research benefited from twenty-eight interviews conducted in the Netherlands during the summer of 1999 with some of the leading figures who dictate the decision-making process and take an active part in the debates. The discussion begins with a review of the two major Dutch reports on euthanasia and the conflicting views and interpretations offered by the literature. Next, I provide some data about the interviews, and then analysis indicating that the Dutch Guidelines on the policy and practice of euthanasia do not provide ample mechanisms against abuse. I argue that the Dutch Guidelines are insufficient, do not provide adequate control over the practice of euthanasia, and that the entire policy should be revised and made more coherent and more comprehensive.
The Dutch experience has influenced the debate on euthanasia and death with dignity around the globe, especially with regard to whether physician-assisted suicide and euthanasia should be legitimized or legalized. Review of the literature reveals complex and often contradictory views about this experience. Some claim the Netherlands offers a model for the world to follow; others believe the Netherlands represents danger rather than promise, that the Dutch experience is the definitive answer why we should not make active euthanasia and physician-assisted suicide part of our lives.
Given these contradictory views, fieldwork is essential to develop a fully informed opinion. Having investigated the Dutch experience for a number of years, in the summer of 1999 I went to the Netherlands to visit the major centers of medical ethics as well as some research hospitals, and to speak with leading figures in euthanasia policy and practice. This article reports the main findings of my interviews and provides detailed accounts of the way in which some of the Netherlands' leading experts perceive the policy and practice of euthanasia in their country. These accounts are quite fascinating.
The discussion begins with a review of the two major Dutch reports on euthanasia and the conflicting views and interpretations offered by the literature. Next, I provide some data about the interviews, and then analysis indicating that the Dutch Guidelines on the policy and practice of euthanasia do not provide ample mechanisms against abuse. Virtually every guideline has been breached or violated. This finding reiterates Hendin's finding.(1) I conclude by recommending that the Netherlands amend its policy and remedy its troubling practice. The findings should compel us to conduct further investigation and research. The Netherlands should overhaul its policy and procedures to prevent potential abuse.
Since November 1990, prosecution is unlikely if a doctor complies with the Guidelines on euthanasia and physician assisted suicide set out in the non-prosecution agreement between the Dutch Ministry of Justice and the Royal Dutch Medical Association. These Guidelines are based on the criteria set out in court decisions relating to when a doctor can successfully invoke the defense of necessity
The substantive requirements are as follows:
* The request for euthanasia or physician-assisted suicide must be made by the patient and must be free and voluntary.
* The patient's request must be well considered, durable and consistent.
* The patient's situation must entail unbearable suffering with no prospect of improvement and no alternative to the end of suffering.(2) The patient need not be terminally ill to satisfy this requirement and the suffering need not necessarily be physical.
* Euthanasia must be a last resort.(3)
The procedural requirements are as follows:
* No doctor is required to perform euthanasia but if he/she is opposed on principle the doctor must make his/her position known to the patient early on and help the patient get in touch with a colleague who has no such moral objections. …