Update: The Legalization of Euthanasia in the Netherlands
Jochemsen, Henk, Ethics & Medicine
On 28 November 2000, the Second Chamber of the Dutch parliament accepted the proposal for law regarding legalization of voluntary euthanasia and assisted suicide.1 The proposal will now go to the First Chamber which will probably discuss it early 2001. It will only become effective after the First Chamber has also accepted it. This law proposal implies a significant step further on the way of accepting euthanasia as part of medical practice.
A fundamental step in the beginning of this process was the decision of the Supreme Court (in 1984) that a physician who has committed euthanasia can, in cases of an objectively established `conflict of duties', appeal to a defense of 'necessity' (Penal Code art. 40). This conflict concerns on the one hand the duty to obey the law that forbids euthanasia and assisted suicide (Penal Code art. 293, 294), and on the other hand to alleviate suffering. The government approved the Supreme Court's decision, thereby accepting euthanasia under certain circumstances.2 The conditions establishing a `conflict of duties' were essentially: a free, well-considered request, unacceptable suffering with no other reasonable possibilities to alleviate the suffering, and consultation of the physician by a colleague.3
In 1991 the government proposed a new legal regulation on the basis of the courts' decisions. The prohibition of euthanasia and assisted suicide was maintained in the Penal Code. At the same time the procedure by which physicians report death in cases of euthanasia, assisted suicide and life-terminating actions without an explicit request, was given a statutory basis by amending the law on the Disposal of the Dead.4 According to this procedure, a physician who has terminated a patient's life informs the local medical examiner, who inspects the body externally and takes from the attending physician a statement which contains the relevant data (the patient's history, request, possible alternatives, consultation with a second physician, intervention). This report, together with an evaluation by the local medical examiner, is checked by the Public Prosecutor who considers if the termination of the patient's life was contrary to the Penal Code as interpreted by the courts. So, to the conditions mentioned above was added the requirement of reporting each case of euthanasia, assisted suicide and life terminating action without an explicit request.
In 1990, and again in 1995, extensive surveys were carried out by P. J. van der Maas et al and G. van der Wal and P. J. van der Maas respectively, to get an insight into end-of-life decision-making by Dutch doctors. The results were published in 1991(5) and 1996(6). The second survey sought particularly to ascertain the incidence of intentional life-shortening by doctors; the extent to which they complied with their duty to report such cases and the quality of their reporting. Some of the main results (of the 1995 survey) are:
1) Euthanasia or assisted suicide was performed in 3600 cases (of 9700 requests for euthanasia). The main reason why physicians did not comply with a request for euthanasia is that in their opinion the suffering was not yet unbearable. On the other hand, in 900 cases physicians terminated the life of a patient without an explicit request because in their opinion the condition of the patient was unbearable.
2) In 2000 cases the physician increases the pain medication with the explicit intention to shorten the life of the patient; in about 25% of these cases there was no explicit request of the patient to do so. in at least 14000 cases a treatment was withdrawn with the explicit intention to shorten the patient's life.
3) In 17% of the cases of euthanasia and of life termination without explicit request the physician still saw other medical possibilities to alleviate the suffering, but nevertheless intentionally ended the patient's life.
4) In a considerable part of the cases physicians do not adequately consult a colleague. …