The Position of Nurses in the New Dutch Euthanasia Bill: A Report of Legal and Political Developments
Daverschot, Marianne, Van Der Wal, Hugo, Ethics & Medicine
Editor's Note: On April 10, 2001, The Netherlands became the first democratic nation to legalize euthanasia. According to press reports, the 75-seat Senate voted 46-28 in favor of the new law permitting active voluntary euthanasia. Even though the following article was written prior to the passage of the law, it's content and argument remains intensely relevant.
In the autumn of 2000, opposing views on euthanasia and physician-assisted suicide clearly came to light when members of the Second Chamber of the Dutch Parliament discussed the new euthanasia Bill, titled `Review Procedures For The Termination Of Life On Request And Assisted Suicide. Meanwhile, this Bill has been approved by the Second Chamber but must still be approved by the First Chamber before it becomes an Act. The debate in the First Chamber is expected to proceed April 10, 2001.
Of course, these opposing views also exist among physicians and nurses. They often give rise to polemics and sometimes even to conflicts on the work floor as well. For Christian nurses, these debates revolve around genuine dilemmas, such as: what do I do with my beliefs when confronted with a request for euthanasia?; what are my rights and duties when I refuse to grant a request?; how far can I be forced to cooperate?; and the like. To a certain extent, of course, they share these dilemmas with non-Christians.
In the Netherlands, individuals and nursing associations of Protestant stripe have a large stake in these issues. Among them are Febe (Reformed Union of Health Care Workers), Hospital Christian Fellowship - The Netherlands, the Reformed Social Association (GMV) and the Reformed Social Union (RMU). To be sure, the secular nursing union NU '91 (the largest Dutch nurses' association), studies these issues as well, particularly with regard to the legal position of nurses in euthanasia. That is why a collaborative Febe and HCF-N task force, 'Ethics and Law in Nursing and Care' (WERVV), has contacted this union before the public and political debates to make policymakers and politicians aware of the importance of adequate legal protection of nurses confronted with euthanasia situations. This will be discussed later in this article.
By explaining some terminology, focusing on the position of nurses in the new bill, addressing the initiative of the aforementioned nurses' associations, and discussing the government's response to this initiative, we hope to provide some insight into what the Dutch practice of health care will be when the new euthanasia bill comes into force.
Euthanasia and the Law
Dutch juridical literature defines euthanasia as follows: `Euthanasia is the intentional termination of a patient's life by someone else on request of that patient' (definition by the State Committee on Euthanasia, 1985). Note that euthanasia is always defined in the Netherlands as voluntary active euthanasia, contrary to international use of the word.
Simply put, ending someone's life is a crime in The Netherlands. According to the penal code, section 293, 'He who takes the life of a person on his/her explicit and serious desire is punished by imprisonment of at most 12 years or a fine of the fifth category (= hfl. 100.000,--).' However, according to a ruling by the highest court of law in The Netherlands, the Supreme Court, a physician who has performed euthanasia will not be punished if he can successfully claim to have been subject of circumstances beyond his control. More precisely, the situation must be one of a conflict of duties, namely the duty to alleviate suffering and the duty to preserve life. This force majeure, or emergency situation, must be apparent from the circumstances, which are formulated for legal review as ,requirements of careful practice' in the present situation, the physician must be able to successfully appeal to force majeure to attain impunity. In the new 'Review Procedures' Bill, these requirements of careful practice are laid down legally, purposing that the physician who complies with the requirements no longer needs to appeal to force majeure, but can claim impunity directly: not because he was in a case of emergency, but because he acted according to the requirements in the law. …