Transcript Euthanasia in the Netherlands

Euthanasia in the
Netherlands
The Policy and Practice of Mercy
Killing
Raphael Cohen-Almagor
Preliminaries: Comparative Law
Part A: Background
1. The Two Research Reports of 1990 and
1995 and Their Interpretations
 2. The Practice of Euthanasia and the
Legal Framework
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Part B: Fieldwork
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3. The Methodology
Phase I: The Interviews
4. Why the Netherlands?
 5. Views on the Practice of Euthanasia
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6. Worrisome Data
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“Some of the most worrisome data in the
two Dutch studies are concerned with the
hastening of death without the explicit
request of patients. There were 1000
cases (0.8%) without explicit and
persistent request in 1990, and 900 cases
(0.7%) in 1995. What is your opinion?”
7. The Remmelink Contention and
the British Criticism

The Remmelink Commission held that actively ending life
when the vital functions have started failing is
indisputably normal medical practice. Is this correct?
What is your opinion?

In its memorandum before the House of Lords, the BMA
held that in regard to Holland, “all seem to agree that
the so-called rules of careful conduct (official guidelines
for euthanasia) are disregarded in some cases. Breaches
of rules range from the practice of involuntary
euthanasia to failure to consult another practitioner
before carrying out euthanasia and to certifying the
cause of death as natural.” I asked my interviewees: Do
you agree?
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8. Should Physicians Suggest Euthanasia
to Their Patients?
9. Breaches of the Guidelines
The physician practicing euthanasia is
required to consult a colleague in regard
to the hopeless condition of the patient.
Who decides who the second doctor will
be?
 What happens in small rural villages where
it might be difficult to find an independent
colleague to consult .

Lack of Reporting
Record-keeping and written requests of
euthanasia cases have improved considerably
since 1990; there are now written requests in
about 60% and written record-keeping in some
85% of all cases of euthanasia. The reporting
rate for euthanasia was 18% in 1990, and by
1995 it had risen to 41%. The trend is
reassuring, but a situation in which less than
half of all cases are reported is unacceptable
from the point of view of effective control.
 What do you think?
 How can the reporting rate be improved?

10. On Palliative Care and the Dutch
Culture


It has been argued that the policy and
practice of euthanasia is the result of
undeveloped palliative care. What do you
think?
I also mentioned the fact that there are
only a few hospices in the Netherlands.
Culture of Death

Daniel Callahan argues that there is a
“culture of death ”in the Netherlands.
What do you think?
I intentionally refrained from explaining
the term “culture of death.” I wanted to
see whether the interviewees have
different ideas on what would constitute
such a culture.
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11. On Legislation and the Chabot Case
Phase II: Interviewees’ General
Comments
Preliminaries
 General Comments

Phase III: Updates
Preliminaries
 On the New Act
 On the Work of the Regional Committees
 Further Concerns
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Part C: Conclusions
Preliminaries
 Suggestions for Improvement
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Since November 1990, prosecution is unlikely if
a doctor complies with the Guidelines 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
established in court decisions relating to the
conditions under which a doctor can successfully
invoke the defense of necessity.

The substantive requirements are as
follows:
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The request for euthanasia or physicianassisted suicide must be made by the
patient and must be free and voluntary.
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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 end
the suffering.
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.
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The procedural requirements are as
follows:
No doctor is required to perform euthanasia, but
those opposed on principle must make this
position known to the patient early on and help
the patient to get in touch with a colleague who
has no such moral objections.
 Doctors taking part in euthanasia should
preferably and whenever possible have patients
administer the fatal drug themselves, rather
than have a doctor apply an injection or
intravenous drip.
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A doctor must perform the euthanasia.
 Before the doctor assists the patient, the doctor
must consult a second independent doctor who
has no professional or family relationship with
either the patient or doctor.
Since the 1991 Chabot case, patients with a
psychiatric disorder must be examined by at
least two other doctors, one of whom must be a
psychiatrist.
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The doctor must keep a full written record of the
case.
 The death must be reported to the prosecutorial
authorities as a case of euthanasia or physicianassisted suicide and not as a case of death by
natural causes.
Since the legalization of the new law, cases of
euthanasia and PAS are reported to the regional
committees instead of the prosecutorial
authorities.
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