Euthanasia In The Netherlands

The Netherlands is the only country in the world in which euthanasia, under narrow-defined circumstances, is legally permissible. Considerable attention has been paid over a number of years to the problem of regulating it and information has been systematically collected concerning actual practice. Therefore the Dutch experience is of interest not only to the Dutch, but to anyone who is considering wether or not to make euthanasia a legal practice. This book is written for a reader without specific knowledge of law. The central focus of the book is on Dutch law pertaining to euthanansia, but it also considers the moral and legal principles that have played a role in the Dutch debate, the available evidence bearing on actual practice and on the effectiveness of legal control. It ends with some reflections on the problem of the 'slippery slope' and the question whether the Dutch experience is 'exportable'. It includes translations of the relevant legislation (including proposed reforms) and of three leading cases.

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. A review of the literature reveals complex and often contradictory views about the Dutch experience. Some claim that the Netherlands offers a model for the world to follow; others believe that the Netherlands represents danger, rather than promise, and that the Dutch experience is the definitive answer regarding why we should not make active euthanasia and physician-assisted suicide part of our lives. Given these contradictory views, it has become clear that fieldwork is essential to developing a more informed opinion. Having investigated the Dutch experience for a number of years, and after thoroughly reading the vast literature published in English, I went to the Netherlands for one month in the summer of 1999 to get a feel for the local situation. I felt that this would provide the basis on which I could better interpret the findings of the available literature. I visited the major centers of medical ethics, as well as some research hospitals, and spoke with leading figures in the euthanasia policy and practice. The time spent was extremely beneficial and enriching. I followed in the footsteps of Carlos Gomez, who 1 published a book following one month of extensive research in the Netherlands.

claim was that he had faced a conflict of duties pitting his legal duty not to kill against his duty as a physician to relieve his patient’s unbearable suffering. He was acquitted on the important grounds of conflict of duty. These grounds are based on a concept in Dutch law called "force majeure" 4 which recognizes extenuating circumstances such as conflicts of duty. The acquittal was upheld by the Lower Court of Alkmaar, but revoked by an Amsterdam court of appeal. The case went on to the Supreme Court, but before the Supreme Court's decision was issued, the Royal Dutch Medical Association (RDMA) attempted to clarify the criteria for euthanasia that many within the profession already accepted. The RDMA proposed that physicians be permitted to perform euthanasia provided that a set of procedures had been met. Variously stated, the guidelines contain the following central provisions: Voluntary, competent, explicit, and persistent requests on the part of the • patient; Requests based on full information; • The patient is in a situation of intolerable and hopeless suffering (either • physical or mental); No further acceptable alternatives to euthanasia. All alternatives • acceptable to the patient for relief of suffering having been tried; Consultation with at least one other physician whose judgment can be • 5 expected to be independent. Indirectly, these guidelines became the criteria prosecutors used to decide whether or not to bring charges.

This book is the first comprehensive report and analysis of the Dutch euthanasia experience over the last three decades. In contrast to most books about euthanasia, which are written by authors from countries where the practice is illegal and therefore practised only secretly, this book analyzes empirical data and real-life clinical behavior. Its essays were written by the leading Dutch scholars and clinicians who shaped euthanasia policy and who have studied, evaluated and helped regulate it. Some of them have themselves practised euthanasia. The book will contribute to the world literature on physician-assisted death by providing a comprehensive examination of how euthanasia has been practised and how it has evolved in one specific national and cultural context. It will greatly advance the understanding of euthanasia among both advocates and opponents of the practice.

In this book, a global panel of experts considers the international implications of legalised euthanasia based on experiences from Belgium.

Physician-Assisted Death is the eleventh volume of Biomedical Ethics Reviews. We, the editors, are pleased with the response to the series over the years and, as a result, are happy to continue into a second decade with the same general purpose and zeal. As in the past, contributors to projected volumes have been asked to summarize the nature of the literature, the prevailing attitudes and arguments, and then to advance the discussion in some way by staking out and arguing forcefully for some basic position on the topic targeted for discussion. For the present volume on Physician-Assisted Death, we felt it wise to enlist the services of a guest editor, Dr. Gregg A. Kasting, a practicing physician with extensive clinical knowledge of the various problems and issues encountered in discussing physician assisted death. Dr. Kasting is also our student and just completing a graduate degree in philosophy with a specialty in biomedical ethics here at Georgia State University. Apart from a keen interest in the topic, Dr. Kasting has published good work in the area and has, in our opinion, done an excellent job in taking on the lion's share of editing this well-balanced and probing set of essays. We hope you will agree that this volume significantly advances the level of discussion on physician-assisted euthanasia. Incidentally, we wish to note that the essays in this volume were all finished and committed to press by January 1993.

Unlike Nazi medical experiments, euthanasia during the Third Reich is barely studied or taught. Often, even asking whether euthanasia during the Third Reich is relevant to contemporary debates about physician-assisted suicide (PAS) and euthanasia is dismissed as inflammatory. Physician-Assisted Suicide and Euthanasia: Before, During, and After the Holocaust explores the history of euthanasia before and during the Third Reich in depth and demonstrate how Nazi physicians incorporated mainstream Western philosophy, eugenics, population medicine, prevention, and other medical ideas into their ideology. This book reveals that euthanasia was neither forced upon physicians nor wantonly practiced by a few fanatics, but widely embraced by Western medicine before being sanctioned by the Nazis. Contributors then reflect on the significance of this history for contemporary debates about PAS and euthanasia. While they take different views regarding these practices, almost all agree that there are continuities between the beliefs that the Nazis used to justify euthanasia and the ideology that undergirds present-day PAS and euthanasia. This conclusion leads our scholars to argue that the history of Nazi medicine should make society wary about legalizing PAS or euthanasia and urge caution where it has been legalized.

This book is a successor to J Griffiths, A Bood and H Weyers, Euthanasia and Law in the Netherlands (Amsterdam University Press 1998) which was widely praised for its thoroughness, clarity, and accuracy. The new book emphasises recent legal developments and new research, and has been expanded to include a full treatment of Belgium, where since 2002 euthanasia has also become legal. The book also includes descriptions written by local specialists of the legal situation and what is known about actual practice in a number of other European countries (England and Wales, France, Italy, Scandinavia, Spain, Switzerland). The book strives for as complete and dispassionate a description of the situation as possible. It covers in detail: - the substantive law applicable to euthanasia, physician-assisted suicide, withholding and withdrawing treatment, use of pain relief in potentially lethal doses, palliative and terminal sedation, and termination of life without a request (in particular in the case of newborn babies); -the process of legal development that has led to the current state of the law; -the system of legal control and its operation in practice; -the results of empirical research concerning actual medical practice. A concluding part deals with some general questions that arise out of the material presented: Is the legalisation of euthanasia an example of the decline of law or should it, on the contrary, be seen as part and parcel of the increasing juridification of the doctor-patient relationship? Does the Dutch experience with legalised euthanasia support the idea of a 'slippery slope' toward a situation in which life-especially of the more vulnerable members of society-is less effectively protected? Is it possible to explain and to predict when a society will decide to legalise euthanasia?