Physician Assisted Suicide And Euthanasia In The Netherlands

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.

A close-up look at the issue of euthanasia integrates case studies and detailed analysis in a study of the practice of euthanasia in the Netherlands, discussing problems with regulation and control, and effects on patients and their families.

This book describes the way assisted death -- physician-assisted suicide and/or voluntary euthanasia - functions in the Netherlands, Belgium, Switzerland and the state of Oregon - and states the lessons that can be drawn from this experience.

"This book is a well-referenced review of the history of the societal debate, attempts at regulation, and the practice itself. In addition, it discusses important and insightful distinctions (active-passive; omission-commission; outcomes-intentions). The unique basis for their conclusion makes an outstanding contribution to the literature." Robert D. Orr, MD, CM, Professor of Bioethics,at Loma Linda University, California, USA. How have Dutch debates on end-of-life care developed so differently from most other countries, finally resulting in the legalization of euthanasia? What are the relevant legal, medical and ethical dimensions of euthanasia and physician assisted suicide? What lessons can be learned from the Dutch experience with euthanasia? In all modern countries a good death and relief of suffering are important issues of public debate. The bioethical debate in the Netherlands is unique since it has been focusing on the issue of euthanasia for more than thirty years. This book describes the debate, explains its origins, and analyses its development, resulting in the legislation of euthanasia. It also presents data on the medical practice of euthanasia with examples of cases. Death and Medical Power details the evolution as well as the complexities of the legal responses to physician involvement in euthanasia. The authors analyze the ethical debate concerning euthanasia, discussing the pros and cons of medical termination of human life. The book concludes with a section on the lessons to be learned from the Dutch experience. This unique study will be of relevance to all clinicians and other professionals involved in end-of-life care, to health policy makers and educators, as well as anybody else interested in the ethics of euthanasia.