Voluntary euthanasia under control? Further empirical evidence from the Netherlands

Journal of Medical Ethics

Volumn 25, Issue 1, 1999, Pages 16-21

  Jochemsen, Henk ^a   Keown, John ^a  

^a NONE

Author keywords

Euthanasia; Regulation; Slippery slope; The Netherlands

Indexed keywords

ARTICLE; EUTHANASIA; LAW; NETHERLANDS;

EID: 0033001827     PISSN: 03066800     EISSN: None     Source Type: Journal    
DOI: 10.1136/jme.25.1.16     Document Type: Article

References (51)

1. Washington v Glucksberg (1997) 117 S Ct 2258; Vacco v Quill (1997) 117 S Ct 2293.
2. Maas PJ van der et al. Medische beslissingen rond het levenseinde. 's-Gravenhage: SDU Uitgeverij Plantijnstraat, 1991 (published in translation as Euthanasia and other medical decisions concerning the end of life. Amsterdam: Elsevier, 1992).
3. See for example Jochemsen H. Euthanasia in Holland: an ethical critique of the new law. Journal of Medical Ethics 1994;20:212; Keown J. Euthanasia in the Netherlands: sliding down the slippery slope? In: Keown J, ed. Euthanasia examined. Cambridge: Cambridge University Press, 1995: ch 16.
4. See for example Jochemsen H. Euthanasia in Holland: an ethical critique of the new law. Journal of Medical Ethics 1994;20:212; Keown J. Euthanasia in the Netherlands: sliding down the slippery slope? In: Keown J, ed. Euthanasia examined. Cambridge: Cambridge University Press, 1995: ch 16.
5. Wal G van der, Maas PJ van der. Euthanasie en andere medische beslissingen rond het levenseinde. De praktijk en de meldingsprocedure. (Euthanasia and other medical decisions concerning the end of life. Practice and reporting procedure.) Den Haag: SDU uitgevers, 1996. For summaries of the research in English see Maas PJ van der. Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990-1995. New England Journal of Medicine 1996;335:1699; van der Wal G. Evaluation of the notification procedure for physician-assisted death in the Netherlands. New England Journal of Medicine 1996;335:1706.
6. Wal G van der, Maas PJ van der. Euthanasie en andere medische beslissingen rond het levenseinde. De praktijk en de meldingsprocedure. (Euthanasia and other medical decisions concerning the end of life. Practice and reporting procedure.) Den Haag: SDU uitgevers, 1996. For summaries of the research in English see Maas PJ van der. Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990-1995. New England Journal of Medicine 1996;335:1699; van der Wal G. Evaluation of the notification procedure for physician-assisted death in the Netherlands. New England Journal of Medicine 1996;335:1706.
7. Wal G van der, Maas PJ van der. Euthanasie en andere medische beslissingen rond het levenseinde. De praktijk en de meldingsprocedure. (Euthanasia and other medical decisions concerning the end of life. Practice and reporting procedure.) Den Haag: SDU uitgevers, 1996. For summaries of the research in English see Maas PJ van der. Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990-1995. New England Journal of Medicine 1996;335:1699; van der Wal G. Evaluation of the notification procedure for physician-assisted death in the Netherlands. New England Journal of Medicine 1996;335:1706.
8. See reference 4: 25.
9. See reference 4: tables 5.3; 6.2; 9.1.
10. See reference 4: table 5.5.
11. Nederlands Juristenblad 1994; 69 nr26: 895ff. See also Jochemsen H. The Netherlands experiment. In: Kilner JF et al, eds. Dignity and dying. Grand Rapids: Eerdmans, 1996: ch 12; Hendin H. Seduced by death: doctors, patients and the Dutch cure. New York: WW Norton, 1997: ch2.
12. Nederlands Juristenblad 1994; 69 nr26: 895ff. See also Jochemsen H. The Netherlands experiment. In: Kilner JF et al, eds. Dignity and dying. Grand Rapids: Eerdmans, 1996: ch 12; Hendin H. Seduced by death: doctors, patients and the Dutch cure. New York: WW Norton, 1997: ch2.
13. Nederlands Juristenblad 1994; 69 nr26: 895ff. See also Jochemsen H. The Netherlands experiment. In: Kilner JF et al, eds. Dignity and dying. Grand Rapids: Eerdmans, 1996: ch 12; Hendin H. Seduced by death: doctors, patients and the Dutch cure. New York: WW Norton, 1997: ch2.
14. Sorgdrager W, Borst-Eilers E. Euthanasie - De stand van zaken. Medisch Contact 1995;12: 381-4.
15. Kastelijn WR. Standpunt hoofdbestuur KNMG inzake euthanasie. Utrecht: KNMG, August 1995.
16. See reference 4: table 5.4.
17. See reference 4: table 5.6.
18. See reference 4: table 5.12.
19. See reference 4: table 6.2; 92.
20. See reference 4: table 6.5.
21. This suggests a disturbing incidence not only of non-voluntary euthanasia but also of involuntary euthanasia.
22. See reference 4: table 6.4.
23. See reference 4: table 6.3.
24. See reference 4: table 6.6.
25. See reference 4: table 7.2. This figure is calculated from the researchers' percentages and estimates at pages 92-93. In fact the figure of 2,000 is conservative as it is derived from the total number of 20,000 cases yielded by the physician-interviews rather than from the larger total of 25,800 in the death certificate study. "Explicit" is the researchers' translation of the word "uitdrukkelijk". We think a more accurate translation would be "primary" as a purpose can be explicit yet secondary or primary yet implicit.
26. See reference 4: 93.
27. See reference 4: table 7.4.
28. See reference 4: tables 7.3; 7.5.
29. See reference 4: tables 8.1; 8.3; 84.
30. See reference 4: tables 8.1; 8.3.
31. See reference 4: table 8.2.
32. See reference 4: 189.
33. See reference 4: table 17.2.
34. The researchers' estimate of 15 cases may be traced to their observation that in 17% of cases in which drugs were administered with the explicit intent to shorten life (totalling 15 cases), one of the drugs administered paralysed muscles and therefore caused death almost immediately whereas in a majority of cases in which drugs were administered in combination with the withdrawal of treatment, the treatment withdrawn was artificial ventilation and the medication may have been administered to prevent suffocation.
35. See reference 4: table 17.3.
36. See reference 4: table 17.5.
37. See reference 4: table 18.1.
38. See reference 8: Hendin: ch 2.
39. See reference 4: table 10.1.
40. See reference 4: table 10.2.
41. See text on page 19 immediately preceding reference 39.
42. The reason for the discrepancy between the two totals might be a certain bias in the physicians' responses. The authors of the survey suggest that some of the physicians interviewed, when asked to discuss their most recent case of euthanasia, in fact discussed a recent case which had a stronger impact, probably because it was reported. See reference 4: 113.
43. See reference 4: 102-7.
44. See reference 4: table 11.6.
45. See reference 4: table 11.8; 225.
46. 14,200 of these cases involved no explicit request from the patient. In cases where the patient had refused treatment, the doctors could properly, had they wished, have omitted treatment for this reason and without intent to shorten life. Similarly, as was mentioned above, it is unclear in how many cases of non-treatment the treatment was in fact disproportionate and could properly have been withdrawn for that reason without the doctors resorting to an intention to shorten life.
47. See reference 4: 240.
48. See reference 4: 144-5.
49. See for example Angell M. Euthanasia in the Netherlands - good news or bad? New England Journal of Medicine 1996;335: 1677.
50. See for example Gomez C. Regulating death. New York: Free Press, 1991; see reference 8: Hendin; see reference 3: Jochemsen; see reference 3: Keown.
51. While acknowledging this fact, Dr Angell suggests that doctors fail to report because they find the reporting procedure "burdensome" and "daunting". See reference 44: 1677. But it is difficult to see how the procedure - the filing of a report with the local medical examiner (another doctor) in the sure knowledge that if the guidelines have been followed there is no prospect of prosecution - can realistically be so described. Indeed, many doctors admit that they omit to report simply because they do not want the inconvenience of an investigation either for themselves or the family (see text at page 19 immediately preceding reference 40).