Why the Netherlands?

Journal of Law, Medicine and Ethics

Volumn 30, Issue 1, 2002, Pages 95-104

  Cohen Almagor, Raphael ^a,b,c  

^a UNIVERSITY OF HAIFA   (Israel)

^b TEL AVIV UNIVERSITY   (Israel)

^c UNIVERSITY OF OXFORD   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; ASSISTED SUICIDE; DECISION MAKING; DOCTOR PATIENT RELATION; EUTHANASIA; HEALTH CARE POLICY; HEALTH PROGRAM; HUMAN; INTERVIEW; LEGAL ASPECT; MEDICAL ETHICS; MEDICAL PRACTICE; MORTALITY; QUESTIONNAIRE; ACTIVE EUTHANASIA; ATTITUDE TO DEATH; CULTURAL FACTOR; DEATH AND EUTHANASIA; EMPIRICAL APPROACH; EVALUATION; HEALTH PERSONNEL ATTITUDE; LEGAL APPROACH; MANAGEMENT; MORALITY; MOTIVATION; NETHERLANDS; POLICY; POLITICAL SYSTEM; RIGHT TO DIE; SOCIAL PSYCHOLOGY; TERMINALLY ILL PATIENT; VOLUNTARY EUTHANASIA;

DEATH AND EUTHANASIA; EMPIRICAL APPROACH; LEGAL APPROACH;

ATTITUDE OF HEALTH PERSONNEL; ATTITUDE TO DEATH; CULTURAL CHARACTERISTICS; DEMOCRACY; ETHICS, MEDICAL; EUTHANASIA, ACTIVE; EUTHANASIA, ACTIVE, VOLUNTARY; HUMANS; INTERVIEWS; MORALS; MOTIVATION; NETHERLANDS; PHYSICIAN-PATIENT RELATIONS; POLICY MAKING; PUBLIC POLICY; RIGHT TO DIE; SOCIAL VALUES; SUICIDE, ASSISTED; TERMINALLY ILL;

EID: 0036512579     PISSN: 10731105     EISSN: None     Source Type: Journal    
DOI: 10.1111/j.1748-720X.2002.tb00725.x     Document Type: Article

References (63)

1. G.K. Kimsma and E. van Leeuwen, "Dutch Euthanasia: Background, Practice, and Present Justifications," Cambridge Quarterly of Healthcare Ethics, 2 (1993): 19-35, especially at 24.
2. See T. Sheldon, "Doctors Not Obliged to Carry Out Treatment They Think 'Futile,'" British Medical Journal, 319 (October 23, 1999): 1088.
3. For a discussion of the double effect doctrine, see R. Cohen-Almagor, "Language and Reality at the End of Life," Journal of Law, Medicine & Ethics, 28, no. 3 (2000): 267-278.
4. See J. Legemaate, "Twenty-Five Years of Dutch Experience and Policy on Euthanasia and Assisted Suicide: An Overview," in David C. Thomasma et al., eds., Asking to Die (Dordrecht: Kluwer Academic Publishers, 1998): at 20; G.K. Kimsma, "Euthanasia and Physician Assisted Suicide in the Netherlands," Medizin, Ethik, Recht (1994): 161-69.
5. See J. Legemaate, "Twenty-Five Years of Dutch Experience and Policy on Euthanasia and Assisted Suicide: An Overview," in David C. Thomasma et al., eds., Asking to Die (Dordrecht: Kluwer Academic Publishers, 1998): at 20; G.K. Kimsma, "Euthanasia and Physician Assisted Suicide in the Netherlands," Medizin, Ethik, Recht (1994): 161-69.
6. J. Griffiths, A. Bood, and H. Weyers, Euthanasia and Law in the Netherlands (Amsterdam: Amsterdam University Press, 1998): at 213.
7. J. Griffiths, "Effective Regulation of Euthanasia and Other Medical Behavior that Shortens Life," in E. Mackaay, ed., Uncertainty and the Law (Montreal: Editions Thémis, 1999): 61-94, especially at 72-73.
8. G. van der Wal, J.Th.M. van Eijk, H.J.J. Leenen, and C. Spreeuwenberg, "Euthanasia and Assisted Suicide. II. Do Dutch Family Doctors Act Prudently?," Family Practice, 9, no. 2 (1992): 135-40.
9. A doctor has an obligation to maintain a full dossier on every patient and to accurately record therein what he or she does and why. Keeping adequate records is a general requirement of medical practice, and is specifically one of the requirements of careful practice in the case of euthanasia.
10. Kimsma notes that written requests of euthanasia are preferable but not mandatory. Another acceptable solution is a witness.
11. Griffiths, supra note 6, at 74.
12. I thank Henk Leenen for this piece of information.
13. H.A.M.J. ten Have, "Euthanasia: The Dutch Experience," Annals de la Real Academia Nacional de Medicina, Tomo CXII (Madrid, 1995): 425-44, at 436-37.
14. Reporting, as opposed to recordkeeping, refers to the requirement that a doctor report a case of euthanasia to the authorities as an unnatural death.
15. Griffiths, supra note 6, at 74-75.
16. P.J. van der Maas, J.J.M. van Delden, and L. Pijnenborg, Euthanasia and Other Medical Decisions Concerning the End of Life, Health Policy Monographs (Amsterdam: Elsevier, 1992): at 98.
17. For further reading, see H.J.J. Leenen, "Euthanasia, Assistance to Suicide and the Law: Developments in the Netherlands," Health Policy, 8 (1987): 197-206; J.K.M. Gevers, "Legal Developments Concerning Active Euthanasia on Request in the Netherlands," Bioethics, 1, no. 2 (1987): 156-162.
18. For further reading, see H.J.J. Leenen, "Euthanasia, Assistance to Suicide and the Law: Developments in the Netherlands," Health Policy, 8 (1987): 197-206; J.K.M. Gevers, "Legal Developments Concerning Active Euthanasia on Request in the Netherlands," Bioethics, 1, no. 2 (1987): 156-162.
19. "Euthanasia and Physician Assisted Suicide in the Netherlands," at 〈http://www.nlembassy.or.kr/c_hlteuth.html〉 (last visited January 14, 2002). This website is a service of the Royal Netherlands Embassy in Seoul, Korea.
20. B. Sneiderman and M. Verhoef, "Patient Autonomy and the Defence of Medical Necessity: Five Dutch Euthanasia Cases," Alberta Law Review, XXXIV, no. 2 (1996): 374-415, at 376. In England and Canada, the defense of medical necessity has been recognized in abortion cases (see R. v. Bourne [1938] 3 All E.R. 615 and R. v. Morgentaler [1975] 20 C.C.C. (2d) 449), but it is not available in euthanasia cases. For England, see R. v. Cox [1992] 12 BMLR 38 (England); R. Porter, "Doctor Convicted of Attempted Murder," Sunday Telegraph (London), September 20, 1992. For Canada, see M. O'Malley and O. Wood, "'Cruel & Unusual': The Law and Latimer," CBC News, at 〈http://www.cbc.ca/news/indepth/background/latimer_robert.html〉 (last visited January 15, 2002), describing the Robert Latimer case, which involves a Saskatchewan farmer who killed his 12-year-old daughter, Tracy, who suffered from severe cerebral palsy and had the capacity of a three-month-old child. Latimer is currently serving a life sentence, which holds no possibility of parole until 10 years.
21. B. Sneiderman and M. Verhoef, "Patient Autonomy and the Defence of Medical Necessity: Five Dutch Euthanasia Cases," Alberta Law Review, XXXIV, no. 2 (1996): 374-415, at 376. In England and Canada, the defense of medical necessity has been recognized in abortion cases (see R. v. Bourne [1938] 3 All E.R. 615 and R. v. Morgentaler [1975] 20 C.C.C. (2d) 449), but it is not available in euthanasia cases. For England, see R. v. Cox [1992] 12 BMLR 38 (England); R. Porter, "Doctor Convicted of Attempted Murder," Sunday Telegraph (London), September 20, 1992. For Canada, see M. O'Malley and O. Wood, "'Cruel & Unusual': The Law and Latimer," CBC News, at 〈http://www.cbc.ca/news/indepth/background/latimer_robert.html〉 (last visited January 15, 2002), describing the Robert Latimer case, which involves a Saskatchewan farmer who killed his 12-year-old daughter, Tracy, who suffered from severe cerebral palsy and had the capacity of a three-month-old child. Latimer is currently serving a life sentence, which holds no possibility of parole until 10 years.
22. B. Sneiderman and M. Verhoef, "Patient Autonomy and the Defence of Medical Necessity: Five Dutch Euthanasia Cases," Alberta Law Review, XXXIV, no. 2 (1996): 374-415, at 376. In England and Canada, the defense of medical necessity has been recognized in abortion cases (see R. v. Bourne [1938] 3 All E.R. 615 and R. v. Morgentaler [1975] 20 C.C.C. (2d) 449), but it is not available in euthanasia cases. For England, see R. v. Cox [1992] 12 BMLR 38 (England); R. Porter, "Doctor Convicted of Attempted Murder," Sunday Telegraph (London), September 20, 1992. For Canada, see M. O'Malley and O. Wood, "'Cruel & Unusual': The Law and Latimer," CBC News, at 〈http://www.cbc.ca/news/indepth/background/latimer_robert.html〉 (last visited January 15, 2002), describing the Robert Latimer case, which involves a Saskatchewan farmer who killed his 12-year-old daughter, Tracy, who suffered from severe cerebral palsy and had the capacity of a three-month-old child. Latimer is currently serving a life sentence, which holds no possibility of parole until 10 years.
23. B. Sneiderman and M. Verhoef, "Patient Autonomy and the Defence of Medical Necessity: Five Dutch Euthanasia Cases," Alberta Law Review, XXXIV, no. 2 (1996): 374-415, at 376. In England and Canada, the defense of medical necessity has been recognized in abortion cases (see R. v. Bourne [1938] 3 All E.R. 615 and R. v. Morgentaler [1975] 20 C.C.C. (2d) 449), but it is not available in euthanasia cases. For England, see R. v. Cox [1992] 12 BMLR 38 (England); R. Porter, "Doctor Convicted of Attempted Murder," Sunday Telegraph (London), September 20, 1992. For Canada, see M. O'Malley and O. Wood, "'Cruel & Unusual': The Law and Latimer," CBC News, at 〈http://www.cbc.ca/news/indepth/background/latimer_robert.html〉 (last visited January 15, 2002), describing the Robert Latimer case, which involves a Saskatchewan farmer who killed his 12-year-old daughter, Tracy, who suffered from severe cerebral palsy and had the capacity of a three-month-old child. Latimer is currently serving a life sentence, which holds no possibility of parole until 10 years.
24. R.J.M. Dillmann and J. Legemaate, "Euthanasia in the Netherlands: The State of the Legal Debate," European Journal of Health Law, 1 (1994): 81-87, especially at 84.
25. A translation of the law can be found in Griffiths, Bood, and Weyers, supra note 5, at 308-13.
26. Reuters, "Dutch Parliament Votes to Legalize Euthanasia," November 28, 2000, available at 〈http://www.worldrtd.org/dutchlaw. html#reuters〉.
27. On the regional committees, see E. van Leeuwen and G. Kimsma, "Problems Involved in the Moral Justification of Medical Assistance in Dying: Coming to Terms with Euthanasia and Physician Assisted Suicide," in R. Cohen-Almagor, ed., Medical Ethics at the Dawn of the 21st Century (New York: New York Academy of Sciences, 2000): 157-173; B. Onwuteaka-Philipsen, Consultation of Another Physician in Cases of Euthanasia and Physician-Assisted Suicide, Doctoral Thesis (Amsterdam: Department of Social Medicine, Vrije Universiteit, 1999).
28. On the regional committees, see E. van Leeuwen and G. Kimsma, "Problems Involved in the Moral Justification of Medical Assistance in Dying: Coming to Terms with Euthanasia and Physician Assisted Suicide," in R. Cohen-Almagor, ed., Medical Ethics at the Dawn of the 21st Century (New York: New York Academy of Sciences, 2000): 157-173; B. Onwuteaka-Philipsen, Consultation of Another Physician in Cases of Euthanasia and Physician-Assisted Suicide, Doctoral Thesis (Amsterdam: Department of Social Medicine, Vrije Universiteit, 1999).
29. "Minderjarige mag euthanasie vragen" (A minor may/is allowed to ask/request for euthanasia), NRC Handelsblad (New Rotterdam), July 10, 1999, at 3. See also M. Gardner, "Dutch Poised to Legalize Euthanasia," Christian Science Monitor, June 30, 2000, available at 〈http://www. csmonitor.com/durable/2000/06/28/text/p1s4.html〉.
30. "Minderjarige mag euthanasie vragen" (A minor may/is allowed to ask/request for euthanasia), NRC Handelsblad (New Rotterdam), July 10, 1999, at 3. See also M. Gardner, "Dutch Poised to Legalize Euthanasia," Christian Science Monitor, June 30, 2000, available at 〈http://www. csmonitor.com/durable/2000/06/28/text/p1s4.html〉.
31. Associated Press, "Dutch Call Off Aided Suicide for Children," International Herald-Tribune, July 15, 2000.
32. H. Jochemsen, "The Legalization of Euthanasia in The Netherlands," Ethics & Medicine, 17, no. 1 (January 2001).
33. In his letter dated June 5, 1999, Dr. Chabot wrote: "After four years waiting for the final court judgement (1991-1995) and discussing the case with many people from abroad, I hope you will understand that I prefer to remain in the background now and not to make an appointment with you." He, however, agreed to answer via e-mail some specific questions relating to his conduct that brought about the charges against him.
34. My questionnaire comprised fifteen questions. The Dutch comprehensive study of 1995 consisted of 120 pages and the interviews lasted for an average of 2.5 hours. The pace of questioning was, apparently, frantic. See P.J. van der Maas et al., "Euthanasia, Physician-Assisted Suicide, and Other Medical Practices Involving the End of Life in the Netherlands, 1990-1995," N. Engl. J. Med., 335, no. 22 (1996): 1699-1711, at 1700.
35. Those commenting included Arie J.G. van der Arend, Rob Houtepen, Henk Jochemsen, Margo Trappenburg, James Kennedy, H.J.J. Leenen, A. van Dantzig, Heleen Dupuis, Johannes JM van Delden, John Griffiths, Sjef Gevers, Ron Berghmans, Ruud ter Meulen, Govert den Hartogh, Arko Oderwald, Evert van Leeuwen, Paul van der Maas, and Gerrit Kimsma. Bert Thijs and George Beusmans read the draft and had no problem with my account of their views.
36. B. Gordijn, "Euthanasie: strafbar und doch zugestanden? Die niederlandische Duldungspolitik in Sachen Euthanasie" (Euthanasia: Criminal offense and still allowed? The Dutch policy of permissiveness/tolerance in cases of euthanasia), Ethik Med, 10 (1998): at 12.
37. Proceedings of Euthanasia and Assisted Suicide in the Netherlands and in Europe, Maastricht, June 10-11, 1994 (Luxembourg: Office for Official Publications of the European Communities, 1996): at 101.
38. Griffiths, Bood and Weyers, supra note 5, at 12-13.
39. L. Pijnenborg, "The Dutch Euthanasia Debate in International Perspective," in End-of-Life Decisions in Dutch Medical Practice, Doctoral Thesis (Rotterdam: Department of Public Health, Erasmus University, 1995): 119-132. I am most grateful to Paul van der Maas for sending me this work as well as some other publications.
40. These included James Kennedy, Govert den Hartogh, Heleen Dupuis, Henk Jochemsen, and A. van Dantzig.
41. Evert Van Leeuwen, Jaap Visser, Margo Trappenburg, Bert Thijs, and Gerrit van der Wal expressed similar views.
42. Ruud ter Meulen made a similar point. For further deliberation on Calvinism, see D.E. Holwerda, ed., Exploring the Heritage of John Calvin (Grand Rapids, Michigan: Baker Book House, 1976). See especially the chapter by T. Minnema, "Calvin's Interpretation of Human Suffering," at 140-162.
43. Ruud ter Meulen made a similar point. For further deliberation on Calvinism, see D.E. Holwerda, ed., Exploring the Heritage of John Calvin (Grand Rapids, Michigan: Baker Book House, 1976). See especially the chapter by T. Minnema, "Calvin's Interpretation of Human Suffering," at 140-162.
44. The book was translated to English and published by W.W. Norton in 1978.
45. J. van Holsteyn and M. Trappenburg, "Citizens' Opinions on New Forms of Euthanasia. A Report from the Netherlands," Patient Education and Counseling, 35 (1998): 63-73.
46. Van den Berg's book responded to widely felt concerns and was reprinted twenty-one times within seven years and endlessly discussed in magazines and other media. See Griffiths, Bood and Weyers, supra note 5, at 48.
47. On changes in public opinion from 1966 to 1991, see P.J. van der Maas, L. Pijnenborg, and J.J.M. van Delden, "Changes in Dutch Opinions on Active Euthanasia, 1966 Through 1991," JAMA, 273, no. 18 (May 10, 1995): 1411-14; D.J. Hessing, J.R. Blad, and R. Pieterman, "Practical Reasons and Reasonable Practice: The Case of Euthanasia in the Netherlands," Journal of Social Issues, 52, no. 2 (1996): 161-66. According to two consecutive polls, 70 percent of the Dutch people accepted active euthanasia in 1985, and 76 percent in 1986. See R. Fenigsen, "A Case Against Dutch Euthanasia," Hastings Center Report, 19, no. 1 (Supp. January/February 1989): 22-25. A 1998 survey showed that more than 90 percent of the population favors euthanasia. See S. Daley, "The Dutch Seek to Legalize Long-Tolerated Euthanasia," New York Times, June 20, 2000, available at 〈http://www10.nytimes.com/library/ world/europe/062000holland-mercy.html〉.
48. On changes in public opinion from 1966 to 1991, see P.J. van der Maas, L. Pijnenborg, and J.J.M. van Delden, "Changes in Dutch Opinions on Active Euthanasia, 1966 Through 1991," JAMA, 273, no. 18 (May 10, 1995): 1411-14; D.J. Hessing, J.R. Blad, and R. Pieterman, "Practical Reasons and Reasonable Practice: The Case of Euthanasia in the Netherlands," Journal of Social Issues, 52, no. 2 (1996): 161-66. According to two consecutive polls, 70 percent of the Dutch people accepted active euthanasia in 1985, and 76 percent in 1986. See R. Fenigsen, "A Case Against Dutch Euthanasia," Hastings Center Report, 19, no. 1 (Supp. January/February 1989): 22-25. A 1998 survey showed that more than 90 percent of the population favors euthanasia. See S. Daley, "The Dutch Seek to Legalize Long-Tolerated Euthanasia," New York Times, June 20, 2000, available at 〈http://www10.nytimes.com/library/ world/europe/062000holland-mercy.html〉.
49. On changes in public opinion from 1966 to 1991, see P.J. van der Maas, L. Pijnenborg, and J.J.M. van Delden, "Changes in Dutch Opinions on Active Euthanasia, 1966 Through 1991," JAMA, 273, no. 18 (May 10, 1995): 1411-14; D.J. Hessing, J.R. Blad, and R. Pieterman, "Practical Reasons and Reasonable Practice: The Case of Euthanasia in the Netherlands," Journal of Social Issues, 52, no. 2 (1996): 161-66. According to two consecutive polls, 70 percent of the Dutch people accepted active euthanasia in 1985, and 76 percent in 1986. See R. Fenigsen, "A Case Against Dutch Euthanasia," Hastings Center Report, 19, no. 1 (Supp. January/February 1989): 22-25. A 1998 survey showed that more than 90 percent of the population favors euthanasia. See S. Daley, "The Dutch Seek to Legalize Long-Tolerated Euthanasia," New York Times, June 20, 2000, available at 〈http://www10.nytimes.com/library/ world/europe/062000holland-mercy.html〉.
50. On changes in public opinion from 1966 to 1991, see P.J. van der Maas, L. Pijnenborg, and J.J.M. van Delden, "Changes in Dutch Opinions on Active Euthanasia, 1966 Through 1991," JAMA, 273, no. 18 (May 10, 1995): 1411-14; D.J. Hessing, J.R. Blad, and R. Pieterman, "Practical Reasons and Reasonable Practice: The Case of Euthanasia in the Netherlands," Journal of Social Issues, 52, no. 2 (1996): 161-66. According to two consecutive polls, 70 percent of the Dutch people accepted active euthanasia in 1985, and 76 percent in 1986. See R. Fenigsen, "A Case Against Dutch Euthanasia," Hastings Center Report, 19, no. 1 (Supp. January/February 1989): 22-25. A 1998 survey showed that more than 90 percent of the population favors euthanasia. See S. Daley, "The Dutch Seek to Legalize Long-Tolerated Euthanasia," New York Times, June 20, 2000, available at 〈http://www10.nytimes.com/library/ world/europe/062000holland-mercy.html〉.
51. C.F. McKhann, A Time to Die: The Place for Physician Assistance (New Haven, Connecticut: Yale University Press, 1999): at 122. The Postma case was the best known prosecution during this period of a person who killed another at the latter's request, but it wasn't the only one. There were at least three other prosecutions for violations of Articles 293 or 294. See C.F. Gomez, Regulating Death (New York: The Free Press, 1991): at 28-32; Griffiths, Bood, and Weyers, supra note 5, at 53.
52. C.F. McKhann, A Time to Die: The Place for Physician Assistance (New Haven, Connecticut: Yale University Press, 1999): at 122. The Postma case was the best known prosecution during this period of a person who killed another at the latter's request, but it wasn't the only one. There were at least three other prosecutions for violations of Articles 293 or 294. See C.F. Gomez, Regulating Death (New York: The Free Press, 1991): at 28-32; Griffiths, Bood, and Weyers, supra note 5, at 53.
53. This is supported by my interviews with John Griffiths, J.K. Gevers, Bert Thijs, Arie van der Arend, Ron Berghmans, and Ruud ter Meulen.
54. P. Ester, L. Halman, and R. de Moor, The Individualizing Society: Value Change in Europe and North America (Tilburg: Tilburg University Press, 1994): at 56-60.
55. This is supported by my interviews with Jaap Visser, Dick Willems, and John Griffiths. This point was reiterated also by Frank Koerselman, Egbert Schroten, and Govert den Hartogh.
56. These include Evert van Leeuwen, John Griffiths, and Gerrit van der Wal.
57. L. Alexander, "Medical Science Under Dictatorship," N. Engl. J. Med., 241 (July 14, 1949): 39-47, especially at 45.
58. This is supported by my interviews with J.K. Gevers, Jaap Visser, Heleen Dupuis, Margo Trappenburg, Gerrit van der Wal, Henk Jochemsen, Govert den Hartogh, Arko Oderwald, and Rob Houtepen.
59. G. van der Wal and R.J.M. Dillmann, "Euthanasia in the Netherlands," British Medical Journal, 308 (1994): 1346-49. For further deliberation on the Dutch health-care system, see J. van der Made and H. Maarse, "Access to Health Care in the Netherlands," in J. Lenaghan, ed., Hard Choices in Health Care: Rights and Rationing in Europe (London: BMJ Publishing Group, 1997): 93-111.
60. G. van der Wal and R.J.M. Dillmann, "Euthanasia in the Netherlands," British Medical Journal, 308 (1994): 1346-49. For further deliberation on the Dutch health-care system, see J. van der Made and H. Maarse, "Access to Health Care in the Netherlands," in J. Lenaghan, ed., Hard Choices in Health Care: Rights and Rationing in Europe (London: BMJ Publishing Group, 1997): 93-111.
61. See R. Cohen-Almagor and M.G. Hartman, "The Oregon Death with Dignity Act: Review and Proposals for Improvement," Journal of Legislation, 27, no. 2 (2001): 269-98.
62. See H. Hendin, Seduced by Death (New York: W.W. Norton, 1997): at 122.
63. See R. Cohen-Almagor, The Right to Die with Dignity: An Argument in Ethics, Medicine, and Law (NJ.: Rutgers University Press, 2001).