Euthanasia history global 3

The Dutch Euthanasia legislation only provides a special provision of exemption from punishment in certain circumstances.

The legislation: requires that due care be used by the physician, that the doctor believe the suffering to be lasting and unbearable, permits 16 to 18 year olds to be killed without parental approval, permits 12 to 16 yr olds to be killed if a parent or guardian agrees.

National character traits, key court rulings, lack of palliative care training and Royal Dutch Medical Association approval, led to this legal decision. In 1990, over 3700 people were euthanaised.

Euthanasia in the Netherlands is widely accepted by the medical establishment, the government and the Dutch people themselves.

A consensus on guidelines was reached and provided doctors kept to the rules, they could practice Assisted Suicide and Euthanasia, without fear of prosecution.

Overseas Concerns Lead to Two Studies

In 1990, international concerns about 'wild Euthanasia' prompted the Dutch government and the Royal Dutch Medical Association to sponsor a study of the practice Assisted Suicide and Euthanasia. This was followed by a second study in 1995.

The 1990 study estimated assisted deaths at 4,813 (3.7% of all deaths in that year). The 1995 study estimated 6,368 deaths (4.7% of all deaths). However, investigators discovered that 60% of all assisted deaths were not being reported and the safeguards, or guidelines, were being routinely ignored. Busy doctors were not prepared to carry out all the required 'safeguard' procedures. Doctors admitted that involuntary Euthanasia is widespread and largely unreported. Those doctors carrying out involuntary euthanasia do not consult with colleagues.

Assisted Suicide

For children aged 12 to 16, the approval of parents or guardian is required.

Declaration of Will

Persons aged 16 years and older can, in effect, make a written statement years before they may actually be in a position where it becomes a critical issue, based on views that may have changed in the meantime. The declaration has the same status as a concrete request for Euthanasia. (1)

Since 1981, guidelines have been interpreted by the Dutch courts and Royal Dutch Medical Association (KNMG) in ever-broadening terms. One example is the interpretation of the "unbearable pain" requirement reflected in the Hague Court of Appeal's 1986 decision. The court ruled that the pain guideline was not limited to physical pain, and that "psychic suffering" or "the potential disfigurement of personality" could also be grounds for Euthanasia. (2)

The main argument in favour of Euthanasia in Holland has always been the need for more patient autonomy -- that patients have the right to make their own end-of-life decisions. Yet, over the past 20 years, Dutch Euthanasia practice has ultimately given doctors, not patients, more and more power. The question of whether a patient should live or die is often decided exclusively by a doctor or a team of physicians.(3)

Falsified Death Certificates

In the overwhelming majority of Dutch Euthanasia cases, doctors - in order to avoid additional paperwork and scrutiny from local authorities - deliberately falsify patients' death certificates, stating that the deaths occurred from natural causes. (19)

In reference to Dutch euthanasia guidelines and the requirement that physicians report all euthanasia and assisted-suicide deaths to local prosecutors, a government health inspector recently told the New York Times:

"In the end the system depends on the integrity of the physician, of what and how he reports. If the family doctor does not report a case of voluntary Euthanasia or an Assisted Suicide, there is nothing to control." (20)

Inadequate Pain Control and Comfort Care

In 1988, the British Medical Association released the findings of a study on Dutch Euthanasia conducted at the request of British right-to-die advocates. The study found that, in spite of the fact that medical care is provided to everyone in Holland, palliative care (comfort care) programs, with adequate pain control techniques and knowledge, were poorly developed. (21) In 1993, the Dutch senior citizens' group, the Protestant Christian Elderly Society, surveyed 2,066 seniors on general health care issues. The Survey did not address the Euthanasia issue in any way, yet ten percent of the elderly respondents clearly indicated that, because of the Dutch Euthanasia policy, they are afraid that their lives could be terminated without their request. According to the Elderly Society director, Hans Homans. "They are afraid that at a certain moment, on the basis of age, a treatment will be considered no longer economically viable, and an early end to their lives will be made." (32)

The Irony of History

During World War ll, Holland was the only occupied country whose doctors refused to participate in the German Euthanasia program. Dutch physicians openly defied an order to treat only those patients who had a good chance of full recovery. They recognized that to comply with the order would have been the first step away from their duty to care for all patients. The German officer who gave that order was later executed for war crimes. Remarkably, during the entire German occupation of Holland, Dutch doctors never recommended nor participated in one Euthanasia death. (33) Commenting on this fact in his essay "The Humane Holocaust," highly respected British journalist Malcolm Muggeridge wrote that it took only a few decades "to transform a war crime into an act of compassion." (34)
Given those circumstances, doctors would be ill-equipped to recognize if a patient's euthanasia request was the result of depression or the sometimes subtle pressures placed on the patient to "get out of the way." Also, given the current push for health care cost containment in the U.S., medical groups and facilities many be tempted to view patients in terms of their treatment costs instead of their innate value as human beings. For some, the "bottom line" would be, "Dead patients cost less than live ones."

Giving doctors the legal power to kill their patients is dangerous public policy.

The Dutch experience in effect

The Dutch reports contain abundant evidence that doctors kill more patients without their explicit request than with their explicit request, and that euthanasia is not restricted by the so-called "strict medical guidelines" provided by the Dutch courts.

The narrow definition of "euthanasia" in the Dutch report masks the real numbers of physician- assisted deaths, the majority of which have not been shown to be at the request of the patient. The so-called "strict medical guidelines" are clearly not strictly followed or enforced.

A Summary for the US Congressional Subcommittee on the Constitution Suicide, Assisted Suicide and Euthanasia by Herbert Hendin, M.D. Lessons From the Dutch Experience

Sources

1. www.justitie.nl/english
2.. Carlos Gomez, Regulating Death (New York: Free Press, 1991), p.32. Hereafter cited as Regulating Death.
3. H. Jochemsen, trans., "Report of the Royal Dutch Society of Medicine on 'Life-Terminating Actions with Incompetent Patients, Part 1: Severely Handicapped Newborns.'" Issues in Law & Medicine, vol. 7, no.3 (1991), p. 366.
4. From KNMG Euthanasia Guidelines as quoted in Regulating Death, p. 40.
5. Alexander Morgan Capron, "Euthanasia in the Netherlands--American Observations," Hastings Center Report (March, April 1992), p. 31.
6. Medical Decisions About the End of Life, I. Report of the Committee to Study the Medical Practice Concerning Euthanasia. II. The Study for the Committee on Medical Practice Concerning Euthanasia (2 vols.), The Hague, September 19, 1991. Hereafter cited as Report I and Report II, respectively.
7. Report I, p. 13.
8. Ibid.
9. Ibid.,p. 15.
10. Report II, p.49, table 6.4.
11. Ibid., p.50, table 6.6.
12. Ibid., table 6.5.
13. Ibid., p. 58, table 7.2.
14. Ibid., p. 72.
15. Ibid.
16. Report I, pp. 17-18.
17. Report II, p. 52, table 6.7.
18. Ibid., table 6.8.
19. I.J. Keown, "The Law and Practice of Euthanasia in The Netherlands," The Law Quarterly Review (January 1992), pp. 67-68.
20. Marlise Simons, "Dutch Move to Enact Law Making Euthanasia Easier," New York Times, 2/9/93, p.A1.
21. Euthanasia: Report of the Working Party to Review the British Medical Association's Guidance on Euthanasia, British Medical Association, May 5, 1988, p. 49, no. 195.
22. Rita L. Marker, Deadly Compassion -The Death of Ann Humphry and the Truth About Euthanasia (New York; William Morrow and Company, 1993), p. 157. Hereafter cited as Deadly Compassion.
23. Abner Katzman, "Dutch debate mercy killing of babies," Contra Costa Times, 7/30/92, p. 3B.
24. "Critics fear euthanasia soon needn't be requested," Vancouver Sun, 2/17/93, p. Al0. Also, "Dutch may broaden rules to permit involuntary euthanasia," Contra Costa Times, 2/17/93, p. 4B.
25. New York Times, 4/5/93. p.A3, and Washington Times, 4/22/93, p.A2.
26. "It's Almost Over -- More Letters on Debbie," Letter to the editor by G.B. Humphrey, M.D., Ph.D., University Hospital, Groningen, The Netherlands, Journal of the American Medical Association, vol. 260, no. 6 (8/12/88), p. 788.
27."Involuntary Euthanasia in Holland," Wall Street Journal, 9/29/87, p.3.
28. "Restructuring Health Care", The Lancet (1/28/89), p.209.
29."The Member's Aid Service of the Dutch Association for Voluntary Euthanasia," Euthanasia Review, vol. 1, no. 3 (Fall 1986), p.153.
30. "Suicide on Prescription," Sunday Observer (London, England), 4/30/89, p. 22.
31. Deadly Compassion, p. 156.
32. "Elderly Dutch afraid of euthanasia policy," Canberra Times (Australia), 6/11/93.
33. Leo Alexander, "Medical Science Under Dictatorship," New England Journal of Medicine, vol.241 (July 14, 1949), p.45.
34. Nancy Gibbs, "Love and Let Die," Time Magazine (March 19, 1990), p.67.