BMJ  2003;327:465 (30 August), doi:10.1136/bmj.327.7413.465-a

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"Terminal sedation" different from euthanasia, Dutch ministers agree

Utrecht

The Dutch ministers of health and justice have rejected a call from the attorney general, Joan de Wijkerslooth, for "terminal sedation" to be covered by the same legal controls as euthanasia. Dutch doctors have welcomed, however, the distinction drawn between euthanasia and terminal sedation, in which a dying patient is given pain relief that induces a permanent coma.

Terminal sedation and the withdrawal of artificial feeding and hydration are "normal medical treatment" and therefore "different from euthanasia," wrote health minister Clémence Ross in answer to MPs' questions. Normal medical treatment such as stopping or not starting treatment considered medically hopeless was not punishable, he said.

Doctors had reacted angrily to Mr de Wijkerslooth's proposal for terminal sedation to be covered by the same legal controls as euthanasia. The Royal Dutch Medical Association feared the "frightening prospect" of legal interference into a normal medical activity already governed by professional guidelines. Mr Ross clarified the distinction, saying that terminal sedation is giving drugs that reduce dying patients' consciousness so that they are no longer aware of their surroundings and suffering.

By contrast, euthanasia involves giving medication at the patient's request that will result in death in a short time. In such a case, the doctors must adhere to legal criteria of care and report the actions to regional committees that review such cases.

The last large scale study into "end of life" decisions in the Netherlands, published in May, suggested that between 4% and 10% of all deaths, about 6000-14 000 patients, occurred following terminal sedation (31 May, p 1164).

Mr de Wijkerslooth, who is the head of the public prosecution service, argued that terminal sedation can have the same effect as euthanasia and therefore should be subject to external controls on the care of treatment.

Counsel for the Royal Dutch Medical Association, Johan Legemaate, professor of health law at Rotterdam's Erasmus University, said it would be a "very frightening prospect for the medical profession" if the very high numbers of these cases were to be treated in the same way as euthanasia.

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