BMJ  2007;334:1075 (26 May), doi:10.1136/bmj.39220.590428.DB

News

Incidence of euthanasia in the Netherlands falls as that of palliative sedation rises

Utrecht

Five years after it was legalised, euthanasia in the Netherlands seems to be declining in favour of palliative sedation, whereby terminally ill patients are kept in a coma while decisions that may shorten their lives are made, such as withdrawal of fluids.

Now the euthanasia lobby and MPs are warning that palliative sedation, which does not involve the same reporting obligations as euthanasia does, must never become a convenient "short cut" to ending the life of someone who is dying.

New government sponsored research that evaluated the effect of the 2002 euthanasia law shows that the number of cases of euthanasia fell from 3500 (2.6% of deaths) in 2001 to 2325 (1.7%) in 2005. By contrast the number of cases of palliative sedation rose from 8500 (5.6%) to 9700 (7.1%). The number of requests for euthanasia and assisted suicide fell from 9700 to 8400.

Dutch law requires doctors to report euthanasia to committees that assess whether the legal requirements have been met. Patients have to be experiencing hopeless and unbearable suffering and to have made a voluntary request for euthanasia, and a second opinion has to have been found.

The researchers, who questioned doctors about more than 5000 deaths, conclude that the 2002 law has more or less achieved its aims of creating legal certainty and greater transparency and control and improving the quality of care.

Reporting of cases has risen sharply, from 54% to 80%. Most of the unreported cases involved the use of morphine, and doctors did not perceive their actions to be necessarily "life ending." The researchers used responses to confidential questionnaires to estimate the number of unreported cases.

The health minister, Jet Bussemaker, said that the increase in the number of cases being reported demonstrated the care with which decisions about euthanasia were now being made. "There can be no question of a slippery slope in the Netherlands."

The researchers accept that the fall in euthanasia can be partly explained by the rise in palliative sedation. Two thirds of the doctors questioned said that there was a clear relation between the two. Also, many new cases of palliative sedation involve patients with cancer, some of whom are likely to have requested euthanasia while being treated.

Now the Society for Voluntary Ending of Life says that it is increasingly confronted with reports that doctors have persuaded patients to choose sedation because euthanasia brings too much "red tape" with it.

MPs have raised concerns too that patients may not be being offered a real choice. The MP Agnes Kant argues that it is a very emotionally complicated process for doctors and for patients' families. "Palliative sedation is a much easier choice," she said.

But one of the report's authors, Bregje Onwuteaka-Philipsen, said that the fall in the number of requests for euthanasia indicates that it is the patients who are demanding euthanasia less. She said that doctors and patients may be making an earlier choice for palliative sedation together, perhaps because of better knowledge of the possibilities of palliative care.

Dr Bussemaker has said that the existence of palliative care, no matter how good, should not in itself be a reason to refuse euthanasia.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?