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Dutch reporting of euthanasia cases falls -- despite legal reporting requirements

BMJ 2004; 328 doi: http://dx.doi.org/10.1136/bmj.328.7452.1336 (Published 03 June 2004) Cite this as: BMJ 2004;328:1336
  1. Tony Sheldon
  1. Antwerp

    The Dutch health minister, Clémence Ross, has appealed to doctors' “medical professionalism” amid concerns that they are not fulfilling legal requirements to report euthanasia. Her appeal follows the fourth consecutive fall in the number of reported cases of euthanasia.

    Last year's research, by Paul van der Maas, professor of social policy at Rotterdam's Erasmus Medical Centre, and Gerrit van der Wal, professor of social medicine at Amsterdam Free University Medical Centre, suggested that, although reporting was increasing, it had only reached 54% by 2001 (BMJ 2003;326:1164). The euthanasia law came into force in 2002 with the aim of improving reporting, but the total number of reported cases has continued to decline.

    The latest figure—for 2003—from the regional committees of lawyers, doctors, and ethicists that judge euthanasia and assisted suicide cases shows 1815 reports. This compares with 1882 for the previous year, 2054 for 2001, and 2123 in 2000.

    Ms Ross has expressed concerns, arguing it is “difficult to appreciate the declining numbers reported” because of “insufficient insight” into the total number of cases. She has now ordered a follow up study to take place in 2005 to clarify whether it is the level of reporting that is declining or euthanasia itself. She also wants the study to explain why some doctors do not report euthanasia.

    In a letter to MPs she writes: “There must be absolutely no misunderstanding … doctors must report.” She states that the Royal Dutch Medical Association shares her view that reporting euthanasia is part of “medical professionalism.”

    She is to raise the issue with the association and has announced that the regional committees will publish their judgments on a database to make them more accessible and encourage further reporting.

    The association's chairman, Peter Holland, agrees with Ms Ross. He explained that this is why the association supports training doctors to understand euthanasia. But he also believes that the total number of people who actively choose to end their lives is falling as “alternatives such as pain relief and sedation become more available” owing to an “enormous increase in expertise in palliative care.”

    Among the reported cases of euthanasia in 2003, all but eight were judged to have followed the legal requirements of care, including a voluntary and well considered request from a patient who was deemed to be suffering “hopelessly and unbearably” (one of four criteria that protect doctors against prosecution). These eight were passed on to the health inspectorate and the prosecution authorities. The vast majority (1605) of cases, were cancer patients, with most (1477) dying at home.