Intended for healthcare professionals


Better palliative care could cut euthanasia

BMJ 1998; 317 doi: (Published 12 December 1998) Cite this as: BMJ 1998;317:1613
  1. Hugh Matthews
  1. BMJ

    Euthanasia in the Netherlands is proving detrimental to the practice of medicine and is usually avoidable, Dutch palliative care physician Dr Ben Zylicz told a meeting at the United Kingdom's House of Lords last week.

    The practice of non-voluntary euthanasia--in which the patient is unable to give consent--is becoming widespread, in contravention of Dutch guidelines, warned Dr Zylicz. He suggested that the fact that there were only 70 specialist palliative care beds in the country was a reason why doctors and patients often resorted to euthanasia. “If you accept euthanasia as a solution to difficult and unresolved problems in palliative care, you will never learn anything,” he warned.

    Dr Zylicz reported that many patients needing terminal care were currently discharged to their GP. Since few doctors received any training in palliative medicine, they often felt that they had no solution other than euthanasia if the patient's suffering became too great. Effective palliative care provides an alternative option; a quarter of the patients admitted to the hospice where Dr Zylicz works had initially requested euthanasia, but none had ultimately used it.

    More worryingly, Dr Zylicz suggested that there is evidence that the Dutch guidelines on euthanasia, established in 1984, are often breached. Under these rules, the patient must have intractable suffering, must make a voluntary request, and the doctor must report each case to the local medical examiner. In 1995 there were 900 cases of non-voluntary euthanasia recorded. While some patients were unable to give consent, as many as a quarter were killed while fully or partly competent, without making any request, he claimed.

    Professor Lord McColl, a member of the Lords Select Committee on Euthanasia, commented on a visit to the Netherlands: “Our visit convinced me that euthanasia is impossible to police and will be abused.”

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