Holland decriminalises voluntary euthanasia
BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7292.947 (Published 21 April 2001) Cite this as: BMJ 2001;322:947
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In as much as I would identify euthanasia as criminal and wrong, I do
think the whole controversy surrounding "it" depends on how well one
argues it out in proving one's view.
Sincerely, I wouldn't like to be one sided but place myself in the
scenerio, in the eyes of the patient, groaning in pain and the doctor's,
trying to alleviate the pain.
Competing interests: No competing interests
The Dutch Senate has finally passed new legislation to legalise
euthansia (1).
But have the rules changed? They sound remarkably like the previous
regulations which, according to Dutch publications, were roundly abused.
If the rules haven’t changed, what about their administration? Cases
of euthanasia will now be judged by local committees of doctors, lawyers,
and ethicists and we are told the prevention of abuse will be left largely
to the principles of individual doctors. So whilst the legal position of
the doctor performing euthanasia may be clarified, there are no grounds to
expect any change in clinical practices.
So what evidence is there of abuse? The 1996 Dutch report (2)
reported 3253 cases of euthanasia and 271 cases of physician-assisted
suicide. But in addition there were 948 patients who had a life-
terminating act performed WITHOUT EXPLICIT REQUEST, plus 3883 deaths
related to treatment and 18071 deaths related to withholding/withdrawing
treatment performed WITH THE PRIMARY INTENTION OF HASTENING DEATH, many
without the patients' consent. So the real number of cases of euthanasia
in Holland is over 26000 persons per year.
The Dutch have conclusively demonstrated that the decriminalisation
of voluntary euthanasia leads to non-voluntary euthanasia, that euthanasia
for the terminally ill leads to euthanasia for the non-terminally ill and
persons with potentially treatable conditions, and that the vulnerable in
society will experience pressure to request euthanasia.
The Dutch concepts of "unremitting and unbearable" suffering and "no
reasonable alternative solution" are founded in their lack of knowledge of
palliative care. Palliative care recognises human suffering and seeks to
relieve it, but it does not accept that euthanasia is ever the answer. The
message of palliative care is that there is always something which can be
done to improve the quality of the life remaining to the patient.
If you give another human being a drug that you know without doubt
will end his or her life, and that is the primary intention, that is
murder.
As the banners outside the Dutch parliament said “Euthanasia remains
Murder”.
And that is something no parliament, not even the Dutch parliament,
can change.
Dr Roger Woodruff FRACP FAChPM
1. Sheldon T Holland decriminalises voluntary euthanasia BMJ 2001;
322: 947
2. van der Maas PJ, van der Wal G, Haverkate I et al. Euthanasia,
physician-assisted suicide, and other medical practices involving the end
of life in the Netherlands, 1990-1995. N Engl J Med 1996; 335 : 1699-705
(392words)
Competing interests: No competing interests
Unfair to the Dutch
While I agree with most of Dr Woodruff's sentiments, and am equally
concerned about the slippery slope, his title, "Going Dutch" and his
repeated use of the phrase, "The Dutch", are unwarranted generalizations,
and unfair to the many people in Holland who neither practice nor favour
active euthanasia. There is quite a vocal anti-euthanasia movement in
Holland.
The study which Dr Woodruff cites, by van der Maas PJ, van der Wal G,
Haverkate I et al, moreover, is quite old. It would be interesting to see
whether or not more recent data indicate that things have improved. Of
course individual scandals are known through the news sections of medical
journals. But it would be interesting to see further large-scale studies.
(I am not claiming that such studies do not exist; I simply do not know).
As for his generalization that the Dutch lack knowledge of palliative
care, I would be surprized if he were right, but
I lack the means to judge whether he is right or wrong. Perhaps Dr
Woodruff can supply references to literature demonstrating that there is
no palliative care in Holland.
For clarity, I must emphasize that, personally, I am strongly against
active euthanasia. I am merely urging fairness.
Competing interests: No competing interests