Abstract
The Dutch understanding of euthanasia is said to be marked by its precision. Unlike other countries that distinguish between active and passive euthanasia, between direct and indirect euthanasia, and between voluntary and involuntary euthanasia, the Dutch definition of the term is exact: the intentional taking of someone’s life at his or her explicit request. According to the law, only a competent patient’s request can be accepted. Consequently:
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a.
What is termed “euthanasia” in the Netherlands is called “active euthanasia” in other parts of the world. In the Dutch conception, euthanasia is active by definition and there is no need to specify the act by the term “active,” as other countries do.
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b.
All other kinds of end-of-life (“terminal”) care bear other names. Thus, for instance, withdrawal of treatment is not considered euthanasia. Elsewhere it is termed “passive euthanasia.” In the Netherlands, this term is deemed illogical and useless insofar as passive euthanasia is self-contradictory because it concerns the omission of a treatment to which the patient has not consented.1 Within the law, the difference between acting and refraining from acting has no particular relevance, and such a legal consideration takes precedence over the psychological experience of the difference. The prevailing Dutch perspective regards any treatment that has no clear medical benefit for the patient as futile. The argument is that no patient should be subjected to useless medical interventions, or that these treatments should be offered as an option to patients. In a leading test case, a Dutch court ruled that contrary to the wishes of the next of kin, a hospital was not obliged to return an 80-year-old cancer patient to intensive care when his condition was deteriorating.2
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References
G.K. Kimsma and E. van Leeuwen, “Dutch Euthanasia: Background, Practice, and Present Justifications,” Cambridge Q. of Healthcare Ethics, Vol. 2 (1993), p. 24.
Cf. Tony Sheldon, “Doctors Not Obliged to Carry Out Treatment They Think ‘Futile’,” British Medical Journal, Vol. 319 (October 23, 1999), at 1088.
The ethical concept of double effect is used to justify medical treatment designed to relieve suffering where death is an unintended, though foreseeable, consequence. The doctrine is based on two basic presuppositions: (1) the doctor’s intention is to alleviate suffering; (2) the treatment must be proportional to the illness. The doctrine applies if the desired outcome is judged to be “good” (e.g. relief of suffering); the “bad” outcome (e.g. death of patient) is not intended; the “good” outcome is not achieved by means of the “bad,” and the “good” outcome outweighs the “bad.” For further discussion on the double effect doctrine, see R. Cohen-Almagor, “Language and Reality at the End of Life,” The Journal of Law, Medicine and Ethics, Vol. 28, No. 3 (Fall 2000): 267–278; Daniel P. Sulmasy and Edmund D. Pellegrino, “The Rule of Double Effect,” Archives of Internal Medicine, Vol. 159 (March 22, 1999): 545–550; Len Doyal, “The Moral Character of Clinicians or the Best Interests of Patients?,” British Medical Journal, Vol. 318 (May 29, 1999): 1432–1433.
Cf. Johan Legemaate, “Twenty-Five Years of Dutch Experience and Policy on Euthanasia and Assisted Suicide: An Overview,” in David C. Thomasma, Thomasine Kimbrough-Kushner, Gerrit K. Kimsma, and Chris Ciesielski-Carlucci (eds.), Asking to Die (Dordrecht: Kluwer Academic Publishers, 1998), p. 20; Gerrit K. Kimsma, “Euthanasia and Physician Assisted Suicide in the Netherlands,” in Medizin, Ethik, Recht (1994): 161–169.
The Medical Association Executive Board emphasized that there are only limited possibilities for verifying whether suffering is unbearable and without prospect of improvement. In any case, the Board considered it the doctor’s task to investigate whether there are medical or social alternatives that could make the patient’s suffering bearable. John Griffiths, Alex Bood and Heleen Weyers, Euthanasia and Law in the Netherlands (Amsterdam: Amsterdam University Press, 1998), p. 66.
John Keown, “The Law and Practice of Euthanasia in the Netherlands,” The Law Quarterly Review, Vol. 108 (January 1992), p. 56.
The Royal Dutch Medical Association’s refinements of the 1984 Guidelines (August 25, 1995). Cf. Marlise Simons, “Dutch doctors to tighten rules on mercy killings,” The New York Times (September 11, 1995), p. A3.
Marcia Angell’s Editorial, “Euthanasia in the Netherlands — Good News or Bad?,” New Eng. J. of Medicine, Vol. 335, No. 22 (November 28, 1996); Adriaan Jacobovits, “Euthanasia in the Netherlands,” Washington Post (January 23, 1997), p. A16; General Health Council, “A Proposal of Advice Concerning Careful Requirements in the Performance of Euthanasia” (The Hague, 1987).
Cf. P.J. van der Maas, J.J.M. van Delden, and L. Pijnenborg, Euthanasia and other Medical Decisions Concerning the End of Life, Health Policy Monographs (Amsterdam: Elsevier, 1992).
Paul J. van der Maas, Gerrit van der Wal, Ilinka Haverkate et al, “Euthanasia, Physician-Assisted Suicide, and Other Medical Practices Involving the End of Life in the Netherlands, 1990–1995,” New Eng. J. of Med., Vol. 335, No. 22 (November 28, 1996): 1699–1705; B.D. Onwuteaka-Philipsen, A. van der Heide, D. Koper, I. Keij-Deerenberg, J.A.C. Rietjens, M.L. Rurup, A.M. Vrakking, J.J. Georges, M.T. Muller, G. van der Wal, P.J. van der Maas, “Euthanasia and Other End-of-life Decisions in the Netherlands in 1990, 1995, and 2001,” Lancet, Vol. 362 (August 2, 2003): 395–399.
For further discussion, see Johannes J.M. van Delden et al., “Deciding Not to Resuscitate in Dutch Hospitals,” J. of Medical Ethics, Vol. 19 (1993): 200–205; Tony Sheldon, “Euthanasia Law Does Not End Debate in the Netherlands,” BMJ, Vol. 307 (December 11, 1993): 1511–1512; Henk Jochemsen, “Euthanasia in Holland: An Ethical Critique of the New Law,” J. of Medical Ethics, Vol. 20 (1994): 212–217; Chris Ciesielski-Carlucci and Gerrit Kimsma, “The Impact of Reporting Cases of Euthanasia in Holland: A Patient and Family Perspective,” Bioethics, Vol. 8, No. 2 (1994): 151–158; J.K.M. Gevers, “Physician Assisted Suicide: New Developments in the Netherlands,” Bioethics, Vol. 9, No. 3/4 (1995): 309–312.
P.J. van der Maas, J.J.M. van Delden, and L. Pijnenborg, Euthanasia and other Medical Decisions Concerning the End of Life, op. cit., p. 41.
B.D. Onwuteaka-Philipsen et al., “Euthanasia and Other End-of-life Decisions in the Netherlands in 1990, 1995, and 2001,” op. cit., p. 396.
Gerrit van der Wal and Paul J. van der Maas, “Empirical Research on Euthanasia and Other Medical End-of-Life Decisions and the Euthanasia Notification Procedure,” in David C. Thomasma, Thomasine Kimbrough-Kushner, Gerrit K. Kimsma, and Chris Ciesielski-Carlucci (eds.), Asking to Die, op. cit., p. 171. See also Bill Mettyear, “advocating legalising voluntary euthanasia” (February 1997), http://www.on.net/clients/saves/South Australian Voluntary Euthanasia Society. In his comments on the first draft of this study, van der Maas wrote that in 1990 the decision had been discussed with a patient in 46% of the cases and in 14% there had been an expressed wish. Because explicit request is defined very strictly in the Dutch studies, these were not counted as euthanasia on request. Van der Maas noted an interesting comparison: Replication studies in Australia and Belgium both found frequencies over 3% for ending of life without explicit request. He estimated the number of active cases involving ending of life among newborns in the Netherlands to be 10–15 cases per year. Personal communication on September 18, 2000.
B.D. Onwuteaka-Philipsen et al., “Euthanasia and Other End-of-life Decisions in the Netherlands in 1990, 1995, and 2001,” op. cit., p. 397.
P.J. van der Maas, J.J.M. van Delden, and L. Pijnenborg, Euthanasia and other Medical Decisions Concerning the End of Life, op. cit., p. 62.
J.J.M. van Delden, and L. Pijnenborg, Euthanasia and other Medical Decisions Concerning the End of Life, Asking to Die Ibid., p. 58.
B.D. Onwuteaka-Philipsen et al., “Euthanasia and Other End-of-life Decisions in the Netherlands in 1990, 1995, and 2001,” op. cit., p. 397.
Ibid.
In another study among family doctors, one quarter of the physicians said that they did not ask for a second opinion before administering euthanasia or assisted suicide, and 12% of the GPs had no consultation with any professional health worker. Cf. G. van der Wal, J. Th. M. van Eijk, H.J.J. Leenen and C. Spreeuwenberg, “Euthanasia and Assisted Suicide. II. Do Dutch Family Doctors Act Prudently?,” Family Practice, Vol. 9, No. 2 (1992), p. 140.
P.J. van der Maas, J.J.M. van Delden, and L. Pijnenborg, Euthanasia and other Medical Decisions Concerning the End of Life, op. cit., p. 65.
J.J.M. van Delden, and L. Pijnenborg, Euthanasia and other Medical Decisions Concerning the End of Life, Family Practice, Vol. 9, No. 2 (1992) Ibid, p. 66.
Henk A.M.J. ten Have, “Euthanasia: The Dutch Experience,” Annals de la Real Academia Nacional de Medicina, Tomo CXII (Madrid, 1995), p. 429.
Remmelink Commission, Rapport Medische Beslissingen Rond het Levenseinde (The Hague: SDU, 1991), p. 37. See also Henk A.M.J. ten Have, “Euthanasia: The Dutch Experience,” Annals de la Real Academia National de Medicina, Tomo CXII (Madrid, 1995), p. 429. In his comments on the first draft of this study, Leenen wrote that the proposal of the Remmelink Commission was rejected by nearly all the Dutch commentators and also by the government. Letter dated July 25, 2000.
Henk A.M.J. ten Have, “Euthanasia: The Dutch Experience,” Annals de la Real Academia National de Medicina, Tomo CXII (Madrid, 1995): 429–430.
See G.A. den Hartogh, “Self-determination and Compassion in the Dutch Euthanasia-debate,” Rekenschap, Vol. 39, No. 2 (1992), p. 110.
Gerrit van der Wal and Robert J.M. Dillmann, “Euthanasia in the Netherlands,” British Medical Journal, Vol. 308 (1994): 1346–1349.
Arie J.G. van der Arend provides data that refute this contention. Cf. “An Ethical Perspective on Euthanasia and Assisted Suicide in the Netherlands from a Nursing Point of View,” Nursing Ethics, Vol. 5, No. 4 (1998), at 313. See also idem, “Euthanasia and Assisted Suicide in the Netherlands: Clarifying the Practice and the Nurse’s Role,” Int. Nurs. Rev., Vol. 45, No. 5 (1998), esp. p. 148; Ada van de Scheur and Arie van der Arend, “The Role of Nurses in Euthanasia: A Dutch Study,” Nursing Ethics, Vol. 5, No. 6 (1998), esp. pp. 505–506.
Gerrit van der Wal and Robert J.M. Dillmann, “Euthanasia in the Netherlands,” op. cit.: 1346–1349.
Margaret P. Battin, The Least Worst Death (New York: Oxford University Press, 1994), at 132–133. See also Pieter V. Admiral, “Justifiable Euthanasia,” Issues in Law and Medicine, Vol. 3, No. 4 (Spring 1988): 361–370; H.M. Kuitert, “Euthanasia in the Netherlands: A Practice and Its Justification,” lecture delivered at the First World Congress of Bioethics (Amsterdam, 1992).
South Australian Voluntary Euthanasia Society, Fact Sheet 17 (February 1997).
Herbert Hendin, Chris Rutenfrans and Zbigniew Zylicz, “Physician-Assisted Suicide and Euthanasia in the Netherlands,” JAMA, Vol. 277, No. 21 (June 4, 1997), p. 1721. Van der Maas et al object to combining different categories of actions at the end-of-life. Cf. Johannes J.M. van Delden, Loes Pijnenborg and Paul J. van der Maas, “Dances with Data,” Bioethics, Vol. 7, No. 4 (1993): 323–329, at 325.
Henk Jochemsen and John Keown, “Voluntary Euthanasia under Control? Further Empirical Evidence from the Netherlands,” Journal of Medical Ethics, Vol. 25 (1999): 16–21, at 19–20, reprinted in brief in Issues in Law and Medicine, Vol. 14 (Spring 1999), at 474. See also J. Keown, “Euthanasia in the Netherlands: Sliding Down the Slippery Slope?,” Notre Dame J. of Law, Ethics and Public Policy, Vol. 9 (1995): 407–448.
Paul J. van der Maas, Gerrit van der Wal, Ilinka Haverkate et al, “Euthanasia, Physician-Assisted Suicide, and Other Medical Practices Involving the End of Life in the Netherlands, 1990–1995,” New Eng. J. of Med., Vol. 335, No. 22 (November 28, 1996): 1699–1705. See also Loes Pijnenborg, Paul van der Maas, Jan W.P.F. Kardaun et al, “Withdrawal or Withholding of Treatment at the End of Life,” Arch. Intern. Med., Vol. 155 (February 13, 1995), esp. at 291.
Herbert Hendin, Chris Rutenfrans and Zbigniew Zylicz, “Physician-Assisted Suicide and Euthanasia in the Netherlands,” op. cit., p. 1721.
Steve Dow, “Dutch laws linked to fears over euthanasia,” The Age: Melbourne Online (July 4, 1997). See http://www.theage.com.au.
Ph. Schepens, “Euthanasia: Our Own Future?,” Issues in Law and Medicine, Vol. 3, No. 4 (Spring 1988): 371–384.
J.H. Segers, “Elderly Persons on the Subject of Euthanasia,” Issues in Law & Medicine, Vol. 3 (1988): 407–424; John Keown, “The Law and Practice of Euthanasia in the Netherlands,” Law Quarterly Review, Vol. 108 (January 1992): 51–78; R. Fenigsen, “A Case Against Dutch Euthanasia,” Hastings Center Report, Vol. 19 (Supp.) (1989): 22–30. See also Fenigsen’s further critique in “The Report of the Dutch Governmental Committee on Euthanasia,” Issues in Law & Medicine, Vol. 7, No. 3 (Winter 1991): 339–344; “Physician-Assisted Death in the Netherlands: Impact on Long-Term Care,” Issues in Law & Medicine, Vol. 11, No. 3 (1995): 283–297, and “Dutch Euthanasia Revisited,” Issues in Law & Medicine, Vol. 13 (Winter 1997): 301–311. In his comments on the first draft of this study, Leenen wrote that Schepens, Segers, Fenigsen and Callahan do not base their arguments on research. These are not’ studies.’ Letter dated July 25, 2000.
Daniel Callahan, The Troubled Dream of Life (New York: Simon and Schuster, 1993), at 113. See also Daniel Callahan and Margot White, “The Legalization of Physician-Assisted Suicide: Creating a Regulatory Potemkin Village,” Un. of Richmond L. Rev., Vol. 30, No. 1 (January 1996): 1–81, esp. 13–18; Richard Fenigsen, “The Netherlands: New Regulations Concerning Euthanasia,” Issues in Law and Medicine, Vol. 9, No. 2 (Fall 1993): 167–173; C..I. Dessaur and C. J. C. Rutenfrans, “The Present Day Practice of Euthanasia,” Issues in Law and Medicine, Vol. 3, No. 4 (Spring 1988): 399–405; Peter A. Singer and Mark Siegler, “Euthanasia — A Critique,” New England J. of Medicine, Vol. 322 (June 1990): 1881–1883; John Keown, “On Regulating Death,” The Hastings Center Report, Vol. 22 (March–April 1992): 39–43.
House of Lords, Select Committee on Medical Ethics, session 1993–94, Vol. II, Minutes of Oral Evidence (London: HMSO, 1994), at 33.
P.J. van der Maas, J.J.M. van Delden, and L. Pijnenborg, Euthanasia and other Medical Decisions Concerning the End of Life, op. cit., p. 47. See also p. 44.
Breje D. Onwuteaka-Philipsen, Gerrit van der Wal, Piet J. Kostense and Paul J. van der Maas, “Consultation with another Physician on Euthanasia and Assisted Suicide in the Netherlands,” Social Science and Medicine, Vol. 51 (2000): 429–438.
Herbert Hendin, “The Slippery Slope: The Dutch Example,” Duquesne L. Rev., Vol. 35 (1996), pp. 429–430. See also KNMG Guidelines on Assisted Suicide and Euthanasia (August 1995).
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(2005). The Three Research Reports of 1990, 1995 and 2001, and Their Interpretations. In: Euthanasia in the Netherlands. International Library of Ethics, Law, and the New Medicine, vol 20. Springer, Dordrecht. https://doi.org/10.1007/978-1-4020-2251-7_2
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