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Should Doctors Suggest Euthanasia to Their Patients? Reflections on Dutch Perspectives

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Abstract

During the summer of 1999 and in April 2002 Iwent to the Netherlands in order to meet someof the leading authorities on the euthanasiapolicy. They were asked multiple questions.This study reports the main findings to thequestion: should doctors suggest euthanasia totheir patients? Some interviewees did notobserve any significant ethical concernsinvolved in suggesting euthanasia. For variousreasons they thought physicians should offereuthanasia as an option. Two intervieweesasserted that doctors don't propose euthanasiato their patients. Five interviewees objectedto physician's initiative.

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NOTES AND REFERENCES

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  3. Ibid., 156.

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  9. On the quality of life concept in medicine, see R. Cohen-Almagor and M. Shmueli, “Can Life Be Evaluated? The Jewish Halachic Approach vs. the Quality of Life Approach in Medical Ethics: A Critical View,” Theoretical Medicine and Bioethics 21(2) (August 2000): 117–137. On the power of the word and certain terminology, see R. Cohen-Almagor, “Language and Reality at the End of Life,” The Journal of Law, Medicine and Ethics 28 (3) (Fall 2000): 267–278.

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  10. Some reflections are presented in my “An Outsider's View on the Dutch Euthanasia Policy and Practice,” Issues in Law and Medicine 17(1) (Summer 2001): 35–68; “ 'Culture of Death' in the Netherlands: Dutch Perspectives,” Issues in Law and Medicine 17 (2) (Fall 2001): 167–179; “The Chabot Case: Analysis and Account of Dutch Perspectives,” Journal of Law, Medicine and Ethics 30 (1) (2002): 95–104.

  11. Personal communication on July 10, 2000.

  12. Cf. Richard B. Balaban, “A Physician's Guide to Talking About End-of-Life Care,” Journal of General Internal Medicine 15, Issue 3 (March 2000): 195; A. Chopra, “Communicating Effectively at the End of Life,” J. Am. Osteopath. Assoc. 101 (10) (October 2001): 594–598; S.Z. Pantilat and A.J. Markowitz, “Perspectives on Care at the Close of Life. Initiating End-of-Life Discussions with Seriously Ill Patients,” JAMA 285 (22) (2001): 2906.

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  13. In a similar fashion, Ron Berghmans and Ruud ter Meulen, medical ethicists from Maastricht, voiced their objections to the doctor's initiation of discussion, but qualified their answers by saying that they could imagine exceptional cases to the general proscription of leaving the issue to be raised by the patient. The physicians should not raise the issue immediately, but they might mention it during the process approaching the end of life.

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  15. Herbert Hendin, Seduced by Death,op. cit., 53. One study, which compared attitudes and practices concerning end-of-life decisions between physicians in Oregon and in the Netherlands, showed that an equal proportion of Dutch physicians considered euthanasia and PAS as ethically acceptable. Conversely, American physicians were consistently less likely to find euthanasia acceptable as compared with PAS. Cf. Dick L. Willems, Elisabeth R. Daniels, Gerrit van der Wal, P.J. van der Maas and E.L. Emanuel, “Attitudes and Practices Concerning the End of Life: A Comparison Between Physicians from the United States and from the Netherlands,” Arch. Intern. Med. 160 (2000): 63–68. See also R. Cohen-Almagor andMonica G. Hartman, “The Oregon Death with Dignity Act: Review and Proposals for Improvement,” Journal of Legislation 27 (2) (2001): 269–298.

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  16. The Dutch Voluntary Euthanasia Society's (NVVE) internet address is: http://www.nvve.nl/ukframe.htm

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  21. Personal communication on August 27, 2000.

  22. Of course, second opinions may lead to contradictory recommendations. As difficult as conflicting recommendations can be for patients, these recommendations still leave patients with the option of accepting one recommendation or another, rather than feeling like they made the entire decision by themselves. When patients face difficult decisions, they are often going to learn that there is no simple right or wrong medical answer. In these situations, it is plausible to think that a series of even contradictory physician recommendations is more comforting than a series of nonrecommendations. Cf. Peter A. Ubel, “ 'What Should I Do, Doc?' Some Psychologic Benefits of Physician Recommendations,” Archives of Internal Medicine 162(9) (May 13, 2002).

  23. Ibid.

  24. Gerrit K. Kimsma and Evert van Leeuwen, “Comparing Two Euthanasia Protocols: The Free University of Academic Hospital Amsterdam and the Medical Center of Alkmaar,” in David C. Thomasma, Thomasine Kimbrough-Kushner, Gerrit K. Kimsma and Chris Ciesielski-Carlucci (eds.), Asking to Die (Dordrecht: Kluwer Academic Publishers, 1998), 119.

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  25. Ibid., 124.

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  26. Cf. Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 3rd edn. (New York: Oxford University Press, 1989); Tom L. Beauchamp and LeRoy Walters, Contemporary Issues in Bioethics (Belmont, CA: Wadsworth, 1989), esp. pp. 28–34.

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  27. “Annie Asked, 'Are You Going to Help Me?',” in David C. Thomasma, Thomasine Kimbrough-Kushner, Gerrit K. Kimsma and Chris Ciesielski-Carlucci (eds.), Asking to Die, 279.

  28. Leenen wrote in his comments that the conclusions of this study are not applicable to the Netherlands because the United States lacks the family-doctor system “as we have it.” Letter dated July 25, 2000. For further discussion, see R. Cohen-Almagor, “Why the Netherlands?,” Journal of Law, Medicine and Ethics 30(1) (2002): 95–104.

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  29. Ezekiel J. Emanuel, Diane L. Fairclough, Elisabeth R. Daniels and Brian R. Clarridge, “Euthanasia and Physician-Assisted Suicide: Attitudes and Experiences of Oncology Patients, Oncologists, and the Public,” Lancet 347 (June 29, 1996): 1808. The Assisted Suicide Consensus Panel asserts that physicians should not encourage patients to hasten death, even when practicing in jurisdictions that allow assisted dying. Cf. James A. Tulsky, Ralph Ciampa and Elliot J. Rosen, “Responding to Legal Requests for Physician-Assisted Suicide,” Annals of Internal Medicine 132 (March 21, 2000): 494–499. For further deliberation, see Timothy E. Quill, “Initiating End-of-Life Discussions with Seriously Ill Patients: Addressing the 'Elephant in the Room',” JAMA 284 (19) (November 15, 2000): 2502; Susan D. Block, “Psychological Considerations, Growth, and Transcendence at the End of Life,” JAMA 285 (22) (June 13, 2001): 2898; Maria E. Suarez-Almazor, Catherine Newman, John Hanson and Eduardo Bruera, “Attitudes of Terminally Ill Cancer Patients About Euthanasia and Assisted Suicide: Predominance of Psychosocial Determinants and Beliefs Over Symptom Distress and Subsequent Survival,” Journal of Clinical Oncology 20, Issue 8 (April 2002): 2134–2141.

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  30. Cf. Raphael Cohen-Almagor, The Right to Die with Dignity: An Argument in Ethics, Medicine, and Law (Piscataway, N.J.: Rutgers University Press, 2001), esp. Conclusions.

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  1. Library and Information Studies and Department of Communication, University of Haifa, Mount Carmel, Haifa, 31905, Israel

    Raphael Cohen-Almagor

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Cohen-Almagor, R. Should Doctors Suggest Euthanasia to Their Patients? Reflections on Dutch Perspectives. Theor Med Bioeth 23, 287–303 (2002). https://doi.org/10.1023/A:1021261723404

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