The Practice of Euthanasia and The Legal Framework

Part of the International Library of Ethics, Law, and the New Medicine book series (LIME, volume 20)

Abstract

The three relevant categories of Dutch doctors who are involved in the practice of euthanasia are GPs, nursing-home doctors, and specialists. Every person in the Netherlands has a more or less permanent relationship with a GP, who provides primary health care and is the point of entry for specialist care. GPs have the most extensive experience with euthanasia insofar as they discuss it most frequently with their patients, they receive two-thirds of all requests, and they are generally the most willing to perform it. The level of experience with euthanasia among specialists is about half that of GPs (with 3% of all deaths in their practice attributable to euthanasia). By contrast, euthanasia plays a small role in the practice of nursing-home doctors, who receive relatively few requests (only a fifth of them have ever honored one).1

Keywords

Depression Tuberculosis Morphine Assure Vale 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    John Griffiths, “Effective Regulation of Euthanasia and Other Medical Behavior that Shortens Life,” in Ejan Mackaay (ed.), Uncertainty and the Law (Montreal: Editions Thémis, 1999), pp. 72–73.Google Scholar
  2. 2.
    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. 112.Google Scholar
  3. 5.
    John Griffiths, “Effective Regulation of Euthanasia and Other Medical Behavior that Shortens Life,” op. cit., p. 74.Google Scholar
  4. 7.
    Henk A.M.J. ten Have, “Euthanasia: The Dutch Experience,” Annals de la Real Academia National de Medicina, Tomo CXII (Madrid, 1995), pp. 436–437.Google Scholar
  5. 9.
    John Griffiths, “Effective Regulation of Euthanasia and Other Medical Behavior that Shortens Life,” op. cit., pp. 74–75.Google Scholar
  6. 10.
    P.J. van der Maas,.J.M. van Delden, and L. Pijnenborg, Euthanasia and other Medical Decisions Concerning the End of Life, op. cit., p. 98.Google Scholar
  7. 11.
    Netherlands Ministry of Foreign Affairs — APPENDICES. For further reading, see H.J.J. Leenen, “Euthanasia, Assistance to Suicide and the Law: Developments in the Netherlands,” Health Policy, Vol. 8 (1987): 197–206; J.K.M. Gevers, “Legal Developments Concerning Active Euthanasia on Request in the Netherlands,” Bioethics, Vol. 1, No. 2 (1987): 156–162, and http://www.bz.minbuza.nl/English/Policy/c_eutheng-app.html#CrossRefGoogle Scholar
  8. 12.
  9. 13.
    Barney Sneiderman and Marja Verhoef, “Patient Autonomy and the Defence of Medical Necessity: Five Dutch Euthanasia Cases,” Alberta Law Review, Vol. XXXIV, No. 2 (1996), p. 376. In England and Canada, the defense of medical necessity has been recognized in abortion cases (see R. v. Bourne [1938] 3 All E.R. 615 and R. V. Morgentaler, [1975] 20 C.C.C. 2d, 449), but it is not available in euthanasia cases. See R. v. Cox [1992], unreported. R. Porter, “Doctor convicted of attempted murder,” Sunday Telegraph (September 20, 1992), and the Latimer case, http://www.cnn.com (November 5, 1997); Reuters, Toronto, “Canada farmer gets two years for mercy killing of daughter” (December 1, 1997).Google Scholar
  10. 14.
    Robert J.M. Dillmann and Johan Legemaate, “Euthanasia in the Netherlands: The State of the Legal Debate,” European J. of Health Law, Vol. 1 (1994), p. 84.Google Scholar
  11. 15.
    A translation of the law can be found in John Griffiths, Alex Bood and Heleen Weyers, Euthanasia and Law in the Netherlands, op. cit., pp. 308–313.Google Scholar
  12. 16.
    Reuters, “Dutch Parliament votes to legalize euthanasia” (November 28, 2000).Google Scholar
  13. 17.
    “Minderjarige mag euthanasie vragen,” NRC Handelsblad (July 10, 1999), p. 3. See also Marilyn Gardner, “Dutch poised to legalize euthanasia,” The Christian Science Monitor (June 30, 2000). http://www.csmonitor.com/durable/2000/06/28/text/pls4.htmlGoogle Scholar
  14. 18.
    “Dutch call off aided suicide for children,” The International Herald-Tribune and The Associated Press (July 15, 2000).Google Scholar
  15. 19.
    Henk Jochemsen, “Update: The Legalization of Euthanasia in The Netherlands,” Ethics & Medicine, Vol. 17, No. 1 (2001): 7–12.Google Scholar
  16. 20.
    Tony Sheldon, “Netherlands Gives More Protection to Doctors in Euthanasia Cases,” British Medical Journal, Vol. 321 (December 9, 2000), p. 1433.Google Scholar
  17. 21.
    Jim Persels, “Forcing the Issue of Physician-assisted Suicide,” Journal of Legal Medicine, Vol. 14 (1993), p. 105.CrossRefGoogle Scholar
  18. 22.
    Joseph B. Vander Veer Jr., “Euthanasia in the Netherlands,” Journal of the American College of Surgeons, Vol. 188, Issue 5 (May 1999): 532–537.CrossRefGoogle Scholar
  19. 23.
    Charles F. McKhann, A Time to Die: The Place for Physician Assistance (New Haven, Conn.: Yale University Press, 1999), p. 122. The Postma case was the best known prosecution during this period of a person who killed another at the latter’s request, but it wasn’t the only one. There were at least three other prosecutions for violations of Articles 293 or 294. Cf. Carlos F. Gomez, Regulating Death (New York: The Free Press, 1991), pp. 28–32; John Griffiths, Alex Bood and Heleen Weyers, Euthanasia and Law in the Netherlands, op. cit., p. 53.Google Scholar
  20. 24.
    Jim Persels, “Forcing the Issue of Physician-assisted Suicide,” op. cit., p. 106; John Griffiths, Alex Bood and Heleen Weyers, Euthanasia and Law in the Netherlands, op. cit., pp. 58–59.Google Scholar
  21. 25.
    Jim Persels, “Forcing the Issue of Physician-assisted Suicide,” op. cit., p. 107. See also Joseph B. Vander Veer Jr., “Euthanasia in the Netherlands,” op. cit. Google Scholar
  22. 26.
    Nederlandse Jurisprudentie, 1985, no. 106. John Griffiths, Alex Bood and Heleen Weyers, Euthanasia and Law in the Netherlands, op. cit., pp. 18–19, 62–63, 322–328; B. Sneiderman and M. Verhoef, “Patient Autonomy and the Defence of Medical Necessity: Five Dutch Euthanasia Cases,” op. cit., pp. 388–392; Julia Belian, “Deference to Doctors in Dutch Euthanasia Law,” Emory Int. L. Rev., Vol. 10 (Spring 1996): 255–295, in URL: http://www.law.emory.edu/EILR/volumes/spring96Google Scholar
  23. 27.
    The case is described in detail by Griffiths et al., Euthanasia and Law in the Netherlands, op. cit., pp. 63–65.Google Scholar
  24. 28.
  25. 29.
    Nederlandse Jurisprudentie 1985, no. 709; Griffiths et al., Euthanasia and Law in the Netherlands, pp. 66–67.Google Scholar
  26. 30.
    B. Sneiderman and M. Verhoef, “Patient Autonomy and the Defence of Medical Necessity: Five Dutch Euthanasia Cases,” op. cit., p. 392.Google Scholar
  27. 31.
    M. Verhoef, “Patient Autonomy and the Defence of Medical Necessity: Five Dutch Euthanasia Cases,” Nederlandse Jurisprudentie Ibid., pp. 396–397.Google Scholar
  28. 32.
    M. Verhoef, “Patient Autonomy and the Defence of Medical Necessity: Five Dutch Euthanasia Cases,” Nederlandse Jurisprudentie Ibid. Ibid., at 398.Google Scholar
  29. 33.
    M. Verhoef, “Patient Autonomy and the Defence of Medical Necessity: Five Dutch Euthanasia Cases,” Nederlandse Jurisprudentie Ibid. Ibid., p. 397.Google Scholar
  30. 34.
    Jos V.M. Welie, “The Medical Exception: Physicians, Euthanasia and the Dutch Criminal Law,” Journal of Medicine and Philosophy, Vol. 17 (1992), p. 430.Google Scholar
  31. 35.
    Ibid., at 431.Google Scholar
  32. 36.
    Ibid., pp. 431–432.Google Scholar
  33. 37.
    B. Sneiderman and M. Verhoef, “Patient Autonomy and the Defence of Medical Necessity: Five Dutch Euthanasia Cases,” op. cit., pp. 393–394.Google Scholar
  34. 38.
    M. Verhoef, “Patient Autonomy and the Defence of Medical Necessity: Five Dutch Euthanasia Cases,” Journal of Medicine and Philosophy, Vol. 17 (1992) Ibid, pp. 393–395.Google Scholar
  35. 39.
    M. Verhoef, “Patient Autonomy and the Defence of Medical Necessity: Five Dutch Euthanasia Cases,” Journal of Medicine and Philosophy, Vol. 17 (1992) Ibid, p. 396.Google Scholar
  36. 40.
    Two important precedents, Prins and Kadijk, not considered here were concerned with the termination of life of severely defective newborn babies. Cf. Griffiths et al, Euthanasia and Law in the Netherlands, op. cit., pp. 83–84, 341–351. For further deliberation, see A. van der Heide, P.J. van der Maas, G. van der Wal et al, “Medical End-of-life Decisions Made for Neonates and Infants in the Netherlands,” Lancet, Vol. 350 (1997): 251–255; Henk Jochemsen, “Dutch Court Decisions on Nonvoluntary Euthanasia Critically Reviewed,” Issues in Law & Medicine, Vol. 13, No. 4 (1998), esp. pp. 450–458; Arlene Judith Klotzko, “What Kind of Life? What Kind of Death? An Interview with Dr. Henk Prins,” in David C. Thomasma, Thomasine Kimbrough-Kushner, Gerrit K. Kimsma, and Chris Ciesielski-Carlucci (eds.), Asking to Die, op. cit., pp. 388–406; Joseph B. Vander Veer Jr., “Euthanasia in the Netherlands,” op. cit. Google Scholar
  37. 41.
    Dr. Herbert Cohen, a well-known practitioner of euthanasia in the Netherlands, explains that all of the cases that have broken new ground in Dutch law involved women by saying that women can make an appeal to a doctor that is stronger, more existential. See Herbert Hendin, “Seduced by Death: Doctors, Patients and the Dutch Cure,” Issues in Law and Medicine, Vol. 10, No. 2 (1994), p. 137. In general, more euthanasia cases are found in women than in men. Cf. 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,” op. cit., p. 157.Google Scholar
  38. 42.
    Johanna H. Groenewoud, Paul J. van der Maas, Gerrit van der Wal et al, “Physician-assisted Death in Psychiatric Practice in the Netherlands,” New Eng. J. of Medicine, Vol. 336, No. 25 (June 19, 1997), p. 1797.Google Scholar
  39. 43.
    Herbert Hendin, Seduced by Death (New York: W.W. Norton, 1997), pp. 60–61.Google Scholar
  40. 44.
    B. Sneiderman and M. Verhoef, “Patient Autonomy and the Defence of Medical Necessity: Five Dutch Euthanasia Cases,” op. cit., p. 400. For further account, see Herbert Hendin, “Seduced by Death: Doctors, Patients and the Dutch Cure,” op. cit., pp. 145–152.Google Scholar
  41. 47.
    “Arlene Judith Klotzko and Dr. Boudewijn Chabot Discuss Assisted Suicide in the Absence of Somatic Illness,” Cambridge Quarterly of Healthcare Ethics, Vol. 4 (1995), pp. 241–242.Google Scholar
  42. 48.
    Ibid., p. 244.Google Scholar
  43. 49.
    Ibid., at 246.Google Scholar
  44. 51.
    B. Sneiderman and M. Verhoef, “Patient Autonomy and the Defence of Medical Necessity: Five Dutch Euthanasia Cases,” op. cit., p. 402. According to Hendin, two of the experts did not recommend Dr. Chabot to assist in her suicide. See “Seduced by Death: Doctors, Patients and the Dutch Cure,” op. cit., p. 147. I asked Chabot about this discrepancy, and he explained “both Sneiderman et al. and Hendin are right; they simply refer to different moments in the process.” Sneiderman et al. refer to the period when Mrs. B. was still alive, whereas Hendin refers to the later phase, when the Medical Disciplinary Board invited another expert to give his opinion and he disagreed with Chabot. Strictly speaking, this latter expert was not consulted by Chabot. Letter dated August 14, 2000.Google Scholar
  45. 53.
    Hendin, “Seduced by Death: Doctors, Patients and the Dutch Cure,” op. cit., p. 147. See also “Arlene Judith Klotzko and Dr. Boudewijn Chabot Discuss Assisted Suicide in the Absence of Somatic Illness,” op. cit., p.Google Scholar
  46. 54.
    Hendin, “Seduced by Death: Doctors, Patients and the Dutch Cure,” op. cit., p. 150.Google Scholar
  47. 55.
    B. Sneiderman and M. Verhoef, “Patient Autonomy and the Defence of Medical Necessity: Five Dutch Euthanasia Cases,” op. cit., p. 402.Google Scholar
  48. 56.
    M. Verhoef, “Patient Autonomy and the Defence of Medical Necessity: Five Dutch Euthanasia Cases,” Cambridge Quarterly of Healthcare Ethics, Vol. 4 (1995) Ibid., p. 403. See also Gene Kaufmann, “State v. Chabot: A Euthanasia Case from the Netherlands,” Ohio Northern University Law Review, Vol. 20 (1994): 815–820.CrossRefGoogle Scholar
  49. 57.
    Nederlandse Jurisprudentie, 1994, no. 656; John Griffiths, “Assisted Suicide in the Netherlands: The Chabot Case,” Modern L. Rev., Vol. 58 (March 1995), p. 239.Google Scholar
  50. 58.
    John Griffiths, “Assisted Suicide in the Netherlands: Postscript to Chabot,” Modern L. Rev., Vol. 58 (November 1995), p. 896. See also http://www.bz.minbuza.nl/English/Policy/c_eutheng-A.htmGoogle Scholar
  51. 59.
    “Arlene Judith Klotzko and Dr. Boudewijn Chabot Discuss Assisted Suicide in the Absence of Somatic Illness,” op. cit., p. 246.Google Scholar
  52. 60.
    Simon Chesterman, “Last Rights: Euthanasia, the Sanctity of Life, and the Law in the Netherlands and the Northern Territory of Australia,” International and Comparative Law Quarterly, Vol. 47 (April 1998), pp. 377–378.Google Scholar
  53. 61.
    Linda Ganzini, Gregory Leong, Darien S. Fenn et al, “Evaluation of Competence to Consent to Assisted Suicide: Views of Forensic Psychiatrists,” American J. of Psychiatry, Vol. 157, No. 4 (April 2000): 595–600, esp. at 599.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Personalised recommendations