Euthanasia in the Netherlands: A Flat Country On A Slippery Slope?

Summary

In the Netherlands “Medical Decisions Concerning End of Life” (MDEL) play a role in 65% of cancer deaths. Non-treatment decisions occur in 18%, treatment with narcotics that may fasten death in 38% and euthanasia or physician-assisted suicide in 8% of cases. Of Dutch physicians 53% have ever performed euthanasia and only 3% would never perform or refer for euthanasia on moral or religious grounds. Of the 30.000 requests for euthanasia or physician-assisted suicide 10%) are eventually granted. In 1993 the Dutch legislation has been reformed. Euthanasia remains a crime and each case will be reviewed by the district attorney. Court discisions, however, have confirmed the view that in cases of euthanasia the physician may be confronted with conflicting obligations and therefore will not be punished. As a consequence, cases fulfilling a number of requirements will not be prosecuted. Comparison between the data from 1990 and 1995 show an increased rate of notification (from 18% tot 41%) without an increase in the percentage of requests that is granted or a shift to less terminal conditions. In the Netherlands euthanasia or physician-assisted suicide are considered ethically justifiable and legally permissible if it is part of an open, honest and careful approach to patients with unbearable suffering, in particular in the case of cancer.