In 2002,
the NetherlandsThe Netherlands is a country in Northwestern Europe, constituting the major portion of the Kingdom of the Netherlands. It is a parliamentary democratic constitutional monarchy. The Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east...
legalized euthanasiaEuthanasia refers to the practice of ending a life in a painless manner. Many different forms of euthanasia can be distinguished, including animal euthanasia and human euthanasia, and within the latter, voluntary and involuntary euthanasia...
. Euthanasia is still a criminal offence but the law codified a twenty year old convention of not prosecuting doctors who have committed euthanasia in very specific cases, under very specific circumstances. The Ministry of Health, Welfare and Sport claims that this practice "
allows a person to end their life in dignity after having received every available type of palliative care."
Termination of Life on Request and Assisted Suicide (Review Procedures) Act took effect on April 1, 2002.
In 2002,
the NetherlandsThe Netherlands is a country in Northwestern Europe, constituting the major portion of the Kingdom of the Netherlands. It is a parliamentary democratic constitutional monarchy. The Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east...
legalized euthanasiaEuthanasia refers to the practice of ending a life in a painless manner. Many different forms of euthanasia can be distinguished, including animal euthanasia and human euthanasia, and within the latter, voluntary and involuntary euthanasia...
. Euthanasia is still a criminal offence but the law codified a twenty year old convention of not prosecuting doctors who have committed euthanasia in very specific cases, under very specific circumstances. The Ministry of Health, Welfare and Sport claims that this practice "
allows a person to end their life in dignity after having received every available type of palliative care."
Legal framework
Termination of Life on Request and Assisted Suicide (Review Procedures) Act took effect on April 1, 2002. It legalizes euthanasia and physician assisted suicide in very specific cases, under very specific circumstances. The law was proposed by
Els BorstElse Borst-Eilers is a former Dutch Politician, she led D66 in the 1998 election campaign and served as Minister of Health, Welfare and Sport for eight years, and the last four as Deputy Prime Minister. Before entering politics she had a distinguished career in medicine.-Life before politics:Borst...
, the D66
minister of HealthThe Ministry of Health, Welfare and Sport is the public health authority of the Netherlands. The current minister is Ab Klink...
. The procedures codified in the law had been a convention of the medical community for over twenty years.
The law allows medical review board to suspend prosecution of doctors who performed euthanasia when each of the following conditions is fulfilled:
- the patient's suffering is unbearable with no prospect of improvement
- the patient's request for euthanasia must be voluntary and persist over time (the request cannot be granted when under the influence of others, psychological illness or drugs)
- the patient must be fully aware of his/her condition, prospects and options
- there must be consultation with at least one other independent doctor who needs to confirm the conditions mentioned above
- the death must be carried out in a medically appropriate fashion by the doctor or patient, in which case the doctor must be present
- the patient is at least 12 years old (patients between 12 and 16 years of age require the consent of their parents)
The doctor must also report the cause of death to the municipal
coronerA coroner or forensics examiner is an official chiefly responsible for investigating deaths, particularly some of those happening under unusual circumstances, and determining the cause of death. Depending on the jurisdiction, the coroner may adjudge the cause himself, or act as the presiding...
in accordance with the relevant provisions of the Burial and Cremation Act. A regional review committee assesses whether a case of termination of life on request or assisted suicide complies with the due care criteria. Depending on its findings, the case will either be closed or, if the conditions are not met brought to the attention of the Public Prosecutor. Finally, the legislation offers an explicit recognition of the validity of
a written declaration of willAdvance health care directives, also known as living wills, advance directives, or advance decisions, are instructions given by individuals specifying what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or incapacity. A living...
of the patient regarding euthanasia (a "euthanasia directive"). Such declarations can be used when a patient is in a
comaIn medicine, a coma is a profound state of unconsciousness. A comatose person cannot be awakened, fails to respond normally to pain or light, does not have sleep-wake cycles, and does not take voluntary actions....
or otherwise unable to state if they wish to be euthanized.
Euthanasia remains a criminal offense in cases not meeting the law's specific conditions, with the exception of several situations that are not subject to the restrictions of the law at all, because they are considered normal medical practice:
- stopping or not starting a medically useless (futile) treatment
- stopping or not starting a treatment at the patient's request
- speeding up death as a side-effect
In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect, and may result from an unsuitable or incorrect dosage or...
of treatment necessary for alleviating serious suffering
Euthanasia of children under the age of 12 remains technically illegal; however, Dr.
Eduard VerhagenEduard Verhagen is the medical director of the department of pediatrics at the University Medical Center Groningen . He is mainly known for his involvement in infant euthanasia in the Netherlands....
has documented several cases and, together with colleagues and prosecutors, has developed a protocol to be followed in those cases. Prosecutors will refrain from pressing charges if this
Groningen ProtocolThe Groningen Protocol is a text created in September 2004 by Eduard Verhagen, the medical director of the department of pediatrics at the University Medical Center Groningen...
is followed.
Practice
In 2003, in the Netherlands, 1626 cases were officially reported of euthanasia in the sense of a physician assisting the death (1.2% of all deaths). Usually the
sedativeA sedative is a substance that induces sedation by reducing irritability or excitement.At higher doses it may result in slurred speech, staggering gait, poor judgment, and slow, uncertain reflexes...
sodium thiopentalSodium thiopental, better known as Sodium Pentothal , thiopental, thiopentone sodium, or trapanal, is a rapid-onset short-acting barbiturate general anaesthetic. It is an intravenous ultra-short-acting barbiturate...
is intravenously administered to induce a
comaIn medicine, a coma is a profound state of unconsciousness. A comatose person cannot be awakened, fails to respond normally to pain or light, does not have sleep-wake cycles, and does not take voluntary actions....
. Once it is certain that the patient is in a deep coma, typically after some minutes,
PancuroniumPancuronium is a chemical compound, used in medicine as the bromide salt pancuronium bromide. It has the brand name Pavulon . It is a muscle relaxant with various purposes. It is one of the drugs administered during a lethal injection in the United States.-Mode of action:Pancuronium is a typical...
is administered to stop the breathing and cause death.
Officially reported were also 148 cases of physician assisted dying (0.14% of all deaths), usually by drinking a strong (10g)
barbiturateBarbiturates are drugs that act as central nervous system depressants, and, by virtue of this, they produce a wide spectrum of effects, from mild sedation to total anesthesia. They are also effective as anxiolytics, hypnotics and as anticonvulsants. They have addiction potential, both physical and...
potionA potion is a consumable medicine or poison.In mythology and literature, a potion is usually made by a magician, sorcerer, dragon, fairy or witch and has magical properties. It might be used to heal, bewitch or poison people...
. The doctor is required to be present for two reasons:
- to make sure the potion is not taken by a different person, by accident (or, theoretically, for "unauthorized" suicide or perhaps even murder)
- to monitor the process and be available to apply the combined procedure mentioned below, if necessary
In two cases the doctor was reprimanded for not being present while the patient drank the potion. They said they had not realized that this was required.
Forty-one cases were reported to combine the two procedures: usually in these cases the patient drinks the potion, but this does not cause death. After a few hours, or earlier in the case of
vomitingVomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Undesired vomiting may result from many causes, ranging from gastritis or poisoning to brain tumors, or elevated intracranial pressure...
, the muscle relaxant is administered to cause death.
By far, most reported cases concerned
cancerCancer is a class of diseases in which a group of cells display uncontrolled growth , invasion , and sometimes metastasis...
patients. Also, in most cases the procedure was applied at home.
In an earlier 2000 study of 649 patients undergoing euthanasia or physician-assisted suicide, 14% of patients undergoing euthanasia had complications such as waking from the coma, spasms or vomiting. Thirty-two percent of patients undergoing physician-assisted suicide had complications which were troublesome enough in 18% to require their doctors to switch to active euthanasia. In this study physicians were absent in 28% of cases of euthanasia and 48% of cases of physician-assisted suicide.
Involuntary euthanasiaInvoluntary euthanasia is a type of euthanasia procedure that is conducted where an individual makes a decision for another person incapable of doing so.-Substituted judgement:...
While the law requires the patient to make an active request for euthanasia, (accounting in a sample year studied for 2,300 cases or 2% of deaths registered) there was thought to be a significant number of instances in which the patient was not consulted. In 1991, a Dutch Government commission chaired by Professor
Jan RemmelinkProfessor Jan Remmelink was Attorney General of the High Council of the Netherlands from 1968 to 1989. He headed the Dutch government committee on euthanasia that released the first, official study of the practice of euthanasia in the Netherlands in 1991...
analyzed actual practice. Remmelink found that 49,000 of the 130,000 annual deaths in Holland were attributable to a "medical decision at the end of life" or MDEL. More than half of Dutch physicians acknowledged practicing euthanasia; of these only 60% kept written records of the cases. A 1996 study found that the number of cases in which euthanasia was carried out without the patient's explicit petition had grown from 15% to almost 20% of total annual mortality in Holland. Under the narrow legal definition the count rose from 2,300 to over 3000 (a 30% increase over five years).
http://www.euthanasia.com/netherlands.html According to The Times (UK, 2-16-99) 900 of 4500, or 20% of all Dutch euthanasia cases for 1996, were carried out without the patient's explicit consent
http://www.euthanasia.com/holland99.html Writing in The Journal of Medical Ethics (1999 February; 25(1): 16–21) H Jochemsen and J Keown
Studied the 1996 data and concluded that “although there has been some improvement in compliance with procedural requirements, the practice of voluntary euthanasia remains beyond effective control.”
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=479162
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