New study examines euthanasia in Netherlands

A new study sheds new light on euthanasia in The Netherlands, the first country to legalise it for terminally ill people, finding that nearly one in eight adult patients who requested mercy killings decided not to go through with it. Nearly half of the euthanasia requests were carried out.

The study comes at a time of heightened scrutiny of euthanasia—especially in The Netherlands—where officials acknowledged last year that they had carried out mercy killings of terminally ill newborns.

Belgium has since enacted a euthanasia law similar to The Netherlands. In the United States, Oregon is alone in allowing physician-assisted suicide, but its law is expected to be argued before the US Supreme Court this autumn.

The study, appearing in Monday’s Archives of Internal Medicine, consists of a survey completed by 3 614 Dutch general practitioners who were asked to describe the most recent request for euthanasia they received during the previous year.

More than half of the doctors had not received a request.
Out of 2 658 requests, 44% resulted in euthanasia. In 13% of the cases, the request was granted but the patient died before the act; in another 13% the patient died before the decision-making process was completed. In 12%, the physician refused the request. In another 13%, patients changed their minds. In the remaining cases, the decision was still ongoing at the time of the survey, or the doctor did not detail the reason euthanasia was not performed.

Project leader Bregje Onwuteaka-Philipsen said she was surprised that “the most important reasons for doing the request are not strictly medical”.

The survey asked physicians the reasons that patients sought help in ending their own lives, with the most frequent being pointless suffering, loss of dignity and weakness.

In cases in which doctors denied the requests, the most common reasons were not wanting to be a burden on their family, tired of living and depression.

The 13% of patients who decided ultimately not to pursue euthanasia demonstrates “it is really very important to keep asking the patient [until the moment of the actual administration] whether this is what he or she wants,” Onwuteaka-Philipsen wrote in an e-mail.

The study does not mention the proposed guidelines for mercy killings of terminally ill newborns designed by officials at Groningen Academic Hospital. In November, officials there revealed they had already begun carrying out such procedures, euthanising four severely ill newborns in 2003.

A Dutch government proposal on guidelines involving infants is expected to be released this autumn.

The Netherlands has a long history on the issue, where for decades euthanasia was outlawed but widely practiced and rarely prosecuted.

Under a law that took effect in 2002, euthanasia is restricted to terminal patients suffering unbearable pain with no hope of improvement, and who request to die when they are of sound mind.

Each case is reviewed by a panel of medical experts.

The study was conducted by researchers at the VU University Medical Centre in Amsterdam. Based on their study, the researchers concluded that physicians are reporting compliance with the official requirements for euthanasia in The Netherlands.

But in a critical accompanying editorial, University of Minnesota law professor Susan Wolf said the important question is whether mercy killings are taking place that do not follow the strict guidelines the Dutch have put in place.

The study could not determine that, she said, because doctors self-reported on whether their efforts complied with Dutch rules, among other reasons.

“The ultimate question remains—if you permit physicians to take life deliberately by assisting suicide or performing euthanasia, can you control the practice? Can you keep it within agreed boundaries? ... We do not yet know the answers,” wrote Wolf, also a professor of medicine at the University of Minnesota Law School.

The head of a group that opposes euthanasia agreed.

“Human nature being what it is, we tend to say we’re following all the guidelines when in reality we’re not,” said Rita Marker, the executive director of the International Task Force on Euthanasia and Assisted Suicide.

She said she fears the legalisation of euthanasia gives a “stamp of approval” even in places where it is not legal and could eventually be suggested by insurance companies as another medical treatment option.

The number of euthanasia cases in the Netherlands rose last year to 1 886 from 1 815, according to the Health Ministry. - Sapa-AP

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