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To provide a context for a discussion of a Dutch Ethics Committee's review of two recent cases involving patients' requests for euthanasia in hospital, three important points should be made at the outset:
(1) Public support for euthanasia has increased gradually over the years (from two fifths in 1966 to two thirds of Holland's 14-million people in 1986). It is estimated that there are 5,000 to 8,000 cases of active euthanasia each year. A recent survey indicates that the average general practitioner would perform euthanasia once every three years; this amounts to approximately two percent of all deaths that occur in general practice.
(2) Despite the fact that euthanasia is practiced openly, officially it remains a crime in the Netherlands; it appears unlikely that in the foreseeable future euthanasia will be legalized in Holland. Since the practice of euthanasia violates the Dutch penal code, each case must be reported to the legal authorities, as a case of unnatural death, by the attending physician. In practice, prosecution will not follow the patient's death provided the physician can prove that he or she has followed very specific and circumscribed guidelines: They are as follows: (1) the patient's request must be voluntary, (2) the explicit wish of the patient to be euthanatized must be repeatedly expressed, (3) all medical alternatives that the patient could pursue, once he or she was fully informed of them, must have been refused, and all care options must have been exhausted, (4) and the physician may not act alone, i.e., he or she must consult with an independent professional colleague. Acting prudently, the physician usually describes fully the circumstances of the case. Legal immunity is thereby given to physicians who satisfy these criteria.
These guidelines are reflected in the definition of euthanasia currently employed in the Netherlands: The intentional termination of life by a physician on the urgent request of the patient.
(3) The distinction between active and passive euthanasia is not one that the Dutch find relevant, since euthanasia is essentially the intention to comply with the patient's repeated wish to have his or her
π SIMILAR VOLUMES
Overview: The Dutch experience has influenced the debate on euthanasia and death with dignity around the globe, especially with regard to whether physician-assisted suicide and euthanasia should be legitimized or legalized. A review of the literature reveals complex and often contradictory views abo