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Why the Netherlands?

Published online by Cambridge University Press:  01 January 2021

Raphael Cohen-Almagor
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Extract

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. Review of the literature reveals complex and often contradictory views about the Dutch experience. Some claim that the Netherlands offers a model for the world to follow; others believe that the Netherlands represents danger, rather than promise, and that the Dutch experience is the definitive answer regarding why we should not make active euthanasia and physician-assisted suicide part of our lives.

Having investigated the Dutch experience for a number of years, in the summer of 1999 I went to the Netherlands to visit the major centers of medical ethics as well as some research hospitals, and to speak with leading figures in euthanasia policy and practice. This essay commences by providing some background information on the practice of euthanasia and on the legal framework, and then reports the main answers to my first question: Why the Netherlands?

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Article
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Journal of Law, Medicine & Ethics , Volume 30 , Issue 1 , Spring 2002 , pp. 95 - 104
Copyright
Copyright © American Society of Law, Medicine and Ethics 2002

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References

Kimsma, G.K. and van Leeuwen, E., “Dutch Euthanasia: Background, Practice, and Present Justifications,” Cambridge Quarterly of Healthcare Ethics, 2 (1993): 19–35, especially at 24.CrossRefGoogle Scholar
See Sheldon, T., “Doctors Not Obliged to Carry Out Treatment They Think ‘Futile,’” British Medical Journal, 319 (October 23, 1999): 1088.CrossRefGoogle Scholar
For a discussion of the double effect doctrine, see Cohen-Almagor, R., “Language and Reality at the End of Life,” Journal of Law, Medicine & Ethics, 28, no. 3 (2000): 267–278.CrossRefGoogle Scholar
See Legemaate, J., “Twenty-Five Years of Dutch Experience and Policy on Euthanasia and Assisted Suicide: An Overview,” in David, C. Thomasma et al., eds., Asking to Die (Dordrecht: Kluwer Academic Publishers, 1998): at 20; Kimsma, G.K., “Euthanasia and Physician Assisted Suicide in the Netherlands,” Medizin, Ethik, Recht (1994): 161-69.Google Scholar
Griffiths, J., Bood, A. and Weyers, H., Euthanasia and Law in the Netherlands (Amsterdam: Amsterdam University Press, 1998): at 213.CrossRefGoogle Scholar
Griffiths, J., “Effective Regulation of Euthanasia and Other Medical Behavior that Shortens Life,” in Mackaay, E., ed., Uncertainty and the Law (Montreal: Editions Thémis, 1999): 61–94, especially at 72–73.Google Scholar
van der Wal, G., van Eijk, J.Th.M., Leenen, H.J.J. and Spreeuwenberg, C., “Euthanasia and Assisted Suicide. II. Do Dutch Family Doctors Act Prudently?,” Family Practice, 9, no. 2 (1992):135–40.CrossRefGoogle Scholar
A doctor has an obligation to maintain a full dossier on every patient and to accurately record therein what he or she does and why. Keeping adequate records is a general requirement of medical practice, and is specifically one of the requirements of careful practice in the case of euthanasia.Google Scholar
Kimsma notes that written requests of euthanasia are preferable but not mandatory. Another acceptable solution is a witness.Google Scholar
Griffiths, , supra note 6, at 74.Google Scholar
I thank Henk Leenen for this piece of information.Google Scholar
ten Have, H.A.M.J., “Euthanasia: The Dutch Experience,” Annals de la Real Academia Nacional de Medicina, Tomo CXII (Madrid, 1995): 425–44, at 436-37.Google Scholar
Reporting, as opposed to recordkeeping, refers to the requirement that a doctor report a case of euthanasia to the authorities as an unnatural death.Google Scholar
Griffiths, , supra note 6, at 74–75.Google Scholar
van der Maas, P.J., van Delden, J.J.M. and Pijnenborg, L., Euthanasia and Other Medical Decisions Concerning the End of Life, Health Policy Monographs (Amsterdam: Elsevier, 1992): at 98.Google ScholarPubMed
For further reading, see Leenen, H.J.J., “Euthanasia, Assistance to Suicide and the Law: Developments in the Netherlands,” Health Policy, 8 (1987): 197–206; Gevers, J.K.M., “Legal Developments Concerning Active Euthanasia on Request in the Netherlands,” Bioethics, 1, no. 2 (1987): 156-162.CrossRefGoogle Scholar
“Euthanasia and Physician Assisted Suicide in the Netherlands,” at <http://www.nlembassy.or.kr/c_hlteuth.html> (last visited January 14, 2002). This website is a service of the Royal Netherlands Embassy in Seoul, Korea.+(last+visited+January+14,+2002).+This+website+is+a+service+of+the+Royal+Netherlands+Embassy+in+Seoul,+Korea.>Google Scholar
Sneiderman, B. and Verhoef, M., “Patient Autonomy and the Defence of Medical Necessity: Five Dutch Euthanasia Cases,” Alberta Law Review, XXXIV, no. 2 (1996): 374–415, at 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. For England, see R. v. Cox [1992] 12 BMLR 38 (England); Porter, R., “Doctor Convicted of Attempted Murder,” Sunday Telegraph (London), September 20, 1992. For Canada, see O'Malley, M. and Wood, O., “‘Cruel & Unusual’: The Law and Latimer,” CBC News, at <http://www.cbc.ca/news/indepth/background/latimer_robert.html> (last visited January 15, 2002), describing the Robert Latimer case, which involves a Saskatchewan farmer who killed his 12-year-old daughter, Tracy, who suffered from severe cerebral palsy and had the capacity of a three-month-old child. Latimer is currently serving a life sentence, which holds no possibility of parole until 10 years.CrossRefGoogle Scholar
Dillmann, R.J.M. and Legemaate, J., “Euthanasia in the Netherlands: The State of the Legal Debate,” European Journal of Health Law, 1 (1994): 81–87, especially at 84.CrossRefGoogle Scholar
A translation of the law can be found in Griffiths, , Bood, , Weyers, , supra note 5, at 308–13.Google Scholar
Reuters, , “Dutch Parliament Votes to Legalize Euthanasia,” November 28, 2000, available at <http://www.worldrtd.org/dutchlaw.html#reuters>..>Google Scholar
On the regional committees, see van Leeuwen, E., Kimsma, G., “Problems Involved in the Moral Justification of Medical Assistance in Dying: Coming to Terms with Euthanasia and Physician Assisted Suicide,” in Cohen-Almagor, R., ed., Medical Ethics at the Dawn of the 21st Century (New York: New York Academy of Sciences, 2000): 157–173; Onwuteaka-Philipsen, B., Consultation of Another Physician in Cases of Euthanasia and Physician-Assisted Suicide, Doctoral Thesis (Amsterdam: Department of Social Medicine, Vrije Universiteit, 1999).Google Scholar
“Minderjarige mag euthanasie vragen” (A minor may/is allowed to ask/request for euthanasia), NRC Handelsblad (New Rotterdam), July 10, 1999, at 3. See also Gardner, M., “Dutch Poised to Legalize Euthanasia,” Christian Science Monitor, June 30, 2000, available at <http://www.csmonitor.com/durable/2000/06/28/text/p1s4.html>..>Google Scholar
Associated Press, “Dutch Call Off Aided Suicide for Children,” International Herald-Tribune, July 15, 2000.Google Scholar
Jochemsen, H., “The Legalization of Euthanasia in The Netherlands,” Ethics & Medicine, 17, no. 1 (January 2001).Google Scholar
In his letter dated June 5, 1999, Dr. Chabot, Wrote: “After four years waiting for the final court judgement (1991–1995) and discussing the case with many people from abroad, I hope you will understand that I prefer to remain in the background now and not to make an appointment with you.” He, however, agreed to answer via e-mail some specific questions relating to his conduct that brought about the charges against him.Google Scholar
My questionnaire comprised fifteen questions. The Dutch comprehensive study of 1995 consisted of 120 pages and the interviews lasted for an average of 2.5 hours. The pace of questioning was, apparently, frantic. See van der Maas, P.J. et al., “Euthanasia, Physician-Assisted Suicide, and Other Medical Practices Involving the End of Life in the Netherlands, 1990–1995,” N. Engl. J. Med., 335, no. 22 (1996): 1699–1711, at 1700.Google Scholar
Those commenting included Arie van der Arend, J.G., Houtepen, Rob, Jochemsen, Henk, Trappenburg, Margo, Kennedy, James, Leenen, H.J.J., van Dantzig, A., Dupuis, Heleen, Johannes, JM, van Delden, , Griffiths, John, Gevers, Sjef, Berghmans, Ron, ter Meulen, Ruud, den Hartogh, Govert, Oderwald, Arko, van Leeuwen, Evert, van der Maas, Paul and Kimsma, Gerrit. Bert Thijs and George Beusmans read the draft and had no problem with my account of their views.Google Scholar
Gordijn, B., “Euthanasie: Strafbar und doch zugestanden? Die niederlandische Duldungspolitik in Sachen Euthanasie” (Euthanasia: Criminal offense and still allowed? The Dutch policy of permissiveness/tolerance in cases of euthanasia), Ethik Med, 10 (1998): at 12.CrossRefGoogle Scholar
Proceedings of Euthanasia and Assisted Suicide in the Netherlands and in Europe, Maastricht, June 10–11, 1994 (Luxembourg: Office for Official Publications of the European Communities, 1996): at 101.Google Scholar
Griffiths, , Bood, and Weyers, , supra note 5, at 12–13.Google Scholar
Pijnenborg, L., “The Dutch Euthanasia Debate in International Perspective,” in End-of-Life Decisions in Dutch Medical Practice, Doctoral Thesis (Rotterdam: Department of Public Health, Erasmus University, 1995): 119–132. I am most grateful to Paul van der Maas for sending me this work as well as some other publications.Google Scholar
These included Kennedy, James, den Hartogh, Govert, Dupuis, Heleen, Jochemsen, Henk and van Dantzig, A..Google Scholar
van Leeuwen, Evert, Visser, Jaap, Trappenburg, Margo, Thijs, Bert and van der Wal, Gerrit expressed similar views.Google Scholar
Ruud ter Meulen made a similar point. For further deliberation on Calvinism, see Holwerda, D.E., ed., Exploring the Heritage of John Calvin (Grand Rapids, Michigan: Baker Book House, 1976). See especially the chapter by Minnema, T., “Calvin's Interpretation of Human Suffering,” at 140–162.Google Scholar
The book was translated to English and published by W.W. Norton in 1978.Google Scholar
van Holsteyn, J. and Trappenburg, M., “Citizens' Opinions on New Forms of Euthanasia. A Report from the Netherlands,” Patient Education and Counseling, 35 (1998): 63–73.CrossRefGoogle Scholar
Van den Berg's book responded to widely felt concerns and was reprinted twenty-one times within seven years and endlessly discussed in magazines and other media. See Griffiths, , Bood, and Weyers, , supra note 5, at 48.Google Scholar
On changes in public opinion from 1966 to 1991, see van der Maas, P.J., Pijnenborg, L. and van Delden, J.J.M., “Changes in Dutch Opinions on Active Euthanasia, 1966 Through 1991,” JAMA, 273, no. 18 (May 10, 1995): 1411–14; Hessing, D.J., Blad, J.R. and Pieterman, R., “Practical Reasons and Reasonable Practice: The Case of Euthanasia in the Netherlands,” Journal of Social Issues, 52, no. 2 (1996): 161-66. According to two consecutive polls, 70 percent of the Dutch people accepted active euthanasia in 1985, and 76 percent in 1986. See Fenigsen, R., “A Case Against Dutch Euthanasia,” Hastings Center Report, 19, no. 1 (Supp. January/February 1989): 22-25. A 1998 survey showed that more than 90 percent of the population favors euthanasia. See Daley, S., “The Dutch Seek to Legalize Long-Tolerated Euthanasia,” New York Times, June 20, 2000, available at <http://www10.nytimes.com/library/world/europe/062000holland-mercy.html>.CrossRefGoogle Scholar
McKhann, C.F., A Time to Die: The Place for Physician Assistance (New Haven, Connecticut: Yale University Press, 1999): at 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. See Gomez, C.F., Regulating Death (New York: The Free Press, 1991): at 28-32; Griffiths, , Bood, and Weyers, , supra note 5, at 53.Google Scholar
This is supported by my interviews with Griffiths, John, Gevers, J.K., Thijs, Bert, van der Arend, Arie, Berghmans, Ron and ter Meulen, Ruud.Google Scholar
Ester, P., Halman, L., de Moor, R., The Individualizing Society: Value Change in Europe and North America (Tilburg: Tilburg University Press, 1994): at 56–60.Google Scholar
This is supported by my interviews with Jaap Visser, Willems, Dick, Griffiths, John. This point was reiterated also by Frank Koerselman, Egbert Schroten, and Govert den Hartogh.Google Scholar
These include van Leeuwen, Evert, Griffiths, John and van der Wal, Gerrit.Google Scholar
Alexander, L., “Medical Science Under Dictatorship,” N. Engl. J. Med., 241 (July 14, 1949): 39–47, especially at 45.CrossRefGoogle Scholar
This is supported by my interviews with Gevers, J.K., Visser, Jaap, Dupuis, Heleen, Trappenburg, Margo, van der Wal, Gerrit, Jochemsen, Henk, den Hartogh, Govert, Oderwald, Arko and Houtepen, Rob.Google Scholar
van der Wal, G. and Dillmann, R.J.M., “Euthanasia in the Netherlands,” British Medical Journal, 308 (1994): 1346–49. For further deliberation on the Dutch health-care system, see van der Made, J. and Maarse, H., “Access to Health Care in the Netherlands,” in Lenaghan, J., ed., Hard Choices in Health Care: Rights and Rationing in Europe (London: BMJ Publishing Group, 1997): 93-111.CrossRefGoogle Scholar
See Cohen-Almagor, R. and Hartman, M.G., “The Oregon Death with Dignity Act: Review and Proposals for Improvement,” Journal of Legislation, 27, no. 2 (2001). 269–98.Google Scholar
See Hendin, H., Seduced by Death (New York: W.W. Norton, 1997): at 122.Google Scholar
See Cohen-Almagor, R., The Right to Die with Dignity: An Argument in Ethics, Medicine, and Law (NJ.: Rutgers University Press, 2001).Google Scholar