DEATH POLL IGNITES DUTCH EUTHANASIA DEBATE
The Age (Melb) Wednesday, 17 February, 1999
AUDREY GILLAN LONDON, TUESDAY
A report alleging that 20 per cent of assisted deaths in the Netherlands are carried out without the patient's permission has initiated renewed debate on the country's euthanasia laws.
Research published in the Journal of Medical Ethics says doctors in Holland where voluntary euthanasia has been decriminalized since 1984 are ignoring guidelines intended to protect patients.
A survey of more than 400 doctors found that many had intentionally terminated a patients life in spite of the fact that the patient had not explicitly expressed a wish to die.
Dutch doctors are obliged by law to report cases where they have assisted death. Euthanasia can only be carried out at the "patient's explicit request" and when there is "intolerable suffering without prospect of improvement. The request must be voluntary, explicit, carefully considered and made repeatedly.
Doctors are allowed to resort to euthanasia only if there is no alternative, such as palliative care of terminally ill patients. Those who breach these rules can be charged with murder.
Usually patients are given an injection to render them comatose, followed by a second injection to I stop the heart. Official guidelines encourage the doctor to allow the patient to take the lethal dosage, under supervision, if this is a practiced alternative.
The survey of more tan 400 doctors found that of the 4500 cases in 1995 where medics admitted they intentionally terminated life, 900 patients had not explicitly stated they wanted euthanasia. Doctors explained that in the majority of cases they could not obtain an "explicit request" because the patients were unable clearly to state their wishes.
The report reveals that in 15 per cent of cases, doctors admitted a discussion could have taken place but did not. They said they had gone ahead because they believed it was in the patients best interests. In 17 per cent of cases there were alternative treatment options and 59 per cent of the cases were not reported to the local medical examiner.
The reports authors conclude: ‘The high incidence of intentional life shortening disclosed by the survey and the relative weakness of the reasons given for euthanasia in so many cases by the doctors tend to suggest that euthanasia is not confined to cases of last resort' and is at least sometimes used as an alternative to palliative care.
"The undisputed fact that a clear majority of cases still goes unreported serves only to reinforce doubts about the ability of the procedure to fulfill its purpose and to undermine Dutch claims of effective regulation, scrutiny and control."