following Fact Sheet has been prepared by the South Australian Voluntary Euthanasia
Society (SAVES). For
further information visit their website at http://www.saves.asn.au
Voluntary Euthanasia Society
Euthanasia in the Netherlands: An Update
Fact Sheet 4 for a summary of the practice
of voluntary euthanasia in the Netherlands.
1990 the Dutch government appointed a commission to investigate the medical
practice of euthanasia. The Commission, headed by Professor Remmelink,
Solicitor General to the Supreme Court, established a comprehensive nation-wide
study of "medical decisions concerning the end of life (MDEL)".
following broad forms of MDEL were studied:
decisions: withholding or withdrawing treatment in situations where
treatment would probably have prolonged life;
of pain and symptoms: administering opioids in such dosages that the
patient's life could be shortened;
and related MDEL: the prescription, supply or administration of drugs
with the explicit intention of shortening life, including euthanasia
at the patient's request, assisted suicide, and life termination without
explicit and persistent request.
study was repeated in 1995, making it possible for the first time to assess
whether there have been harmful effects over time which might have been
caused by the availability of voluntary euthanasia in the Netherlands.
[The results of a comparable study carried out in Australia became available
early in 1997. End-of-life medical decisions in two countries, one of
which allows the practice of voluntary euthanasia in certain circumstances
and one which does not, are compared. See Fact Sheet
studies gave the best estimate of all forms of MDEL (ie all treatment
decisions with the possibility of shortening life) in the Netherlands
as around 39% of all deaths in 1990 and 43% in 1995.
the third category of MDEL, the studies gave the best estimate of voluntary
euthanasia as 2300 persons (1.8% of all deaths) in 1990 and 3250 persons
(2.4%) in 1995. The estimate for assisted suicide was about 0.3% in 1990
and in 1995. There were 0.8% without explicit and persistent request in
1990 and 0.7% in 1995. (In a majority of the latter cases the patient
had earlier expressed a wish for voluntary euthanasia. In almost all of
those cases the patient was no longer competent and death was hastened
by a few hours or days.)
were 8900 explicit requests for euthanasia or assisted suicide in the
Netherlands in 1990 and 9700 in 1995. Less than 40% were proceeded with.
results of the 1995 study do not support the claim that the Dutch are
on a slippery slope. A number of factors have contributed to the increase
of voluntary euthanasia and medically assisted suicide from 2.1% to 2.7%
of total deaths in the five year period. Mortality rates increased as
a consequence of the ageing of the population. The proportion of deaths
from cancer increased as a consequence of a decrease in deaths from heart
disease. Life-prolonging techniques became increasingly available and
there were possibly generational and cultural changes in patients' attitudes.
The slightly fewer cases of ending life without an explicit request may
be a result of the increasing openness with which end-of-life decisions
are discussed with patients.
conclusion recorded in the abstract to the report on the 1995 study published
in the New England Journal of Medicine in January 1997 was:
"Since the notification procedure was introduced, end-of-life decision
making in the Netherlands has changed only slightly, in an anticipated
direction. Close monitoring of such decisions is possible, and we found
no signs of an unacceptable increase in the number of decisions or of
less careful decision making."
information contact SAVES at: http://www.saves.asn.au
contact: Hon Secretary, SAVES, PO Box 2151, Kent Town, SA 5071, Australia
- Fax + 61 8 8265 2287