Netherlands, first country to legalize euthanasia

Last month, the Netherlands became the first country to decriminalize voluntary euthanasia. Under new legislation a doctor will not be prosecuted for terminating a person’s life providing he or she is convinced that the patient’s request is voluntary and well considered and that the patient is facing ‘‘unremitting and unbearable’’ suffering.

The doctor must have advised the patient of his or her clinical condition and have reached a firm conclusion with the patient that there is ‘‘no reasonable alternative’’. In addition, at least one other independent physician must have examined the patient and reached the same conclusion.

The legislation reached its final hurdle on 10 April when the Dutch senate voted by 46 votes to 28 to approve the bill. The vote was seen as a formality, after the lower house voted last autumn by 2:1 in favour of decriminalization.

There will be little change in practice, as Dutch doctors have offered euthanasia to terminally ill patients for at least two decades. In 1994, a law was introduced which obliged doctors to report any cases of euthanasia to the authorities, who would then decide not to prosecute if the doctor had followed certain guidelines. Euthanasia still remained a crime, however, carrying a maximum 12-year prison sentence.

The Royal Dutch Medical Association welcomed the move, saying it would resolve the ‘‘paradoxical legal situation’’ and ensure that doctors acting in good faith and with due care would not face criminal proceedings.

Although surveys show that the change in law is supported by 90% of the Dutch population, there were still angry protests outside the parliament building. In the weeks preceding the debate, the senate received over 60 000 letters urging legislators to vote against the bill. The mostly Christian protesters view the measure as an assault on the sanctity of life.

About 3000 cases of voluntary euthanasia are carried out each year in the Netherlands. Mr Rob Jonquierre, managing director of the Dutch Voluntary Euthanasia Society, believes that the new legislation will not lead to a massive increase in the number of cases. He told the Bulletin: ‘‘We may see more requests, as patients may find it easier to talk to a doctor about euthanasia knowing that the doctor will not now be committing a crime.’’

But he adds: ‘‘One of the main reasons for requesting euthanasia is fear of the dying process. So if patients are confident that a doctor won’t refuse euthanasia at a future date this can be very reassuring and can give them the strength to continue.’’

Belgium could be the next country to change its laws on mercy killing, as a bill to partially decriminalize euthanasia is currently before parliament. In Belgium, 72% of the population is believed to support some sort of death on demand.

The issue of euthanasia is likely to remain high on the medicolegal or ethical agendas of many countries in coming years. One reason, according to some experts, is a growing insistence among patients in many countries on having the final say — in all senses of the word ‘‘final’’ — about their medical treatment.

Another reason is that people are living longer and because of medical advances increasing numbers are surviving with debilitating conditions, such as cancer and heart disease. However, some experts in palliative care argue that advances in palliative medicine mean that more patients should be able to live a pain-free life, thereby reducing the need for euthanasia.

Jonquierre believes it should not be an issue of palliative care vs euthanasia. ‘‘The best possible care should be given before the issue of euthanasia arises. However, a discussion of euthanasia should be part of the palliative care package.’’

Jacqui Wise, London, UK

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