Euthanasia in the Netherlands

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 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. Given these contradictory views, it has become clear that fieldwork is essential to developing a more informed opinion. Having investigated the Dutch experience for a number of years, and after thoroughly reading the vast literature published in English, I went to the Netherlands for one month in the summer of 1999 to get a feel for the local situation. I felt that this would provide the basis on which I could better interpret the findings of the available literature. I visited the major centers of medical ethics, as well as some research hospitals, and spoke with leading figures in the euthanasia policy and practice. The time spent was extremely beneficial and enriching. I followed in the footsteps of Carlos Gomez, who 1 published a book following one month of extensive research in the Netherlands.

From the reviews:

"Euthanasia in the Netherlands is an excellent book on an important topic. It succeeds in giving an even-handed appraisal of Dutch euthanasia practices, providing a better understanding and valuable insights of the Dutch experience with euthanasia and physician-assisted suicide. Cohen-Almagor analyses clearly and accurately the weaknesses of the policy and offers recommendations for correcting the deficiencies and developing a sounder policy. He combines an overview of the literature with analyses and interpretations of the intriguing interviews he conducted with key people in the Netherlands. [] Cohen-Almagor's book is critical but judicious. He gives a balanced account of the views with which he disagrees and he carefully explains the basis for his disagreement. His style of writing is straightforward, clear, easy to follow, logical, and coherent. Bioethicists and other scholars in medicine, public health, and law will be interested in this book. College teachers of medical ethics will also find it valuable, and educated general readers with a special interest in euthanasia will find it helpful."
(Professor William R. Winslade, Institute for the Medical Humanities, University of Texas)
"Writing a book on the Dutch experience with euthanasia is not an easy matter. [] Several reasons can explain the difficulty. First of all the ethics of the present palliative and terminal care has not been spelled out in detail until recent years. The difficulties every physician meets more than once in his career when confronted with a sincere wish of the patient to die in a humane way in a situation of unbearable suffering, are still puzzling for moral and legal thinking. Secondly, our ways of legal and public thinking are still not adapted to the situation in which death is a part of life, not so much as a natural fact but as a process that can be controlled. The goals of medicine to uphold human dignity and to alleviate suffering areat stake in this process. [] The Dutch policy to aim at a system of both legal clarity and control is perhaps at this moment the most articulated answer to the difficulties, but will almost certainly not be the last word in the issues of death and dying. [] Rafi Cohen-Almagor has contributed much to the ongoing discussions by interviewing all the prominent legal, moral, political and medical people involved in the development of the Dutch legal ruling. His analysis of the interviews is based on clear, lucid thinking and argument. Unlike some others he tries to stay with the facts without entangling them with moral or political prejudice. Instead he tries to develop a view according to best standards of academic thinking. In the end he gives his own conclusion based on his experiences. One does not need to subscribe them in order to appreciate the work Prof. Cohen-Almagor has done. This book will certainly be helpful in every discussion on the legal and moral principles of assistance in dying, in traditions of legal philosophy such as the schools of Dworkin, Rawls and Kelsen. It can help physicians, nurses and others engaged in palliative care to sharpen their views in the ethics of palliative care as well in the forms of public and legal control that are needed in the burdensome but rewarding work of assistance in dying."
(Prof. Evert van Leeuwen, Faculteit der Geneeskunde, Section Philosophy and Medical Ethics, Free University of Amsterdam)

Contenu

Acknowledgments. Introduction.- Preliminaries: Comparative Law.- Part A: Background. 1: The Three Research Reports of 1990, 1995 and 2001, and Their Interpretations. 2: The Practice of Euthanasia and the Legal Framework.- Part B: Fieldwork. 3: The Methodology.- Phase I: The Interviews. 4: Why the Netherlands? 5: Views on the Practice of Euthanasia. 6: Worrisome Data. 7: The Remmelink Contention and the British Criticism. 8: Should Physicians Suggest Euthanasia to Their Patients? 9: Breaches of the Guidelines. 10: On Palliative Care and the Dutch Culture. 11: On Legislation and the "Chabot" Case.- Phase II: Interviewees' General Comments. a. Preliminaries. b. General Comments.- Phase III: Updates. a. Preliminaries. b. On the New Act. c. On the Work of the Regional Committees. d. Further Concerns.- Part C: Conclusion. a. Preliminaries. b. Suggestions for Improvement.- Appendix I: Interviews in the Netherlands (Summer 1999). Appendix II: Interviews and Telephone Conversations in the Netherlands (Summer 2001). Appendix III: Interviews in the Netherlands (April 2002).- Index: General. Index: Court Cases.