BMJ 2002;324:1354 ( 8 June )
Tony Sheldon Utrecht
For the second year running, Dutch doctors have reported fewer cases of euthanasia and assisted suicide, raising questions over whether mercy killing is declining or doctors are failing to fulfil their legal obligation to notify the authorities.
In 2001 the five regional euthanasia assessment committees received 2054 reports, compared with 2216 in 1999.
The committees, comprising a doctor, a lawyer, and an ethicist, replaced the system of reporting to a local magistrate in 1998. This followed a national study of euthanasia in 1995 that estimated that the 1466 cases reported represented only 41% of total cases. In April 2002 the reporting procedure was enshrined in the new euthanasia law.
The committees must judge whether doctors have fulfilled criteria such as whether the patient was suffering unbearably and hopelessly and had freely made a well considered and long standing request to die. In only one of the 2054 cases reported in 2001 was the doctor judged not to have followed the criteria. The director of public prosecutions is investigating that case. In a number of other cases doctors were required to give further written or verbal explanations.
The Ministry of Health says the reasons for the current decline in reported cases are unclear, and it awaits the results of the next study, by professors Gerrit van der Waal and Paul van der Maas, in 2003. The chairwoman of the assessment committees, Reina de Valk, argues that the decline in reporting could be due to doctors’ increasing knowledge of palliative care, promoted by the Ministry of Health since 1997. She also argues that a recently completed national advisory network of 465 doctors belonging to Support and Consultation over Euthanasia in the Netherlands (SCEN) could have led to a decline in euthanasia.
Dr Henk Jochemsen, director of the Lindeboom Institute, a medical ethics body that opposes euthanasia, said that doctors may be more reluctant to report euthanasia to an assessment committee of experts—who are able to seriously question euthanasia decisions—than to a local magistrate.
Former professor of social medicine and health law at Amsterdam University, Henk Leenen, who chairs a committee overseeing the doctors’ advisory network, said there were signs that some doctors feel the committees were "going too far" and asking questions "not covered by the law," such as whether the patient is in a terminal phase. He hoped for a considerable increase in reporting now that the new law had come into force.
The KNMG (Royal Dutch Medical Association) has said that it is clear that Dutch doctors today are much better informed about the situations they face and that patients and their families can now make better choices.