31 May 2003
Utrecht Tony Sheldon
A study shows that in 2001 just over half of doctors in the Netherlands fulfilled their legal responsibility to report their actions concerning euthanasia.
Researchers for the study, which was commissioned by the Dutch government, admit dissatisfaction with the levels of reporting but deny that there is cause for serious concern. Instead they say that reporting levels have increased steadily since the last report commissioned by the government six years ago and that the overall number of cases of euthanasia has stabilised.
The researchers were able to extrapolate the number of cases of euthanasia each year in the Netherlands from written questionnaires sent to doctors concerning 5500 deaths and from confidential interviews with about 600 doctors.
The study shows that since 1996 reporting of cases of euthanasia cases increased from 41% to 54% of cases.
The researchers estimated that overall 3500 cases of euthanasia occurred in 2001, 2.5% of all deaths. This compares with 3200 (2.4%) in 1995. The number of assisted suicides fell from 400 in 1995 to 300 in 2001.
The total number of requests for euthanasia remained the same, at about 9700. Of these 39% were accepted by the doctor in 2001, a similar percentage to that in 1995. The number of cases where a doctor ended a patientís life without an explicit request, which have caused controversy in the past, also remained the same, at around 900.
The level of reporting is highest among GPs, where it has increased from 44% to 60% of doctors. Reporting levels among hospital consultants and doctors in nursing homes have increased far less.
The researchers believe the increase among GPs is due to the work of a network of independent and specially trained doctors, the Euthanasia Support and Consultation Network, which offers advice and information to GPs. The researchers recommend that the network, which was set up with the support of the Royal Dutch Medical Association, extend its coverage to all doctors.
The researchers deny claims of a "slippery slope," arguing that euthanasia is not increasing significantly, that treatment is not less careful, and that vulnerable people such as children, elderly patients, and patients with dementia are rarely involved.
GPs carry out 77% of cases of euthanasia, and 77% of patients have untreatable cancer. Four fifths (79%) of patients are younger than 80, five cases a year involve children, and euthanasia involving patients with dementia who expressed their wishes in a previously written declaration is "rare."
The research team, headed by Paul van der Maas, professor of social policy at Rotterdamís Erasmus Medical Centre, and Gerrit van der Wal, professor of social medicine at Amsterdam Free University Medical Centre, carried out the research over two years, in cooperation with the Central Office of Statistics.
The Royal Dutch Medical Association will now increase efforts to encourage reporting of euthanasia. It was pleased that reporting had increased but "regretted" the number of doctors still not following the guidelines.
Professor van der Wal said reporting levels were still not high enough
but that this was a cause for dissatisfaction not concern.
© 2003 BMJ Publishing Group Ltd