Dutch doctors have a professional obligation to refer patients who request euthanasia to a compliant colleague if they object, says the national doctors association, the KNMG.

Ten years after euthanasia was legalised, the KNMG has issued guidelines on the participation of doctors in euthanasia and assisted suicide. Recently there have been well-publicised demands for euthanasia for the demented and those who are merely tired of living. The report, ”The role of the physician in the voluntary termination of life”, requires further study, but here are some of the main conclusions:

♦ The report attempts to correct a common misconception about euthanasia in the Netherlands. Euthanasia and assisted suicide are illegal unless a doctor is involved and unless there is an underlying disease which is unbearable.

♦ “Contrary to what is generally assumed, the Euthanasia Law includes provisions permitting assisted suicide for patients with psychiatric conditions and dementia.”

♦ If a doctor does not want to participate, “there is a moral and professional duty to provide patients with timely assistance in finding a physician (for example, within the practice) who does not have fundamental objections to euthanasia and assisted suicide.”

♦ If the patient does not have unbearable suffering, he may not be euthanased, but he can decide to stop eating and drinking. In that case, the doctor must respect this decision and “is obligated, in such cases, to supervise the patient and to alleviate the suffering by arranging effective palliative care.”

♦ Similarly, if there is no unbearable suffering and a patient wants to commit suicide with stockpiled drugs, the doctor can give guidance without being liable for punishment.

♦ The burdens of old age are sufficient to request euthanasia. “An accumulation of geriatric afflictions, including loss of function, that result in progressive deterioration may also qualify as unbearable and lasting suffering” for which euthanasia is a solution.

What lies ahead for the practice of medicine in the Netherlands? The report observers that there are already 1 million elderly with “multimorbidity” and in ten years time there will be 1.5 million – 10% of the population. All of these will be eligible for euthanasia if their suffering feels interminable and their life seems meaningless.

This falls short of demands by the group Uit Vrije Wil (By Free Choice) for euthanasia to be made available for anyone over 70 who wants it without reference to a patient’s state of health. But it comes very close. Being elderly, ipso facto, seems to qualify a person for euthanasia if he or she requests it.

The KNMG acknowledges that there will always be doctors unwilling to perform euthanasia. But now they are clearly under pressure to collaborate in some fashion, either by giving sympathetic advice or by referring cases to a colleague. The KNMG regards euthanasia as an ordinary part of good patient care. ~ Radio Netherlands, Sept 8

Michael Cook
euthanasia
Netherlands

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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