The Dutch health minister, Cl?mence Ross, has insisted that doctors who perform euthanasia must report it, after the number of reported cases dropped for the fourth year in a row. She appealed to their sense of “medical professionalism” and insisted that “There must be absolutely no misunderstanding… doctors must report.”

According to the latest statistics, there were 1,815 cases of euthanasia in 2003, compared to 1,882 in 2002; 2,054 in 2001; and 2,123 in 2000, although these do not include cases of “terminal sedation”. Last year a government-commissioned report revealed that just over half of Dutch doctors failed to fulfil their legal responsibility to report cases.

The chairman of the Royal Dutch Medical Association, Dr Peter Holland, attributes the fall in numbers to the increasing availability of “alternatives such as pain relief and sedation” as doctors’ expertise in palliative care improves.

Of the cases reported in 2003, all but eight were deemed to have fulfilled the four criteria which protect doctors against prosecution. Most (1,605) were cancer patients and most (1,477) died at home.