Euthanasia, Physician-Assisted Suicide, and Other Medical Practices Involving the End of Life in the Netherlands, 1990–1995

Abstract

Since the notification procedure was introduced, end-of-life decision making in the Netherlands has changed only slightly, in an anticipated direction. Close monitoring of such decisions is possible, and we found no signs of an unacceptable increase in the number of decisions or of less careful decision making.

Increased nonbeneficial care in patients spending their birthday in the ICU

“…Previous studies identified substantial biases during the end-of-life decision-making process [4,11,14,15]. These biases were related to the patients, the family, or the ICU physicians.…”

“…These biases may account for considerable practice differences that cannot be explained by routinely collected information. Sources of bias may be patient related (e.g., patient unwilling to receive life support or be dependent on vasopressors), family related (e.g., cultural factors, religion, and religiosity [4,14,15]), and clinician related (e.g., gender, role, specialty, and time working in ICUs [16][17][18][19][20]). In addition, treatments are more likely to be withdrawn if they are expensive or scarce or if they support noniatrogenic events.…”

“…End-of-life decisions were made in 22% and 24% of cases and controls, respectively. However, these decisions were made later in the cases than in the controls (18 versus 9 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] days). Conclusions: Our finding that patients who spent their birthday in the ICU received a higher intensity of lifesustaining care and had longer ICU stays but did not have significantly different mortality rates compared with the controls suggests the use of nonbeneficial interventions.…”

Treatment, Palliative Care or Euthanasia? Comparing End of Life Issues in Veterinary and Human

“…The Dutch Government took the bull by the horns in 1990, by requesting the first of a series of comprehensive, nationwide, research articles into euthanasia and other medical decisions concerning the end of life [48]. It is time for the British Government to urgently instigate a study of the need for PAS, in the whole of the UK, for the terminally ill, already on palliative care and whose life has become unbearable to them, including those with advanced dementia and advanced neurodegenerative diseases who have a valid 'advance directive' which clearly describes the stage at which they would like assistance to die.…”

Physician-Assisted Death and Pharmacy Practice in the Netherlands

“…Under Dutch legislation euthanasia and physician-assisted suicide are technically crimes, but through an amendment to the Burial Act physicians are granted immunity from prosecution if they adhere to certain conditions. 2 The Royal Dutch Pharmaceutical Association has issued guidelines for pharmacists who receive requests to dispense drugs for euthanasia or physician-assisted suicide. The guidelines, however, have no legal status.…”