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Medicine, Health Care and Philosophy
Published in: Medicine, Health Care and Philosophy 4/2010

Open Access 01-11-2010 | Scientific Contribution

Death by request in The Netherlands: facts, the legal context and effects on physicians, patients and families

Author: G. K. Kimsma

Published in: Medicine, Health Care and Philosophy | Issue 4/2010

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Abstract

In this article I intend to describe an issue of the Dutch euthanasia practice that is not common knowledge. After some general introductory descriptions, by way of formulating a frame of reference, I shall describe the effects of this practice on patients, physicians and families, followed by a more philosophical reflection on the significance of these effects for the assessment of the authenticity of a request and the nature of unbearable suffering, two key concepts in the procedure towards euthanasia or physician-assisted suicide. This article does not focus on the arguments for or against euthanasia and the ethical justification of physician-assisted dying. These arguments have been described extensively in Kimsma and Van Leeuwen (Asking to die. Inside the Dutch debate about euthanasia, Kluwer Academic Publishers, Dordrecht, 1998).
Footnotes
1
The presence of the LAWER group has been the reason for much criticism of the Dutch end-of-life practice. It should be noted that this subject itself, even though it is very important, is not the focus of this paper. Clearly these cases are not in conformity with the Dutch conditions of acceptable PAD. The main justification of the physicians has been the impossibility to communicate in situations of extreme suffering and a shortening of life of hours or days at the most. See Pijnenborg (1995, pp. 81–88).
 
2
The ‘extension’ of acceptable euthanasia to ‘early Alzheimer’s patients’, as reflected in the Annual Reports of the ERCs, undoubtedly will be judged by some as a sure sign of ‘the slippery slope’. However, this extension can be seen also as a correct and nuanced interpretation of the legal conditions in particular individual cases after a long process of evaluation by geriatricians and psychiatrists. Denying PAD in these circumstances with that particular diagnosis of early Alzheimer’s, with competence, might be seen as unlawful discrimination. It should be clear that this paper does not address the issue of life-ending of severely deformed newborns: under Dutch law that intervention cannot be seen as euthanasia, because euthanasia is by definition the ending of life after a request of a competent person. Newborns are not competent and do not request an end to life.
 
3
One of the reviewers pointed out a presumed comparability between the dangers of sex in the physician-patient relationship and the risks of euthanasia. Both issues, it is claimed, are based on a seduction that may promote behavior beyond the ethos of medicine. The drive for sex is controlled by Eros and the other, to help people die, by Thanatos, expressed as ‘a drive to rid themselves (e.g. the physicians, GKK) of ‘difficult’ and undesired patients.’ See Barilan (2003, pp. 460–463). In my view, this connection between sex and euthanasia, as euthanasia is practiced in The Netherlands, may not be entirely theoretical, but has no validity. The practice of euthanasia is open, transparent and evaluated, before and after the intervention. Patients are the prime movers of the process and each next step is initiated by patients, not by physicians. Cost concerns have no place, since patients are entitled to all possible palliative care. The motives behind claims of this nature are all based on anxieties and fears of ‘slippery slopes’ and a lack of trust in the medical profession. The Dutch democracy has chosen a different path.
 
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Metadata
Title
Death by request in The Netherlands: facts, the legal context and effects on physicians, patients and families
Author
G. K. Kimsma
Publication date
01-11-2010
Publisher
Springer Netherlands
Published in
Medicine, Health Care and Philosophy / Issue 4/2010
Print ISSN: 1386-7423
Electronic ISSN: 1572-8633
DOI
https://doi.org/10.1007/s11019-010-9265-0

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