Euthanasia in the Netherlands

In 1991, in an effort to come to grips with the actual medical practice of euthanasia and assisted suicide, the Dutch Government established a government commission, headed by Professor Jan Remmelink to study the problem. The Remmelink Report opened the eyes of both the people of the Netherlands and the world to the extent of the practice of euthanasia in Holland. Remmelink found that 49,000 of the 130,000 deaths in the Netherlands each year were not natural but involved a “medical decision at the end of life” or MDEL. 95% of these MDEL cases involve, in equal numbers, either withholding treatment/discontinuing life support or the alleviation of pain and symptoms through medication that might hasten death. This latter (alleviating pain and symptoms) category accounted for approx. 20,000 deaths that had been hastened by a physicians decision. Actual euthanasia, using the official Dutch definition, occurred in 2,300 cases or 2% of all Dutch deaths. Dutch physicians helped 400 patients who requested suicide, for either mental illness or discomfort, to kill themselves in 1990. The alarming statistics of the Remmelink Report indicate that in thousands of cases decisions that might or were intended to end a fully competent patient’s life were made without consulting the patient.

Over 50% of Dutch physicians admitted to practicing euthanasia, most often on cancer patients. Only 60% kept written records of their euthanasia practice and only 29% filled out death certificates honestly in euthanasia cases.

In 1996 a second report on euthanasia in Holland (for 1995) was published. In the interim the number of cases where a doctor had made a decision with the intention to hasten death without the patients express request had risen from 15% to almost 20% of the total annual mortality rate of the Netherlands. At the same time, the number of cases of euthanasia, using the narrow Dutch definition, rose from 2,300 to over 3000, a 30% increase in just 5 years.

“If the patient is aged between 12 - 18, his or her legal representatives are involved in the decision making. If one of them cannot agree with the termination of life, the patients request is not granted, unless he keeps requesting and his termination of life is well-considered and the emergency situation does not permit delaying the termination of life according to the doctor’s judgement.”

Canadian professor of law and medicine at McGill University, Margaret Somerville, has said “…strict guidelines or no, legalized euthanasia has less to do with “unbearable suffering” than with institutionalizing murder in the medical profession.” This is precisely what has happened in the Netherlands.

In 30 years Holland has moved from assisted suicide to euthanasia, from euthanasia of people who are terminally ill to euthanasia of those who are chronically ill, from euthanasia for physical illness to euthanasia for mental illness, from euthanasia for mental illness to euthanasia for psychological distress or mental suffering, and from voluntary euthanasia to involuntary euthanasia or as the Dutch prefer to call it “termination of the patient without explicit request”.

It is now considered a form of discrimination against the chronically ill to deny them assisted death because they will be forced to suffer longer than those who are terminally ill and it is considered bias to force endurance of psychological pain when it is not associated with physical illness. The next step, non-voluntary euthanasia, is then justified by appealing to our social duty to care for patients who are not competent to choose for themselves.