The Dutch Disaster
by Carrie Gordon Earll
Euthanasia advocates argue that strict guidelines will protect the dependent, disabled and elderly from family members or medical professionals who deem their lives are no longer worth living. These “right to die” supporters point to Holland, where physicians have practiced physician-assisted suicide and euthanasia for more than two decades.
While euthanasia and assisted suicide remain illegal in Holland, doctors are free to engage in such practices without prosecution if they follow specific guidelines. Among others, these parameters require that the patient be competent, voluntarily repeating the request for death and experiencing unbearable suffering from an irreversible illness.1
However, two Dutch studies, conducted in 1990 and 1995 found that doctors in the Netherlands practiced euthanasia apart from these guidelines. These studies substantiate the suspicion that granting physicians the legal liberty to intentionally bring about the death of a patient could result in people being killed who did not ask to die.
The studies make a distinction between two forms of euthanasia: euthanasia — the intentional killing of a patient by the direct intervention of a physician at the patient’s explicit request, and ending life without the explicit request of the patient — the intentional killing of a patient by the direct intervention of a physician without the patient’s explicit request. An analysis of deaths in both categories reveals that 31 percent of cases in 1990, and 22.5 percent in 1995 involved patients who did not give their explicit consent to be killed.2
Dutch physicians have also extended the practice of euthanasia to include comatose patients, handicapped infants and healthy but depressed adults. In 1996, a Dutch court found a physician guilty of euthanizing a comatose patient at the request of the patient’s family. Although the court determined the patient was not suffering and did not ask to die, the doctor was not punished.3
In April 1995, Dutch physician Henk Prins was convicted of giving a lethal injection to Rianne Quirine Kunst, a baby born with a partly formed brain and spina bifida. The court refused to punish Prins.4 Likewise, though psychiatrist Boudewijn Chabot was found guilty in 1994 of prescribing a fatal dose of sleeping pills for Hilly Bosscher, who was suffering from depression, Chabot was not penalized.5 That same year, the Dutch Supreme Court ruled physician-assisted suicide might be acceptable for patients with unbearable suffering but no physical illness. A 1996 survey of Dutch psychiatrists found 64 percent of those responding “thought physician-assisted suicide for psychiatric patients could be acceptable.”6
As the Dutch experience demonstrates, euthanasia does not remain limited to competent, terminally ill adults who choose to end their own lives. Furthermore, guidelines have proven to be no protection for Holland’s disabled, depressed or elderly citizens. In fact, involuntary euthanasia has become so prevalent that many Dutch citizens carry “Life Passports,” cards that state they do not want so-called “physician aid-in-dying” if they are hospitalized.7
Analysis of Dutch Euthanasia Studies
The studies were conducted in 1990 and 1995. Methods included surveys of and interviews with Dutch physicians as well as analysis of Dutch death certificates listing the cause of death. The 1990 study is often referred to as the Remmelink Report, named after the government representative who chaired a national commission formed to examine medical decisions at the end of life. In the Netherlands, physicians are able to engage in the practices of both euthanasia and physician-assisted suicide, generally without fear of prosecution. However, the two Dutch studies indicate that, on the average, euthanasia is practiced 10 times more frequently than physician-assisted suicide (PAS).
Table 1: Comparison of euthanasia and physician-assisted suicide deaths (% in total deaths):
1990– Euthanasia (1.8%), PAS (0.2%), Ratio 9:1 1995– Euthanasia (2.4%), PAS (0.2%), Ratio 12:1 Average: 10.5
(Percentages used in this analysis are based on the total number of deaths in the Netherlands in the year: 128,786 deaths in 1990 and 135,546 deaths in 1995.)
The Dutch studies make a distinction between two forms of euthanasia: euthanasia — the intentional killing of a patient by the direct intervention of a physician at the patient’s explicit request and ending life without the explicit request of the patient or ELWERP — the intentional killing of a patient by the direct intervention of a physician without the patient’s explicit request. Based on these definitions, the studies document the following number of deaths:
Table 2: Analysis of euthanasia deaths with and without explicit request (% of total deaths):
Method of death 1990 Euthanasia (with request) 2318 (1.8%) ELWERP (without request) 1030 (0.8%) TOTAL 3348
1995 Euthanasia (with request) 3253 (2.4%) ELWERP (without request) 948 (0.7%) TOTAL 4201
(Percentages used in this analysis are based on the total number of deaths in the Netherlands in the year: 128,786 deaths in 1990 and 135,546 deaths in 1995.) These numbers reveal that, of all euthanasia deaths (3348 and 4201, respectively), 30.76 percent in 1990 and 22.56 percent in 1995 involved patients who did not give their explicit consent to be killed.
1990 study: van der Maas, P.J., van Delden, J.J.M., Pijenborg, L. (1992). Euthanasia and other medical decisions concerning the end of life: An investigation performed upon request of the Commission of Inquiry into the medical practice concerning euthanasia. Amsterdam: Elsevier Science Publishers. (p. 178, 181-182).
1995 study: van der Maas, P.J., van der Wal, G., Haverkate, I., et al. (1996). Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990-1995. New England Journal of Medicine, 335, 1699-1705.
1Carlos Gomez, Regulating Death, (New York: Free Press, 1991), p. 32; “The Dutch Guidelines: How a Nation Tolerates Euthanasia,” Newsday, January 6, 1997, p. A6 2P. J. van der Maas, J.J.M. van Delden and L. Pijenborg, Euthanasia and other Medical Decisions Concerning the End of Life: An Investigation Performed Upon Request of the Commission of Inquiry into the Medical Practice Concerning Euthanasia, (Amsterdam: Elsevier Science Publishers, 1992) p. 178-179, 181-182; P.J. van der Maas, G. van der Wal, I. Haverkate, C.L.M et al.,(1996). Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990-1995. New England Journal of Medicine, 335, p. 1700-1701 3“The Dutch Guidelines,” Newsday, 1997, p. A6 4 “Doctor Freed in ‘Justified’ Mercy Killing,” Chicago Tribune, April 27, 1995, p. N21; “Murder Charge Proved Against Euthanasia Doctor, but Case Dismissed,” Associated Press, April 27, 1995 5 “Doctor Unpunished for Dutch Suicide,” New York Times, June 22, 1994, p. 10A 6 J.H. Groenewoud, P.J. van der Maas, G. van der Wal, et al., Physician-assisted death in psychiatric practice in the Netherlands. New England Journal of Medicine, 336, p. 1796 7 “Dutch Death,” Oregonian, January 8, 1995, p. 17A
This article was originally posted in June 1996.
Carrie Gordon Earll is the Senior Policy Analyst for Bioethics at CitizenLink (an affiliate of Focus on the Family) and a fellow with the Center for Bioethics and Human Dignity.