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17: Voluntary Euthanasia in the Netherlands - MDEL Studies
See Fact Sheet 4 for a summary of the practice of voluntary euthanasia in the Netherlands.
In 1990 the Dutch government appointed a commission to investigate the
medical practice of euthanasia. The Commission, headed by Professor Remmelink,
Solicitor General to the Supreme Court, established a comprehensive nation-wide
study of "medical decisions concerning the end of life (MDEL)".
The following broad forms of MDEL were studied:
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Non-treatment decisions: withholding or withdrawing treatment in situations
where treatment would probably have prolonged life;
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Alleviation of pain and symptoms: administering opioids in such dosages
that the patient's life could be shortened;
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Euthanasia and related MDEL: the prescription, supply or administration
of drugs with the explicit intention of shortening life, including euthanasia
at the patient's request, assisted suicide, and life termination without
explicit and persistent request.
The study was repeated in 1995 and is to be repeated again in 2001.
The 1995 study made it possible for the first time to assess whether there
had been harmful effects over time which might have been caused by the
availability of voluntary euthanasia in the Netherlands. [The results
of a comparable study carried out in Australia became available early in
1997. End-of-life medical decisions in two countries, one of which allows
the practice of voluntary euthanasia in certain circumstances and one which
does not, are compared. See Fact Sheet 21.]
The studies gave the best estimate of all forms of MDEL (ie all treatment
decisions with the possibility of shortening life) in the Netherlands as
around 39% of all deaths in 1990 and 43% in 1995.
In the third category of MDEL, the studies gave the best estimate of
voluntary euthanasia as 2300 persons (1.8% of all deaths) in 1990 and 3250
persons (2.4%) in 1995. The estimate for assisted suicide was about 0.3%
in 1990 and in 1995. There were 0.8% without explicit and persistent request
in 1990 and 0.7% in 1995. (In a majority of the latter cases the patient
had earlier expressed a wish for voluntary euthanasia. In almost all of
those cases the patient was no longer competent and death was hastened
by a few hours or days.)
There were 8900 explicit requests for euthanasia or assisted suicide
in the Netherlands in 1990 and 9700 in 1995. Less than 40% were proceeded
with.
The results of the 1995 study do not support the claim that the Dutch
are on a slippery slope. A number of factors have contributed to the
increase of voluntary euthanasia and medically assisted suicide from 2.1%
to 2.7% of total deaths in the five year period. Mortality rates increased
as a consequence of the ageing of the population. The proportion of deaths
from cancer increased as a consequence of a decrease in deaths from heart
disease. Life-prolonging techniques became increasingly available and there
were possibly generational and cultural changes in patients' attitudes.
The slightly fewer cases of ending life without an explicit request may
be a result of the increasing openness with which end-of-life decisions
are discussed with patients.
The conclusion recorded in the abstract to the report on the 1995 study
published in the New England Journal of Medicine in January 1997 was:
"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."
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