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Conference studies
ethics of euthanasia

An expert says the Dutch practice
euthanasia and might legalize it soon

By Mary Adamski
Star-Bulletin

Eighty percent of the Dutch people favor having the option of legal physician-assisted suicide and euthanasia, and those choices already account for 2.7 percent of all deaths in the Netherlands, said a Dutch medical scholar.

Although deliberately caused death is still illegal, there were 3,200 cases of euthanasia and 400 physician-assisted suicides reported in the last nationwide survey in 1995, said Gerrit van der Wal, professor of social medicine at Vrije University in Amsterdam.

He spoke yesterday at the International Bioethics Conference on "End of Life Care, Learning from Home and Abroad." The meeting, attended by 215 people from medical, legal, educational and religious fields, continued today at the Sheraton-Waikiki Hotel. It is sponsored by St. Francis Healthcare System of Hawaii, International Center for Healthcare Ethics.

Conference discussions about legal and ethical aspects in deliberate end-of-life decisions focused on recent political developments about legalization. Oregon is the first jurisdiction to legalize physician-assisted suicide, limited to a doctor providing medication but not administering it.

Attempting to thwart such state actions, the U.S. House of Representatives approved a bill requiring the Drug Enforcement Administration to pursue criminal charges against a doctor who administers deadly medication. In Hawaii, a governor's blue ribbon panel on death with dignity last year recommended legalization of euthanasia, but the idea failed to fly in the Legislature.

Van der Wal said that when the Netherlands Parliament legalizes mercy killing as expected this year, it will just formalize the cultural acceptance and current practice.

The idea had gained favor since the previous national survey in 1990 and "I expect further increase because of cultural developments ... the younger population who want to reach their own decision about life's end; also there is growing number of physicians who will grant the request.

"Euthanasia poses a problem for society," van der Wal acknowledged. "It is a transgression of the basic medical rule to protect life."

He said, "Protestant churches are very open-minded, with the exception of the more fundamental. Catholic authorities are opposed. If you look at the religious people, 80 percent of all Dutch people including the religious are in favor of at least the opportunity of euthanasia."

Some 53 percent of Dutch doctors said they had been requested to end a life, 35 had not and 12 percent said they would never consider it.

Doctors don't face prosecution as long as they follow the system which involves reporting assisted deaths, he said. He was among the country's medical experts who helped create the current system that "requires a high quality of decision making."

One aspect is that a physician must consult with another, unaffiliated doctor about the patient's condition and death request. Another facet is a network of regional review committees, including lawyers and doctors, which scrutinize deliberate death decisions.

Van der Wal presented statistics from the 1995 Dutch survey:

Some 34,500 people said they'd want euthanasia later and 9,700 asked for euthanasia now.
Doctors granted 37 percent of the requests.
Refusals in 27 percent of the cases were for reasons such as other alternatives were available or doctors discerned that patients were suffering from mental disorders or depression.
Six percent of the patients changed their minds.
Of the euthanasia deaths that year, 80 percent were cancer patients.

One element discussed in the United States does not come into play in Holland. The European country has national health insurance that covers 100 percent of long-term care. "There is no financial advantage for physicians, hospitals or family members to stop care," van der Wal said.

He also said legalization might actually lower the incidence of intentional death. "Debating leads to a higher consciousness also of better end-of-life care and more clarity in discussing wishes."