What can we learn from the Dutch experience of euthanasia?


Euthanasia was decriminalized in Holland in 2002 after 20 years of widespread practice under legal guidelines.  Euthanasia was originally allowed for those experiencing intolerable suffering at the end of life.  By the time the law had passed, the courts had already legitimized the death of patients who were not terminally ill.  Then they allowed it for people whose suffering was not physical. [1] The Dutch are currently debating the need to allow people over 70 years of age to be killed when they are ‘tired of life’[2].   And early in 2005 a Dutch hospital published their guidelines on how to kill disabled newborn babies.[3]

The number of reported euthanasia deaths in Holland rose 13% last year to 2636, following an increase of 10% in 2008[4].  Euthanasia is becoming more common.  A generation of Dutch have had members of the Voluntary Euthanasia society giving them talks at school regarding the benefits of euthanasia.  There are advertisements on TV.  The taboo surrounding euthanasia is fading.

Proponents of euthanasia will tell you that legal guidelines will prevent abuse from happening, but the facts suggest otherwise.

The Dutch Government’s first euthanasia report was published in 1991.  The Remmelink report showed that around 1/3 euthanasia deaths the previous year occurred without the patient’s knowledge or consent (around 1000/year).[5]

In 1995 it was a similar number, working out to be 1 in 5 cases of euthanasia being performed without the clear and explicit request of the patient.[6]

In 1998, 1200 people in the Netherlands were given lethal injections without their knowledge. Over 100 of those patients were mentally competent. And so it goes on.  There are stringent guidelines in place in Holland, but the numbers continue to grow.

We should not be naïve about proposals to legalise euthanasia.

Dr Megan Best, on behalf of the SIE, October 2010.

Further information on the Dutch Experience 

Psychiatrist Dr Herbert Hendin has appraised euthanasia practice in the Netherlands and Oregon (which is available here when you register). His report remains relevant 15 years later, in which he called euthanasia 'the latest result of our failure to develop a better response to the needs of the terminally ill'. Hendin notes the inexorable expansion of candidates for euthanasia: 'The Netherlands has moved from assisted suicide to euthanasia, from euthanasia of the terminally ill to euthanasia of the chronically ill, from euthanasia for physical illness to euthanasia for psychologial distress and from voluntary euthanasia to involuntary euthanasia (called "termination of the patient without explicit request").' He gives several chilling examples of the way euthanasia finally represents a therapist's 'failure of imagination to find a better way'.

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[1] Sheldon, T. (1994). Dutch argue that mental torment justifies euthanasia. BMJ;308:431-432.

[2] Dutch News.nl. 09-02-2010. Tired of life? Group calls for assisted suicide.

[3] Eduard Verhagen, M. D., J.D., and Pieter J.J. Sauer, M.D., Ph.D. (2005). "The Groningen Protocol — Euthanasia in Severely Ill Newborns." NEJM 352(10): 959-962.

[4] Euthanasia cases in Holland rise by 13 per cent in a year – Telegraph.co.uk.c By Simon Caldwell

Published: 6:04PM BST 20 Jun 2010

[5] doi: 10.1136/jme.20.4.212 1994 20: 212-217

J Med Ethics  H Jochemsen Euthanasia in Holland: an ethical critique of the new law.

[6] Henk Jochemsen and John Keown. Voluntary euthanasia under control? Further empirical evidence from the Netherlands. Journal of Medical Ethics 1999;25: 16-2 1