Michigan State University DCL Journal of International Law
Abstract The aim of this paper is to outline the legal framework of euthanasia in the Netherlands and to analyze the leading court cases involving adults. I will first explain the legal ambiguity that existed in the Netherlands until the enacting of the euthanasia law on April 10, 2001 which is supposed to come into effect in early 2002 and then discuss how did the courts treat cases of mercy killings.
The purpose of this paper is to address how analysts and commentators approach the relationship between abortion law and law governing medically assisted death, discussion of which is here limited to assisted suicide and voluntary active euthanasia. The issue of involuntary euthanasia or “mercy killing” of non-consenting persons is beyond the present discussion. This paper is further limited to English language literature, and to legal experience and commentary primarily from the United States of America, Britain and Canada, although reactions to developments in the Netherlands are included. Attention will be directed initially to legal and related analysts and commentators who oppose legalization both of abortion and of medically assisted death, and who resist application of the reasoning that supported decriminalization of abortion to medically assisted death. They represent the socalled Pro-Life protagonists in the debate. Language is often employed instrumentally in the conduct of the disagreement, but the practice adopted here is to refer to protagonists by the titles they give themselves.
Second, attention will be given to adherents to the so-called pro-choice position, who favor both liberalized abortion laws and tolerance of medical means by which individuals may end their own lives when they find survival excessively painful, burdensome, or undignified. Consideration is then given to those who oppose liberal abortion laws, perhaps because of fetal vulnerability, but who consider that non-vulnerable, competent persons, such as terminal patients in unrelievable distress, should be legally entitled to assistance in dying. The reverse is then addressed, concerning those who favor women’s choice on abortion, but oppose medically assisted death because, for instance, it may be exploitive of disabled patients or violative of ethical duties that health care professionals owe patients. In conclusion, it will be proposed that reconciliation of opposing views may be approached through promotion of choice, both to continue unplanned pregnancy and burdensome life, through availability of options that individuals may be encouraged and supported, but not coerced, to adopt.
Johanna H. Groenewoud, Agnes van der Heide, Bregje D. Onwuteaka-Philipsen, Dick L Willems, Paul J van der Maas, Gerrit van der Wal
New England Journal of Medicine
Abstract Background and Methods The characteristics and frequency of clinical problems with the performance of euthanasia and physician-assisted suicide are uncertain. We analyzed data from two studies of euthanasia and physician-assisted suicide in the Netherlands (one conducted in 1990 and 1991 and the other in 1995 and 1996), with a total of 649 cases. We categorized clinical problems as technical problems, such as difficulty inserting an intravenous line; complications, such as myoclonus or vomiting; or problems with completion, such as a longer-than-expected interval between the administration of medications and death.
Results In 114 cases, the physician’s intention was to provide assistance with suicide, and in 535, the intention was to perform euthanasia. Problems of any type were more frequent in cases of assisted suicide than in cases of euthanasia. Complications occurred in 7 percent of cases of assisted suicide, and problems with completion (a longer-than-expected time to death, failure to induce coma, or induction of coma followed by awakening of the patient) occurred in 16 percent of the cases; complications and problems with completion occurred in 3 percent and 6 percent of cases of euthanasia, respectively. The physician decided to administer a lethal medication in 21 of the cases of assisted suicide (18 percent), which thus became cases of euthanasia. The reasons for this decision included problems with completion (in 12 cases) and the inability of the patient to take all the medications (in 5).
Conclusions There may be clinical problems with the performance of euthanasia and physician-assisted suicide. In the Netherlands, physicians who intend to provide assistance with suicide sometimes end up administering a lethal medication themselves because of the patient’s inability to take the medication or because of problems with the completion of physician-assisted suicide.
Extract . . . In unanimous rulings last month, [United States] Chief Justice Rehnquist, writing for the court, held that there is no fundamental right to assistance in committing suicide1 and that, legally, distinguishing between refusing life saving medical treatment and requesting assistance in suicide “comports with fundamental legal principles of causation and intent.”
. . . Attempts to decriminalise assisted suicide in Britain have so far fallen well short of legislation.. . . Pressure groups in favour of voluntary euthanasia seem to accept that it will be difficult to achieve euthanasia legislation in one step but consider that assisted suicide represents a more attainable goal. From an opinion survey of Scottish doctors, the medical profession seems less resistant to assisting suicide than to practising euthanasia. . .
. . . it remains to be seen whether societal acceptance of physician assisted suicide will increase and how it will affect both social support for vulnerable and dying citizens and trust between patients and their doctors.
Extract We can ask ourselves: Where will we stand in 30 years if there are amendments to the Criminal Code in regard to the taking of human life, as are now being discussed? If mercy killing, physician-assisted suicide and euthanasia became legal activities — even under certain restricted guidelines — there would be inevitable progression until widespread acceptance of these practices would be accompanied by major changes in attitudes. [Dr. Waugh planned to respond to these letters but was unable to do so before his death on Apr. 18, 1997. In this issue, CMAJ features a tribute to Waugh (page 1524) as well as an article on is- sues surrounding access to abortion services (page 1545). — Ed.].
Abstract The deaths last September of a British Columbia physician and his wife have raised troubling questions about euthanasia and Alzheimer’s disease. Police described the deaths of Dr. Tom Powell and his wife Dr. Lorraine Miles, a retired dentist, as a murder-suicide. Friends of the couple wonder if more lenient laws concerning euthanasia and assisted suicide might have saved Miles’ life.
Extract The ethical principles of care have to balance patient autonomy or control with the justice owed to society as a whole. Our choices do not take place in a purely individual setting and the change in society’s attitude when a hastened death is available is illustrated by the changes that are taking place in the Netherlands.
Extract The implications of legalizing euthanasia for the medical profession and the potential for abuses are very troubling. Before public policy or legislation is formulated, the ethical issues inherent in the practice of euthanasia must be critically examined. . . It is the author’s assertion that the legalization of assisted suicide and/or physician-aid-in-dying is not the proper course of action at this time. There are too many other options available to doctors, nurses, hospitals and other health care institutions which must be exercised to their fullest extent before any form of active euthanasia is legalized.
Abstract This article sets out a descriptive typology of religious perspectives on legalized euthanasia — political advocacy, individual conscience, silence, embedded opposition, and formal public opposition — and then examines the normative basis for these perspectives through the themes of sovereignty, stewardship, and the self. It also explores the public relevance of these religious perspectives for debates over legalized euthanasia, particularly in the realm of public policy. Ironically, the moral discourse of religious traditions on euthanasia may gain public relevance at the expense of its religious content. Nonetheless, religious traditions can provide a context of ultimacy and meaning to this debate, which is a condition for genuine pluralism.
Extract Like it or not, physicians are going to be reading a lot about euthanasia in the next few years. . . . Many physicians are more or less comfortable with the idea of withholding or withdrawing “medically useless” treatment. In other words, they accept passive euthanasia. . . . .If the medical profession thinks a physician might become responsible for a patient’s death through inaction, but without automatically bearing moral guilt, why does it insist that a physician who becomes responsible for the death of a patient through action automatically becomes morally guilty? . . . Medical ethics should never be decided by consensus or because of what is politically expedient. . .I am not making a plea for active euthanasia. I am suggesting that Canadian physicians should look at this issue honestly and openly.
