These are the only two places in the world where laws specifically permit euthanasia or assisted suicide. Oregon permits assisted suicide while the Netherlands permits both euthanasia and assisted suicide. In Belgium, lawmakers have agreed on the provisions of a key article in a draft proposal to legalize euthanasia. Advocates for assisted suicide in Michigan are releasing their own radio and television ads in attempt to counter the anti-proposal ads.
Many court cases have come out of the heated topic as well. In , A Rotterdam court ruled on conditions under which aiding suicide and administering voluntary euthanasia will not be prosecuted. The Supreme Court of the Netherlands declared that voluntary euthanasia is acceptable subject to ten clearly defined conditions in , and in the Netherlands passed a law which prevented doctors from being prosecuted when certain guidelines are followed.
In , Oregon passed a law to allow doctors to prescribe lethal drugs, but an injunction prevented it from taking effect. In , Singapore introduced a right- to-die law which was originally sought after not to legalize euthanasia but to give the terminally ill the right to make a living will. Throughout this time many societies that were pro euthanasia began forming all over the world. In , voluntary euthanasia societies began forming in the Netherlands. Three years later more societies started forming in Japan and Germany.
There are many pros and cons that deal with euthanasia. In dealing with the pro view, the major argument is that all Americans have a constitutional right to life, and with this control of life also comes the authority to end it. Patients may want to seek euthanasia in order to avoid being seen in a diminished capacity and protect their memory of an able-bodied life. Another argument for the use of euthanasia is to avoid leaving loved ones the expensive costs of medical care and posing a financial burden to them.
Choosing assisted suicide may prove to be more cost efficient than long-term medical care. People who oppose the legalization of euthanasia use the argument that once the gate is opened, others lives will be at risk. If euthanasia was readily available, the patient might feel obligated to use it.
There are many more arguments on the legalization of euthanasia or assisted suicide. If a request is made while an individual is suffering or under excruciating pain, then it is arguable that drugs may have prevented the person from making a fully rational decision. The Hemlock society is a major proponent in assisted suicide.
They ought to have the option of a peaceful, gentle, certain and swift death in the company of their loved ones. Along with this law certain safeguards should be in place such as; a diagnoses of a terminal or irreversible illness by two independent physicians, an evaluation by a mental health professional, a written and witnessed request that is revocable at any time, a waiting period, and monitoring by a state health department.
The American Medical Association strictly opposes the use of euthanasia. While modern advances in medical science and technology have helped physicians to treat patients with once critical and life-threatening illnesses, some of these new technologies have merely prolonged the suffering for patients. The AMA still maintains that physicians should practice medicine with respectful and compassionate attitudes.
One pro-life group called Not Dead Yet, understands that people have the right to refuse unwanted treatment.
CURE is another pro-life group. Their reasons are for compassion and unity. Uniting together will bring strength and a prolonged life. One of their reasons is complications that can occur from usage.
More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life.
Many people have pronounced opinions about the acceptability of euthanasia and the circumstances in which it should or should not be allowed.
Worldwide, the topic sparks debates. Many of these debates are based on personal and moral views, whereas actual facts rooted in empirical research will contribute to a more enlightened debate. To improve understanding of the Dutch situation regarding euthanasia, this paper provides a concise overview of research that has been performed in this field during the past two decades. Because the legalization of euthanasia in the Netherlands is the result of decades of debates, an overview is provided of the history of the Dutch debate on euthanasia, including the highlighting of some specific aspects of Dutch culture that contributed to the legalization of euthanasia.
In the Netherlands, euthanasia has been defined since as the administration of drugs with the explicit intention to end life at the explicit request of a patient. Physician-assisted suicide is defined as the administration, supply or prescription of drugs with the explicit intention to enable the patient to end his or her life. Since , in the Netherlands both euthanasia and physician-assisted suicide have been lawful and they are both subject to the same criteria for due care.
The law restricted medicine to those physicians who had passed a state exam, made it subject to governmental inspection, and introduced organization and standardization into medical practice. Four years later, in , the Burial Act was enacted, regulating the way physicians should deal with deceased patients. It stated that a burial could only take place after written permission of a municipal registrar. This permission was only given when the attending physician stated on the death certificate that the patient died from a natural cause.
In case of an unnatural death, the death should be reported to the national authorities. A physician helped her dying mother end her own life following repeated and explicit requests for euthanasia. The physician eventually received a short, suspended sentence. While the court upheld that she did commit murder, it offered an opening for regulating euthanasia by acknowledging that a physician does not always have to keep a patient alive against his or her will when faced with pointless suffering.
As the first euthanasia test case, it broke social taboos in a country with strong Christian traditions. In the s, the debate about euthanasia progressed and formalized. To achieve uniformity in policy, they decided that every case of euthanasia should be scrutinized and that it should be decided whether or not the attending physician should be prosecuted.
In , the Health Council advised that a State Commission should be installed to address the definition of euthanasia as well as the criteria under which it should be allowed. In , the Commission produced its report. This definition has been used ever since. The Commission also drew up a series of criteria for due care to be met in every case of euthanasia. We shall return to those criteria later.
When the State Commission was working on its report, the Supreme Court ruled on the Schoonheim case, in Griffiths et al. It was the first euthanasia case that was judged by the Dutch Supreme Court. Euthanasia was performed on the explicit request of a year-old patient who suffered unbearably of a combination of deteriorating eyesight, hearing and speech, as well as being bedridden and experiencing general deterioration and loss of dignity.
The physician was acquitted from prosecution. The Royal Dutch Medical Association also undertook important steps towards formal societal control of euthanasia in the Netherlands in the s. It took an official affirmative position regarding the legalization of euthanasia, and called for the elimination of barriers for physicians who intended to report their life-ending acts. It emphasized that only physicians should be allowed to perform euthanasia and that euthanasia can only take place within a physician-patient relationship.
The Royal Dutch Medical Association further tried to improve formal societal control of euthanasia through encouraging physicians to report their cases.
In this way the medical professionals, through their professional organization, influenced the development of the due care criteria. After the start of the debate on euthanasia, some physicians were willing to report euthanasia cases and thus be held accountable. However, until the mids only a very small number of cases were reported. In , the Ministry of Justice—together with the Royal Dutch Medical Association—agreed to proclaim a formal and uniform notification procedure, aiming at transparency, accountability, and harmonizing regional prosecution policies.
Physicians who had complied with the criteria for due care for euthanasia would not be prosecuted. Examples are physicians treated as a murder-suspect, policemen interrogating relatives shortly after a patient died of euthanasia, or doctors who were taken for questioning from their surgeries, in front of patients, but subsequently found to have done nothing wrong.
This notification procedure entailed that the physician performing euthanasia informed the local medical examiner about his or her act through filling in an extensive questionnaire. Subsequently, the medical examiner informed the public prosecutor, who decided whether the physician had adhered to the criteria for due care or should be prosecuted. As a next step, in , a national reporting procedure was developed through establishing multidisciplinary review committees, consisting of a lawyer, a physician, and an ethicist.
These committees judged the reported cases and advised the public prosecutor about whether or not the criteria for due care had been fulfilled. The reporting procedure was endorsed by many physicians, and the review committees only rarely found serious violations of the requirements. On April 1st, , the Euthanasia Act came into effect to regulate the ending of life by a physician at the request of a patient who was suffering unbearably without hope of relief.
The criteria for due care, originally formulated by the State Commission, had been further developed, partly through case law de Haan They require a physician to assess that:.
The Act officially legalized euthanasia, but in effect it mainly legalized an existing practice. The only major change was that, under the Act, the review committees needed to forward to the public prosecutor only those cases in which the criteria for due care criteria were not met.
In the period —, the review committees gave the verdict of non-compliance in 15 cases on a total of 5, reported cases. None of the involved physicians was eventually prosecuted Onwuteaka-Philipsen et al. Most physicians think that the Act has improved their legal certainty and contributes to the care with which euthanasia and physician-assisted suicide are practiced Onwuteaka-Philipsen et al.
The legalization of euthanasia is often considered to be the result of three changes in society: The fact that these changes occurred in many Western countries but led to legislation in only a few makes clear that some other elements of the Dutch culture and healthcare system played a significant role in the process of legalization of euthanasia. First of all, the Dutch health care system has several important attributes that shaped a context of safeguards in which the legalization of euthanasia could take place.
Social policies in the Netherlands have given broad support for equity in sharing financial burdens Griffiths et al. As a result, virtually everyone is covered by health insurance and healthcare is freely accessible and affordable to all. Also, the general structure of the Dutch health care system is unique. The Dutch general practitioner is the pivot of primary care in the Netherlands: Almost all inhabitants in the Netherlands have a general practitioner with whom they often have a longstanding and personal relationship Janssens and ten Have This might enable a general practitioner to judge whether a patient fulfills the first three, patient-related criteria of due care for euthanasia.
Second, the Netherlands has a history in which candor is highly valued Kennedy and the Netherlands on the whole can be considered a climate in which new views and ideas are generally welcomed and openly discussed, as was the case for euthanasia.
Further, in political culture, there is a general conviction that it is better to guide social developments than to try to stop them Griffiths et al. A unique feature of the process of legalizing euthanasia in the Netherlands was the position of systematic empirical research. In , along with the establishment of the notification procedure, the government decided that further legislation of euthanasia should await the findings of a commission appointed to conduct research on the frequency and characteristics of euthanasia, physician-assisted suicide and other medical end-of-life decisions in the Netherlands.
This commission, known as the Remmelink Commission, appointed a research-group supervised by Professor Paul van der Maas. To enhance the cooperation of physicians, the information that was collected from physicians could not be claimed from the researchers by the public prosecutor in case of legal prosecution.
Nationwide frequencies and characteristics of end-of-life decisions were studied through death certificates studies in van der Maas et al. Stratified samples of deaths cases were drawn from the central death registry of Statistics Netherlands, where all deaths in the Netherlands are reported. All physicians attending a death case—unless the cause of death precluded an end-of-life decision such as a car accident resulting in instant death —received a written questionnaire, accompanied by a recommendation letter of the Chief Inspector for Health care and the president of the Royal Dutch medical Association.
The anonymity of physicians and patients was guaranteed. These measurements resulted in high response rates: Such decisions can be characterized by several aspects: When at least one of the questions a were answered with yes , the case was classified as a non-treatment decision. When at least one of the questions b was answered with yes , the case was classified as the alleviation of symptoms with a possible life-shortening effect. When question c was answered with yes , the case was classified as euthanasia when the drug was administered by the physician at the explicit request of the patient, and as physician-assisted suicide when the patient had taken the drug him- or herself.
In the remaining cases where question c was answered with yes , but without explicit patient request, the case was classified as ending of life without an explicit request. For cases in which more than one question had been answered affirmatively, the decision with the most explicit intention prevailed over other decisions, whereas in cases of similar intentions question c prevailed over b and b over a.
In each study, the key questions were followed by questions about the decision-making process, the type of drugs that had been used, and the degree to which death had been hastened, according to the physician.
Numbers of reported cases of euthanasia of physician-assisted suicide were obtained from the Public Prosecutors , or the regional review committees , This trend reversed in , when 1. The number of euthanasia requests also decreased in this period: Despite recommendations from the Royal Dutch Medical Association that physician-assisted suicide should be preferred over euthanasia, physician-assisted suicide had a much lower frequency than euthanasia in each study; in this occurred in 0.
Possible explanations for the frequent choice of euthanasia over physician-assisted suicide are that physicians want to control the act of ending life and to have medical assistance available in case of unforeseen difficulties, which are more likely to occur when patients take the drugs orally themselves Groenewoud et al. Euthanasia is also often preferred when patients are physically too weak to take the drugs themselves.
Frequency of euthanasia and other end-of-life practices in the Netherlands, in , , and Forgoing of potentially life prolonging treatments either withholding or withdrawing and intensified alleviation of symptoms occurred much more often than active ending of life. In the study, it could be established that the major reason for not reporting was that the physician did not regard the course of action as euthanasia or physician-assisted suicide and therefore did not see the necessity to legally report the case Onwuteaka-Philipsen et al.
This was strongly related to the kind of drugs used. The rates in and were comparable to those of The highest rates of the use of euthanasia were found in cancer patients: This explains partly the higher frequency of euthanasia and physician-assisted suicide among younger patients. Furthermore, compared to clinical specialists and nursing home physicians, general practitioners performed euthanasia or physician-assisted suicide in a higher proportion of deaths.
This can be explained by the fact that euthanasia is usually performed in the context of a longstanding patient-physician relationship, which is typical for the type of contact that general practitioners have with their patients. Euthanasia and physician-assisted suicide in different patient groups in and This indicates that euthanasia is usually performed in an open atmosphere.
The rates from and were comparable. Thus, there seems to be a tendency to use the recommended drugs when performing euthanasia or physician-assisted suicide, which is probably due to increased knowledge of physicians of how to perform euthanasia. Discussion and use of drugs for euthanasia and physician-assisted suicide in and The death certificate study of was simultaneously and with the same questionnaire performed in five other European countries: These countries have a rather comparable epidemiology of diseases and quality of health care.
They differ, however, in the legal regulations regarding euthanasia and physician-assisted suicide. Both practices are prohibited in Sweden, Denmark and Italy. In Switzerland, physician-assisted suicide is allowed if it is done without any self-interest, for physicians and other citizens, while euthanasia is forbidden. Interestingly, until recently in Switzerland, physicians could not provide physician-assisted suicide because being paid for their services could be seen as self-interest. Euthanasia was also prohibited in Belgium at the time of the study, but a new law that allowed euthanasia under comparable circumstances as in the Netherlands had already been discussed in the Parliament Adams and Nys This was the first time that end-of-life decisions were studied in these countries, except for Belgium where in a similar study had been performed Deliens et al.
The response percentages were satisfactory: In all countries, physicians reported to have used drugs with the explicit intention to hasten the death of a patient euthanasia, physician-assisted suicide, or ending of life without an explicit patient request. Ending of life without a patient request occurred more often than euthanasia and physician-assisted suicide in all countries apart from the Netherlands. Frequency of euthanasia and other end-of-life decisions in the Netherlands, Belgium, Denmark, Italy, Sweden, and Switzerland in The proportion of non-treatment decisions also differed substantially between countries: Alleviation of pain and symptoms while taking into account or appreciating hastening of death as a possible side-effect happened more frequently and in comparable rates in all countries: These rates show that end-of-life decision-making with a possible or certain life-shortening effect is practiced everywhere in the studied West-European countries.
End-of-life decisions that are mainly a medical response to the suffering of patients, such as alleviation of pain and symptoms, are performed in rather similar frequencies. However, the frequency of end-of-life decisions that are to a large extent determined by cultural factors—such as euthanasia, physician-assisted suicide and non-treatment decisions—varies much more between the countries.
Another striking finding of this study was that in countries where patients and relatives are more often involved in the decision-making at the end of life, the frequency of end-of-life decisions was higher, for example in the Netherlands. Many terminally ill patients who are facing death are offered interventions that may prolong their lives but at the same time may diminish their quality of life, such as cardiopulmonary resuscitation, mechanical ventilation or nasal-gastric feeding tubes.
Discussion between patient, relatives and professional caregivers about whether or not to use such interventions may result in the recognition that quality of life is sometimes to be preferred over prolonging life at all costs. While initially we thought that the high response rates of the Dutch studies could probably be explained by the Dutch tradition of openness about the subject, our European study showed that quite large proportions of physicians in other countries were also willing to share their experiences.
Second, our research shows that end-of-life decision-making is a significant aspect of end-of-life care. In approximately 4 out of every 10 patients, death is preceded by a decision that possibly or certainly hastened their dying process. Rather, it is also aimed at improving the quality of life of patients through the prevention and relief of their symptoms, sometimes to the extent that far-reaching decisions such as euthanasia are requested by the patient.
Third, public control and transparency of the practice of euthanasia is to a large extent possible, at least in the Netherlands. The review and notification procedure has increasingly been accepted by physicians, which shows their trust in the system. A last important lesson that can be learnt is that the legalization of euthanasia in the Netherlands did not result in a slippery slope for medical end-of-life practices. Besides religious or principal-based arguments, the slippery slope argument is the mainstay of opponents of the legalization of euthanasia.
Briefly, the argument states that: B is morally not acceptable; therefore, we must not allow A Griffiths et al. Our studies show no evidence of a slippery slope. The frequency of ending of life without explicit patient request did not increase over the studied years. Also, there is no evidence for a higher frequency of euthanasia among the elderly, people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations Battin et al.
Some of the criteria for due care for euthanasia are formulated as open general concepts, because they have to be interpreted taking into account the specific circumstances of every new case. The best example of such an open concept is the condition that the patient should suffer unbearably. In the Chabot-case , the Court decided that suffering that has a non-somatic origin such as a severe and refractory depression can also be a justification for euthanasia; in the Brongersma-case this was further specified in the sense that suffering should originate from a medically classifiable disease, either somatic or psychiatric Griffiths et al.
Euthanasia is most often performed in cases of severe suffering due to physical disease and symptoms and severe function loss, for patients with a limited life expectancy Onwuteaka-Philipsen et al. In such cases there is usually little discussion about whether or not the suffering was unbearable. A previous study showed that a quarter of physicians who receive euthanasia requests find it problematic to assess the criteria of due care Buiting et al.
Problems are mostly related to the assessment of whether the patient suffered unbearably. To assess unbearability, physicians have to know how their patients experience the suffering, and there is no specific instrument to do so. What can be objectively determined is the underlying disease and the accompanying symptoms and loss of function. Hence, what is still bearable for one person may be unbearable for another.
Some claim this makes the unbearability of suffering something a physician can hardly assess and which should mainly be left to the judgment of the patient Beijk ; Buiting et al. Yet, the review committees argue that suffering should be at least partly open to objectification Regional Euthanasia Review Committees Consequently, it is likely that physicians may have different opinions about which suffering can count as a legitimate ground for euthanasia.
On the one hand, different opinions about when suffering becomes unbearable could be interpreted as problematic.
Jul 28, · Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the.
Involuntary euthanasia occurs without the consent of the individual, either because the patient is incompetent, because the patient’s wishes are not known, or because it is a policy to end the life of a person with certain traits (e.g., Nazi euthanasia policies).
Research on Euthanasia / Assisted Suicide A study published in the Canadian Medical Association Journal found that 32% of all euthanasia deaths in the Flanders region of . Euthanasia is a unique practice of ending the life of an individual suffering from a terminal disease/illness or an incurable condition by means of the.
Such unnatural extension of a person’s anguish has lead to an increasing number of euthanasia supports, who view the practice of euthanasia as ways and means to a peaceful, dignified, humane and self determined death. Euthanasia Research Paper: Writing Tips. Writing your euthanasia research paper would be more difficult for you than a simple essay. Nevertheless, if you know the structure and know what to do in each part of your research, nothing is impossible!