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| Article - Abstract. To view full article click on the article title. | |
eMJA: Hendin, Euthanasia consultants or facilitators? Euthanasia consultants or facilitators? Few euthanasia consultants in the Netherlands act as independent evaluators of the patient's situation MJA 1999; 170: 351-352 As the Netherlands alone has long practised legally sanctioned assisted suicide and euthanasia, its experience is of great interest to the rest of the world. Of particular significance have been the Dutch government-sponsored studies conducted by van der Maas and his colleagues in 19901 and 1995.2,3 Those studies relied on data collected from a stratified sample of physicians selected because their practices were likely to involve them in end-of-life decisions. In each of the studies, more than 6000 physicians were surveyed and over 400 were interviewed. Informative data were collected. However, the investigators' analysis of their data has been criticised for emphasising procedural problems in the Dutch system while ignoring more basic substantive flaws, such as whether patients were offered treatment alternatives that might have made euthanasia seem unnecessary.4-6 The same might be said of the article in this issue of the Journal by Onwuteaka-Philipsen et al7, which draws on the individual interviews with physicians conducted in 1995 to discuss the use of consultants, a requirement in the Netherlands in intended cases of assisted suicide and euthanasia. The purpose of consultation is to confirm that the attending physician has followed established guidelines regarding the voluntary, well-considered nature of the patient's decision, the presence of suffering that must be unbearable and hopeless, and the absence of any alternative treatment. In a substantial number of cases, however, a consultation is not obtained. Most of these cases involve violation of another Dutch guideline: although all cases of assisted suicide and euthanasia must be reported to the authorities, most (59%) are not.2 Only a minority of unreported cases involve consultants.3 In the most flagrant violation of Dutch guidelines, consultants are not called: between 900 and 1000 patients' lives are ended without their explicit consent each year.1,2 In the 1995 study, 21% of these patients were competent; in the 1990 study, 37% were competent. Full Article: http://www.mja.com.au/public/issues/apr19/hendin/hendin.html |
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