[Right_to_die] No big slippery slope in the Netherlands, study finds
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org.opn.lists.right-to-die at lists.opn.org
Wed May 9 21:43:18 PDT 2007
CBC news in Canada reported:
Dutch Euthanasia Rates Steady After Legalization
Published: Wednesday, May 9, 2007
Canadian Press: AMANDA GARDNER, HEALTHDAY REPORTER
(HealthDay News) - Since euthanasia and physician-assisted suicide were
legalized by the Dutch in 2002, use of the practices has dropped
slightly and now has stabilized, a new report finds.
That marks an abrupt turnaround from trends during the last 10 years,
say the authors of a study in the May 10 New England Journal of Medicine.
In the United States, physician-assisted suicide is legal only in the
state of Oregon, while euthanasia is not legal in any state.
"One lesson is there's not a big slippery slope in this area, that the
practice will be used relatively infrequently and that it's generally a
good thing to have an open conversation," said Dr. Timothy Quill,
director of the Center for Ethics, Humanities and Palliative Care at the
University of Rochester Medical Center in Rochester, N.Y. He also wrote
a related perspective article in the journal.
Dr. Nancy W. Dickey, president of the Texas A&M Health Science
Center and vice chancellor for health affairs for the Texas A&M
System, agreed. "Neither Oregon nor the Netherlands appear to have
started down a slippery slope," she said. "Also, physicians have become
better equipped to offer a wide variety of palliative care, leading them
to become more effective at it and very rarely having to resort to
assisted death," she said.
In the Netherlands, euthanasia is defined as death resulting from
medication administered by a physician with the intention of hastening
death at the request of the patient. In assisted suicide, the patient
hastens death by giving him or herself medication prescribed by a
Although neither procedure was legal in the Netherlands in the early
1990s, physicians were generally not prosecuted if they had adhered to
"The passing of the law was a formalization of a practice that the
Netherlands freely admitted occurred on a less-than-rare basis," Dickey
In 1990, the reporting rate for euthanasia and physician-assisted
suicide was 18 percent. An official reporting procedure was established
in 1993, after which the reporting rate climbed to almost 41 percent.
"An important goal of the euthanasia law in the Netherlands is to
achieve public control of this practice," said study co-author Bregje
Onwuteaka-Philipsen, associate professor at the VU University Medical
Center in Amsterdam, EMGO Institute/Department of Public and
Occupational Health. "The increase in the reporting of euthanasia and
physician-assisted suicide to the review committees, from 18 percent in
1990, through 41 percent in 1995 and 54 percent in 2001 to 80 percent in
2005, shows that that goal of the law is met."
According to Onwuteaka-Philipsen, approximately 8,400 people per year
explicitly request euthanasia or physician-assisted suicide, at which
point physicians must determine whether or not to grant the request
according to legal criteria. This results in approximately 2,300 cases
of euthanasia and 100 cases of physician-assisted suicide per year
which, together, make up 1.8 percent of all deaths in the Netherlands.
For this study, researchers mailed questionnaires to doctors who had
attended 6,860 deaths. More than three-quarters (77.8 percent) of
In 2005, 1.7 percent of all deaths in the Netherlands were the result of
euthanasia and 0.1 percent were the result of physician-assisted
suicide. This a substantial decrease from 2001, when 2.6 percent of all
deaths resulted from euthanasia and 0.2 percent from assisted suicide.
"The euthanasia law did not coincide with an increase of the practice,"
In 2005, 0.4 percent of all deaths were the result of the ending of life
without an explicit request by the patient.
In 7.1 percent of all deaths in 2005, continuous deep sedation was used
in conjunction with a possible hastening of death. This was an increase
from 5.6 percent in 2001.
Why the decrease in overall euthanasia and physician-assisted suicide?
"We have three likely explanations," Onwuteaka-Philipsen said. "The
first one is a demographic one. The percentages of deaths of people of
80 years and older was higher in 2005 than in 2001. Since euthanasia and
assisted suicide relatively infrequently occur in this age group, this
explains a small part of the decrease."
Other explanations include improvement in palliative care as well as
changing opinions and knowledge as to the effects of opioids.
"There has been increasing evidence that the potentially life-shortening
effects of opioids are often overestimated, making physicians less
inclined to attribute life-shortening effects to opioids,"
According to the perspective piece, the palliative care movement has
grown similarly robust in the United States, albeit with some disparities.
"Clearly, we're moving in a direction of widespread acceptance and
growth of palliative care as the standard of care for people who are
dying," Quill said. "In the last 10 years, there is a wider acceptance,
but there's still going to be some tough cases, and we will have to
figure out ways to respond to those cases."
And disparities remain, Dickey added.
"We have made substantial progress 1/8in end-of-life care 3/8, but we
probably do not pay it enough attention in this country," she said. "One
of the most troubling statements in the perspective paper was that this
is still largely limited to people who are white, relatively educated,
insured and enrolled in hospice. I can think of few disparities that are
more troubling to my soul than the thought that we give
less-than-satisfactory end-of-life care to the poor, to the less
well-educated, to the newest immigrants. We're not there yet."
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