Published online by Cambridge University Press: 02 June 2020
This paper explores the common argument proposed by opponents of the legalization of euthanasia that permitting ending a patient’s life at their request will lead to the eventual legalization of terminating life without request. The author’s examination of data does not support the conclusion that a causal connection exists between legalizing ending of life on request and an increase in the number of cases without request.
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12. See note 7, Deliëns et al. 2000, at 22–4 (chapter on methodology); 207–8 (chapter on sedation). The report doesn’t contain the full questionnaire that has been used, as the Dutch reports do. See also, Mortier, F, Deliëns, L, Bilsen, J, et al. End-of-life decisions of physicians in the city of Hasselt (Flanders, Belgium). Bioethics 2000;14:254–67CrossRefGoogle Scholar.
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15. Even in cases in which the patient had requested the doctor to end his life, by using benzodiazepines and/or morphine, a Dutch doctor would violate one of the requirements of due care of the euthanasia law. A Belgian doctor would only act contrary to a professional rule.
16. Donald van Tol has observed that it is precisely the lack of certainty about the consequences of their actions that makes doctors sometimes prefer the use of morphine to regular euthanatics. It enables them to harbor the somewhat contradictory thoughts: Yes, I am helping this suffering patient, I am not leaving him to his fate, but, no, I am not killing him ‘at the needle,’ I do what doctors always do in such cases. van Tol D. Grensgeschillen: Een rechtssociologisch onderzoek naar het classificeren van euthanasie en ander medisch handelen rond het levenseinde. PhD dissertation, University of Groningen 2005:208.
17. It should be noted that there is a large body of philosophical literature suggesting that the distinction between effects intended as an end or as a means, and merely foreseen side-effects, is fundamentally indeterminate.
18. In 1995, interviews were held with a number of physicians who had first completed a questionnaire. 6 of the 46 physicians on that occasion who had reported an “explicit intention to hasten death” rejected the correctness of that description during those interviews. Van der Wal G, van der Maas PJ. Euthanasie en andere medische beslissingen rond het levenseinde. Den Haag: SDU; 1996:303.
19. The hypothesis that doctors classify their end-of-life decisions mainly for strategic reasons has been discredited. Their classification is determined by the drugs they use, not by their intention. Griffiths J, Weyers H, Adams M. Euthanasia and Law in Europe. Oxford: Hart Publishing; 2008:200–4, referring to research by Van Tol (see Van Tol 2005), and Onwuteaka-Philipsen B, Gevers JKM, van der Heide A. Evaluatie Wet toetsing levensbeëindiging op verzoek en hulp bij zelfdoding. Den Haag: ZonMw; 2007:122–4.
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28. Cf. the decision of the medical board Zwolle in the Vencken-case, 10 Mar 2005, Medisch Contact 2005:499-501; and the Belgian decision in KI Gent, 9 Dec 2004, T. Gez. /Revue de Droit de la Santé 2007:39, with comment by E. Delbeke.
29. See note 2, Keown 2002, at 100.
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31. The points made in sub-sections three and four also apply to termination of life on the patient’s request. As a result, the figures given about the actual number of euthanasia cases in all Dutch and Flemish surveys since 1992 are incorrect, see Den Hartogh, G.The regulation of euthanasia: How successful is the Dutch system? In: Youngner, SJ, Kimsma, GK, eds. Physician-Assisted Death in Perspective: Assessing the Dutch Experience. Cambridge: Cambridge University Press; 2012:351–91CrossRefGoogle Scholar. The reporting rate of euthanasia cases as calculated by these reports relies on these incorrect figures, as do some of the criticisms standardly made about the Belgian practice, e.g., about the involvement of nurses and the consultation of colleagues who cannot be considered sufficiently independent. These supposed violations of the requirements of due care may largely occur in cases that the doctors involved rightly do not classify as cases of euthanasia at all.
