Five years ago, 1 April 2002, the Netherlands introduced a new law on euthanasia, becoming the first country in the world to legalise the practice within strict boundaries. Now, five years later, the law seems to have brought some clarity for both doctor and patient, although there are still weaknesses in the legislation.

For the US broadcaster CNN - it was breaking news - when the Upper House of the Dutch Parliament voted to rubber stamp the Lower House's law "to allow the ending of a life on request and assisted suicide" as the law officially states. The measures brought an end to a 25 year debate in this country about the legalising of euthanasia.

"I don't think that the law will have much changed the daily routine of death," says Bert Keizer, a doctor who specialises in care for the dying and long-term sick:

"But I think it has given doctors some peace of mind. Not that euthanasia is ever easy, but with procedures in place, doctors and patients have more idea where they are."

No law
The existence of the law doesn't mean that a patient has the right to euthanasia. A doctor can refused it. Dr Keizer believes it's right that no medical professional is obliged to carry out the procedure.

"Every doctor has a healthy problem with euthanasia. It is an unattractive part of medicine."

According to the rules, a doctor with a conscientious objection to ending the life of a patient must refer to another doctor.

"But I don't believe that happens in practice. At least no colleague of mind has ever rung me with a request to take over the treatment of a patient who's asked for euthanasia. Even so, patients themselves can choose a different doctor."

And that, according to Keizer, is also part of the law:

"A patient knows now that he can ask for euthanasia. There are rules laid down about that in the Netherlands. And that gives clarity and therefore some peace of mind."

Weakness
Professor of medical ethics, Evert van Leeuwen, believes there's a weakness in the Dutch system on euthanasia. He's been a member of the euthanasia commission and he thinks the system stands or falls with the voluntary reporting of euthanasia by doctors.

"It is actually odd that a doctor firstly helps someone to die and afterwards sends on case notes to a commission which subsequently decides whether the doctor will be pursued for causing a death or murder!", says Van Leeuwen.

Even so he still has the feeling that most euthanasia cases in the Netherlands have been faithfully reported although he's not so naive to think that there are doctors who don't do that.

"And there is that sticking point which is a hole in the procedure."

So should that be changed? Van Leeuwen isn't sure how it can be:

"We have tried to work out the best possible procedure. You can expect that Dutch doctors will behave responsibly. So it's a matter of investigating those cases that have gone wrong. But despite this weakness, it is still better to have this law, than nothing at all."

Pressure
With the introduction of this law in the Netherlands, many people, particularly abroad, felt that in the future, seriously ill elderly people would come under pressure to end their lives. Dr Bert Keizer thinks these fears are unfounded:

Yes, sorry. People who ask for euthanasia are not put under pressure, they are under the burden of suffering."

In any case, he's never experienced it:

"Financially, it's also not a problem. You can get everything as a patient here. So you don't need to ask for euthanasia because you can't pay for an operation. I won't say that this sort of situation doesn't ever occur in the world, but up to now not in our country!"

Pain Control
Doctors in foreign countries tend to rely more on pain control, also known as palliative care, than their Dutch colleagues. This is also a common criticism levelled at Dutch healthcare: more emphasis on pain control is thought to lead to fewer requests for euthanasia. Doctor Keizer says there could be some truth to that theory.

“If you watch someone die in agony, you are most likely going to say to yourself: not me! If you are going to your own death haunted by such a spectre, you are sure to ask for a speedy end.”

But the reverse could also be true: could improved palliative become a form of euthanasia in disguise? Professor Van Leeuwen says palliative care is used this way in some countries. “So I would not go so far as to deny that this is not also - illegally - happening in the Netherlands.” Even though as an ethicist Professor Van Leeuwen hopes doctors will not make that choice.

“It is not right, let's put it that way. Palliative sedation is standard medical treatment, whereas euthanasia is not, taking place only at a patient's explicit request. That distinction should be carefully maintained. When a patient requests euthanasia, their request should be treated as such. On top of which many doctors asked for the introduction of this euthanasia law as long as 25 years ago.”

RNW translation (cc)