Euthanasia and Law in the Netherlands
Distributed for Amsterdam University Press
382 pages
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6-1/4 x 9-1/2
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© 1998
The Netherlands is the only country in the world in which euthanasia, under narrow-defined circumstances, is legally permissible. Considerable attention has been paid over a number of years to the problem of regulating it and information has been systematically collected concerning actual practice. Therefore the Dutch experience is of interest not only to the Dutch, but to anyone who is considering wether or not to make euthanasia a legal practice. This book is written for a reader without specific knowledge of law. The central focus of the book is on Dutch law pertaining to euthanansia, but it also considers the moral and legal principles that have played a role in the Dutch debate, the available evidence bearing on actual practice and on the effectiveness of legal control. It ends with some reflections on the problem of the 'slippery slope' and the question whether the Dutch experience is 'exportable'. It includes translations of the relevant legislation (including proposed reforms) and of three leading cases.
Contents
Extended Table of Contents
List of Figures and Tables
Acknoledgements
Glossary
Prologue: The Neterlands and the Dutch
Chapter 1: Introduction
1.1 What this book is about and for whom it is intended
1.2 The definition of 'euthanasi' and of other 'medical behavior that shortens life' (MBSL)
1.3 A sketch of the current legal situation
1.4 Criticisms from abroad and the Dutch reaction
Intermezzo: The Dutch health-care system and the care of the terminally ill
A. The Dutch health-care system
B. Institutions for health care and care of the elderly
C. Health-care professionals
Chapter 2: Legal Change 1945-1997
2.1 1945-1970: How room for public debate became available
2.2 1970-1982: The early stages of public debate
2.3 1982-1986: The breakthrough
2.3.1 The justification of necessity and the 'requirements of careful practice'
2.3.2 The definition of euthanasia and initial proposals for legislation
2.4 1986-1997: Efforts to codify emerging practice in legislation; broadening the subject of debate
2.5 Concluding remarks on the process of legal change
Chapter 3: The Current Legal Situation
3.1 A summary of current law concerning medical behavior that shortens life
3.1.1 'Normal medical practice', the 'medical exception' and a 'natural death'
3.1.2 The conept 'medical behavior that shortens life' (MBSL)
3.1.3 Euthanasia
3.1.4 Euthanasia versus assistance with suicide
3.2 Reporting procedure
3.3 The CAL and NVK reports: law in statu nascendi
3.3.1 The legitimacy of decisions to shorten life in the absence of a competent request
3.3.2 Severly defective newborn babies (and late abortion)
3.3.3 Coma (PVS patients)
3.3.4 'Help in dying'
3.3.5 Assessment of the approach of the CAL and NVK reports
3.4 The demented elderly
3.5 Euthanasia in the absence of somatic suffering
3.5.1 Persons whose suffering is due to a psychiatric disorder
3.5.2 The legal horizon: assistance with suicide by the non-'sick' and the non-'suffering'
3.6 Conclusion
Chapter 4: The terms of debate since 1982
4.1 Distinguishing euthanasia from other MBSL
4.1.1 Killing versus letting die
4.1.2 Intentionally shortening life
4.2 Conclusion
4.2.1 The principle of autonomy
4.2.2 The principle of beneficence
4.2.3 the principle of the sanctity of life
4.2.4 The slippery-slope argument
4.2.5 Control arguments
4.3 A fundamental difference of opinion?
4.3.1 The nature of a question of legal policy
4.3.2 A quest for common ground
4.3.3 The appeal to tolerance
4.3.4 Respect for life
4.3.5 Conclusion
Chapter 5: What is known about medical practice and its regulation?
5.1 Public opinion concerning euthanasia and other MBSL
5.2 The first national survey: euthanasia by GPs and nursing-home doctors
5.3 Two major national surveys of MBSL
5.3.1 Euthanasia and other MBSL: frequencies, circumstances and characteristics
5.3.2 Termination of life without an explicit request
5.3.3 Severely defective newborn babies (and late abortion)
5.3.4 Psychiatric patients and patients with a psychiatric disorder
5.3.5 The control system and its operation in practice
5.4 Other recent research
5.4.1 Communication between doctor and patient
5.4.2 The euthanasia policy of hospitals and nursing homes
5.4.3 The role of pharmacists
5.4.4 Institutionalized, mentally handicapped patients
5.5 Summary and conclusions
Chapter 6: Euthanasia and other medical behavior that shortens life as a problem of regulation
6.1 Criteria for a control system
6.1.1 What are the objectives of legal control?
6.1.2 What should we expect of a regulatory regime?
6.2 Criminal law is the problem, not the solution
6.2.1 The regulatory situation recapitulated
6.2.2 The intrinsic unsuitability of criminal law
6.2.3 The impossibility of enforcing criminal prohibitions
6.2.4 Control in the context of criminal enforcement offers the doctor insufficient legal security
6.2.5 Can tinkering with the reporting procedure improve the effectiveness of criminal enforcement?
6.2.6 Would 'legalizing' euthanasia help?
6.3 Decriminalization and the prospects of non-criminal enforcement
6.3.1 Legalization, decriminalization, and the 'medical exception'
6.3.2 A system of decriminalized enforcement
6.3.3 A uniform regulatory regime for all MBSL?
6.4 Conclusion
Chapter 7: Two reflections on the significance of the Dutch experience
7.1 Whither leads the slippery slope?
7.2 Is euthanasia law exportable?
Appendix I: Some relevant legal documents
A. Articles 40, 228(1), 255, 287, 289, 293, 294, and 307 of the Criminal Code
B. The amendment to the Law on the Disposal of Corpses and the Order in Council pursuant to the law
C. Some legislative proposals
1. The proposal of the State Commission on Euthanasia (1985)
2. The proposal of Wessel-Tuinstra (1984-1986)
3. The proposal of the Dutch Association for Voluntary Euthanasia (1996)
Appedix II: Three leading cases
1. Schoonheim (Supreme Court 1984)
2. Chabot (Supreme Court 1994)
3. Kadijk (Court of Appeals, Leeuwarden, 1996)
Literature
Index
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