Active euthanasia in the Netherlands

Article Abstract:

Euthanasia, or mercy killing, is the act of willfully ending life in individuals with an incurable disease. As in most countries, euthanasia is a criminal offense in the Netherlands. However, a 1973 court case resulted in allowing physicians to practice euthanasia under certain strict conditions. The four most important criteria have been: one, incurable illness; two, unbearable suffering; three, the request be initiated by the patient; and four, the patient's physician perform euthanasia. Despite the fact that such procedures and policies define how physicians and health care providers can practice active euthanasia, there is continuing debate among health care professionals and the general public over the status of active euthanasia. In the defense of euthanasia cases prosecuted between 1973 and 1983 two essential conditions were that the patients freely request euthanasia and that the patients experience their condition as unbearable. Some courts have required that the patient's physician consult a colleague. In 1984 the Supreme Court referred a case to the court of appeal in The Hague which ultimately acquitted a physician who had practiced active euthanasia. Subsequently legislation to legalize euthanasia was proposed. The Royal Dutch Medical Association and the government-appointed State Commission on Euthanasia have proposed changes to the current law which states that active euthanasia is punishable by up to 12 years in prison. The University Hospital of Utrecht has prepared two documents, one dealing with the deliberation and the other dealing with the administration of euthanasia. These recommendations are described. The director of health care services in the city of Amsterdam, the district attorney and inspector of public health also developed a policy which addresses the administration of euthanasia and the physician's liability. This policy is outlined.

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Health insurance values and implementation in the Netherlands and the Federal Republic of Germany: an alternative path to universal coverage

Article Abstract:

Although the Canadian health care system is often proposed as a model for health care reform in the United States, other models should also be considered. In the Netherlands and in Germany, for example, health care ''rights'' are less an issue than ''obligations'' that bind the participants. The first obligation is that of physicians, hospitals and other providers to provide necessary, but not unlimited, medical care for all patients, regardless of their ability to pay. Patients are obligated to pay for the care they receive, through an obligation to purchase insurance, which employers are obligated to help their employees obtain. Medical care providers are obligated to accept insurance fees, and insurers are obligated to accept all low- and moderate-income applicants. In the Netherlands, individuals must purchase insurance through regional funds from which no eligible person can be excluded. The Exceptional Medical Expenses Act covers long-term care, maternal aid and child health services, as well as care of physical and mental retardation for all, thereby excluding these expensive coverages from the private insurance system. It is funded by the government, employers and contributions from the self-employed. Patients choose their primary care physician, who recommends hospital-based specialists when necessary. Specialists only care for patients during the acute phase of the illness. The German system is based on the same values as the Dutch system, but there is a greater variety of funds and a higher income cutoff point for obligatory membership. These models may be closer to US values than the Canadian, British, and Swedish systems. Four specific lessons for future policy are discussed, and a model of a health system based on American values is proposed. (Consumer Summary produced by Reliance Medical Information, Inc.)

United States, Germany, National health insurance

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Physician-assisted suicide and euthanasia in the Netherlands: lessons from the Dutch

Article Abstract:

The legalization of euthanasia and physician-assisted suicide in the Netherlands appears to have led to some abuses. Surveys of Dutch physicians in 1990 and 1995 show that many of the guidelines set up to protect patients have been ignored or modified. About 60% of physicians did not report their activities as required by law and more than half began suggesting euthanasia to patients who were not necessarily terminally ill. About one-fourth did not have the patient's consent when planning euthanasia even though many of the patients were competent to make such a decision.

Assisted suicide

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