News
26-04-2010

No increase in demand for euthanasia after implementation of the Dutch Euthanasia Act

The Netherlands was the first country in the world to implement a Euthanasia Act in 2002. Research comparing the requests for euthanasia in Dutch general practices before and after implementation of the Euthanasia Act did not show an increase. The Act provides a framework for developing professional guidelines enhancing compliance to the criteria allowing euthanasia. As reported by NIVEL researchers in the British Journal of General Practice.
 


The Netherlands is well known in many countries as the first country worldwide to implement a Euthanasia Act. The number of reported euthanasia procedures has slightly increased. But the number of requests for euthanasia in Dutch general practice did not increase since the implementation of the Euthanasia Act in 2002. This was shown in a study comparing the number of and reasons for requests for euthanasia carried out in the 45 Dutch sentinel practices by NIVEL, the Netherlands Institute for Health Services Research. “The increase in reported euthanasia procedures does not mean that euthanasia is executed more frequently,” explains family physician and epidemiologist at NIVEL Gé Donker, project leader of the Dutch sentinel stations. “It means that euthanasia is reported relatively more frequently, enhancing transparency and quality of care. The use of appropriate procedures, drugs and dosages can be monitored more adequately since the implementation of the Euthanasia Act.”

Strictly defined criteria
The reasons for requests of euthanasia shifted slightly, with a decrease in ‘loss of dignity’ as a reason for requesting euthanasia, especially in women. The Act has not resulted in the often feared slippery slope as legislation has been embedded in extensive procedures meeting strictly defined criteria for careful practice as explained by Gé Donker. “Physicians adhere to the strict criteria defined in the Dutch Euthanasia Act. Adequate legislation provides a framework for developing professional guidelines enhancing compliance to the criteria allowing euthanasia. These guidelines may be implemented in GP training, postgraduate training and institutional policy. Hospitals and nursing homes may clarify the institutional attitude concerning euthanasia requests at their website. The Euthanasia Act enhances transparency.”

Optimal care
Gé Donker is a practicing family physician: “No physician executes euthanasia easily. It remains a difficult and emotional procedure. The choice to be a medical professional is founded by the intention to provide optimal care and euthanasia may be an option to optimize care for patients with endless and unbearable suffering requesting for euthanasia. A physician responds to a request for euthanasia from these patients for empathic reasons.”

CMR Sentinel Stations
The Continuous Morbidity Registration (CMR) Sentinel Stations of NIVEL constitutes of 61 Dutch GPs in 45 practices. The patient population covers 0.8% of the Dutch population and is nationally representative by age, gender, geographic distribution and population density. The GPs report weekly (to enhance rapid discovery of trends) or annually about the incidence of diseases, events and interventions in general practice in addition to other general practice networks. The CMR-sentinel network exists since 1970. Most subjects are surveyed for several consecutive years.