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Essay: Euthanasia in the Netherlands: Examining Historical and Legal Changes

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 Dutch History, Politics and Culture

Dr. Hans SLOMP

 Euthanasia in the Netherlands

 Emel KALEM- 4726286

TABLE OF CONTENTS

1. Introduction …………………………………………………

2. Historical Background……………………………………………

3. Legal Change…………………………………………………….

4. Health- Care Systems in the Netherlands……………….

4.1. Approaches of Institutions against Euthanasia……

5. Conclusion ……………………………………………………………….

1. Introduction

 From past to present the concept of ‘euthanasia’ has carried different meanings depending on a usage. The word “euthanasia” was first used in a medical context by Francis Bacon in the 17th century, to refer to an easy, painless, happy death, during which it was a “physician’s responsibility to alleviate the ‘physical sufferings’ of the body.”  Currently, when we look at the dictionary meaning  the term is defined as the act of killing someone who is very ill or very old so that they do not suffer any more.   Except for these definitions, ‘euthanasia’ in the strict- and in the Dutch context the only proper- sense refers to the situation in which a doctor kills a person who is suffering ‘unbearably’ and ‘hopelessly’ at the latter’s explicit request ( usually by administering a lethal injection). When a distinction made, then ‘euthanasia’ is in the Netherlands reserved for killing on request as opposed to assistance with suicide (Griffiths, Bood & Weyers, 1998, p.17).  Obviously, it is possible to find different definitions, approaches for this controversial concept.

 This paper’s aim is firstly to examine the historical background, and try to understand why the Netherlands; secondly, looking for the Dutch health care systems and try to understand approaches of the health care institutions against the act of euthanasia; thirdly search for the legal change related to the euthanasia from past to present, and finally, trying to understand legal borders and conditions of this action in the Netherlands.

2. Historical Background

The Netherlands was the first democracy to tolerate euthanasia. If we ask for the significant factors that made the Dutch tradition and culture open to the euthanasia movement, we can find the answer in the Dutch history. Bert Gordjin argues that the Dutch policy is a typical example of a policy of pragmatic tolerance. The historical roots can be traced to the Dutch republic of 17th century, where two dominant and sometimes contradictory societal forces influenced Dutch mentality and policy. The merchants advocated peace and freedom through a policy of tolerance, exemptions and compromises. The Calvinists on the other hand, strove for normative regulation of all human behavior in accordance with their rigid moral standards. These two forces constituted the Dutch Policy of pragmatic tolerance: Certain criminal acts remained unpunished, and certain conditions for immunity from criminal prosecution were formulated in advance and in public by the authorities. Gordjin contends that the practice of tolerance of illegal deeds was normatively regulated and that its influence is significant in the present euthanasia policy (Cohen, 2004, p.57).  Other than that there are different approaches and answers for the question about the significant factors that made the Dutch tradition and culture open to the euthanasia movement. Egbert Schroten and his colleagues give another explanation. They emphasize the developments that took place since the 1960s, arguing that the 1960s and 1970s were a crucial watershed for the Dutch society. From a conservative tradition- bound country, the Netherlands transformed into a society of social and cultural experimentation. The Netherlands took a prominent place in the sexual revolution, the legalization of abortion, the acceptance of soft drugs, the democratization of educational institutions, and the questioning of religious authority. The process of secularization that started in the 1960s gradually undermined the status of traditional institutions. In 1958, 24% of the population had no affiliation,  42% belonged to the Roman Catholic Church, and about 33% were affiliated with the Protestant churches. In the 1990s, the perspective figures were 57% (no affiliation), 22% (Catholic), and a bit more than 10% (Protestant) (Cohen, 2004, p.57). Briefly, it is possible to say that Netherlands found a secular basis for morality. With the help of increasing democracy of the society and the emphasis on the individual control the practice of euthanasia become more open and available. In the mid- 1970s, the Dutch Voluntary Euthanasia Movement was formed. After that the discussion about the act of euthanasia spread into different areas such as media, literature, politics and academia. The Conservatives, Socialist and social liberals all give place to euthanasia in their political platforms. After the long deliberations in the Parliament, there were no concrete steps because all the initiatives were blocked by the ruling party, the Christian Democrats.  In 1983, the Dutch Medical Association set up a committee in order to examine the practice of euthanasia. According to Cohen the Society did not adapt a specific standpoint, but nevertheless said that if physicians practiced euthanasia, they need to follow the jurisprudential Guidelines that Henk Leenen helped to formulate. This was a very important step in the processes, and Leenen perceives those years as the formative years in the euthanasia debate (Cohen, 2004, p.60). After that the social movement which includes physicians, patient’s groups, politicians, lawyers, courts and religious organizations was created.  It is possible to say that Dutch have the history that is full of tolerance. In this country there is an absolute respect for individual autonomy. Especially if the subject is about life or death, decisions should be left in the hands of individuals. And euthanasia is one way of resolving the issue of suffering. Henk Jochemsen says that the social climate in the Netherlands is one in which euthanasia seems a good solution for suffering, and that it is up to the doctor to provide this solution. Bert Keizer explained that Dutvh are relatively stable society; ‘our commonwealth is not under threat’; people are dare to address complicated issues such as euthanasia. The Dutch have the time to focus on such issues (Cohen, 2004, p.61).

3. LEGAL CHANGE

We can examine the legal change about euthanasia in four periods. The first one which is between 1945 and 970, it is not possible to see euthanasia in the public discussion. The second period is between 1970 and 1980 the notion of euthanasia entered the public discussion. The public becomes the aware of the situations that the doctors sometimes give their patients support in the dying process. They are doing that sometimes to cease trying to prolong life or to become a helping hand to death. On those times, the term euthanasia referred to variety of behaviors, and also it stayed legally unclear in the debates. When we come to the third period which covers the years 1982 and 1986 sees a fundamental legal breakthrough on two fronts. In the first place, it becomes clear that only active termination of life at the explicit request of the person concerned constitutes. ‘euthanasia’ in the Dutch sense and that a variety of other sorts of medical behavior that shorten life fall within the scope of ‘normal medical practice’ and are legally unproblematic. In the second place, ‘euthanasia’ itself becomes generally accepted under circumstances carefully defined both by the courts and Medical Association (Griffiths, Bood & Weyers, 1998, p.43-44). And in the fourth period which is between 1986 and 1977, is the consolidation of the legal change and application of the new legal insights to some related problems.

There is a story in the history that brought the euthanasia to the agenda at past. On 11 March 1952, a doctor from Eindhoven stood trial. The reason for the trial is killing her brother who had been suffering from advanced tuberculosis. The sick man before his death strongly urged to his brother to put an end to his misery. And then the doctor finally agreed him.  The doctor gave his brother Codinovo tablets and injected him with morphine. The doctor led to his brother’s death. He told on the District court that’ it was impossible for him, and he could not be expected, to ignıre the claims of his conscience, which compelled him to comply with the explicit wish of his brother.’ The district court found him guilty on killing on request (article 293 of the criminal code) (Griffiths, Bood & Weyers, 1998, p.44). The court decided to sentence the doctor one year probation.  This was the first time that euthanasia has been subject to the ruling of a Dutch judge. This situation did not cause much commotion.

Particular individualistic and secular ideas got into the public agenda on these times, and dying process was not the only topic pitting traditional views against more modern. The starting point was about 1950s. For example sexual morality was the subject of great deal of public discussion. In 1970 legislation was enacted legalizing the free sale of contraceptives, in 1971 the crime of adultery was repealed, and in 1971 we see repealing a restrictive provision on homosexuality. Abortion was also the subject of the extensive public discussion in the same period. And it is possible to say that the debate on the legalization of abortion shows great similarities with the latter debate on euthanasia.

Another story happened in 1973, Ms. Postma who is a doctor had terminated her mother’s life with an injection of morphine. Her mother was a widow of 78, and she had been in a nursing home because he a cerebral hemorrhage had left her paralyzed on one side a few months earlier and she had asked her daughter to end her life several times.  While the doctor was convicted, the court’s judgment set out criteria when a doctor would not be required to keep a patient alive contrary to their will. This set of criteria was formalized in the course of a number of court cases during the 1980s. Termination of Life on Request and Assisted Suicide (Review Procedures) Act took effect on April 1, 2002. It legalizes euthanasia and physician assisted suicide in very specific cases, under very specific circumstances. These circumstances are;

• the patient’s suffering is unbearable with no prospect of improvement

• the patient’s request for euthanasia must be voluntary and persist over time (the request cannot be granted when under the influence of others, psychological illness or drugs)

• the patient must be fully aware of his/her condition, prospects, and options

• there must be consultation with at least one other independent doctor who needs to confirm the conditions mentioned above

• the death must be carried out in a medically appropriate fashion by the doctor or patient, and the doctor must be present

• the patient is at least 12 years old (patients between 12 and 16 years of age require the consent of their parents)

 Euthanasia remains a criminal offense in cases not meeting the law’s specific conditions, with the exception of several situations that are not subject to the restrictions of the law at all, because they are not considered euthanasia but normal medical practice:

• stopping or not starting a medically useless (futile) treatment

• stopping or not starting a treatment at the patient’s request

• speeding up death as a side-effect of treatment necessary for alleviating serious suffering.

4. Health- Care Systems in the Netherlands   

Everyone is the Netherlands has the health insurance. In this funding, there is a distinction between ‘normal’ medical expenses and exceptional cases such as long term care or high cost medical treatments. There is a compulsory national health insurance scheme which covers the exceptional cases, and this insurance is for everyone who is living in the Netherlands. If we look at the institutions for health care, there are almost 750 health- care institutions that provide 24 hour nursing care in the Netherlands.   The eight university hospitals offer the highest level of care available. Each of these hospitals offers specialized services such as neurosurgery, cardiac surgery, a high-level emergency department, advanced oncology, departments for infectious diseases, and other services generally not found in smaller hospitals.  

 The patients have two different choices; one of them is going to the hospital and obtain the necessary health care, and the other option is receiving the care at home. Dutch people generally prefer the second option. Even the pregnant women prefer to give birth at their homes, although it is more dangerous to give birth at home. They see the home as starting and finishing place of their lives. So the general practitioners (GPs) visit their patients in their homes. It is possible to say that the Netherlands has inclusive health insurance based on general practitioners. The GPs have longstanding relation with their patients, and most of the patients trust their doctors. Cohen says that the GP typically visits the patient at home and establishes a personal relationship that is discrete and private. In this realm of intimacy, outside control often does not exist and is conceived by both parties as interfering and damaging to the personal trust and special bond thatb have evolved over time. Many incidents of euthanasia happen at home and are not reported because this is considered a private matter, something between the patient, his /her family, and the doctor (Cohen, 2004, p.63).

4.1. Approaches of Institutions against Euthanasia

Hospitals are private institutions, and they can determine their own policy with regard to the euthanasia and other medical behavior for shortening life with the certain degree of freedom. Except from the hospitals, there are nursing homes and residential homes. Nursing homes which are called verpleeghuizen, are institutions for people who require continual nursing care and have significant difficulty coping with the required activities of daily living. Nursing homes determine their own policy with regard to abstinence, euthanasia and related medical behavior that shortens life. Since the doctors who are responsible for patients in a nursing home are usually employed by the institution, nursing homes can generally exert far more control over life-shortening behavior than hospitals are able to do (Griffiths, Bood & Weyers, 1998, p.17). And residential homes which are called Verzorgingshuizen, provide for the long term-care for adults and children who stay in residential setting than in their own home or family home. People who are living in these homes have their own GPS. GP means general practitioner that  is a medical doctor who treats acute and chronic illnesses and provides preventive care and health education to patients.  The residents are free to organize their lives as they please, which in principle means that euthanasia or assistance with suicide is a matter between a residential and his GP, although a residential home with a strong religious orientation may find euthanasia so objectionable that is difficult for a GP to carry it out there (Griffiths, Bood & Weyers, 1998, p.17).

5. Conclusion

The Netherlands respect individual autonomy. The moral rules are secular, and people have their freedom to make their choices within the framework of laws. When we look at the history it is possible to see discussions about the act of euthanasia. People discussed about it, sometimes the frameworks were blocked, but when we look at the result it become a legal act with certain conditions. Again the person has his/her individual autonomy that their lives had left on their hands as it should be.  

Word Account: 2.547

References

• Griffiths, J., Bood, A., & Weyers, H. (1998). Euthanasia and law in the Netherlands. Amsterdam: Amsterdam University Press.

• Cohen-Almagor, R. (2004). Euthanasia in the Netherlands: The policy and practice of mercy killing. Dordrecht: Kluwer Academic.

• https://en.wikipedia.org/wiki/Euthanasia_in_the_Netherlands

• http://www.britannica.com/topic/euthanasia

• https://en.wikipedia.org/wiki/General_practitioner#Netherlands_and_Belgium

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