Zylicz, a palliative care physician who has worked extensively in the Netherlands with people requesting euthanasia and PAS, provides a taxonomy to understand the reasons for requests and provides springboards to respond to requests. Applications can be divided into five categories (summarized by the abbreviation abcde) 54: Assisted suicide has the same purpose as euthanasia: to cause the death of a person. The difference lies in how this objective is achieved. In the SAP, a physician prescribes a lethal amount of medication at the request of a competent patient, with the intention that the patient will use the chemicals to commit suicide. In short, in the case of assisted suicide, the person takes the product causing death; In euthanasia, it is managed by another person. Both are idiosyncratic deaths. The first is idiosyncratic and self-inflicted; The latter is idiosyncratic and externally indebted. Although the means vary, in both cases the intention to cause death is present. Rohr W. “Medical Euthanasia”; a journal published in Latin in 1826, which was translated and reintroduced into the medical profession. J hist med allied sci.
1952;7(4):401–416. There is therefore evidence that protective measures are ineffective and that many people who should not be euthanized or who should not be given steps die in this way. Another source of concern is the fact that violations of the law are not prosecuted and tolerance for violations of the law has increased. Moreover, in the next section, the boundaries of what constitutes “good” euthanasia and SAP practices continue to change, and some of the current practices would have been considered unacceptable just a few decades ago in jurisdictions that legalized these practices. CURE is another pro-life group. Their reasons are compassion and unity. The people at CURE believe that “caring does not mean killing”. (10) They believe that there is an alternative to death and euthanasia, which is life and hope. Uniting brings strength and a long life.
As already described, the Netherlands has several unique characteristics that have contributed to the legalization of euthanasia, probably the most important of which is the decades-long debate about euthanasia rooted in society. The Dutch healthcare system has several attributes that have shaped a context of protective measures in which the legalization of euthanasia could take place, such as the fact that virtually everyone has health insurance. In addition, health care, including home care for chronic or incurable diseases, is freely accessible and affordable for all. This gives no reason for the sometimes heard fear that euthanasia can be (abused) at the high cost of medical care. In addition, the overall structure of the Dutch health system is quite unique, with the Dutch general practitioner as the nucleus of primary care. Euthanasia is performed in the vast majority of cases by general practitioners who have often known the patient for a long time, which could allow the doctor to assess whether the patient meets the first three patient-related due diligence criteria. These factors suggest that exporting the Dutch legalization process to other countries is not easy. The involvement of nurses is a cause for concern, as all jurisdictions except Switzerland require that actions be carried out only by doctors. In a recent study in Flanders, 120 nurses claimed to have cared for a patient who had received life-ending medication without an explicit request.15 Nurses performed euthanasia in 12% of cases and 45% of cases without explicit consent. In many cases, doctors were lacking.
Factors significantly associated with the administration of end-of-life medications by a nurse included the fact that the nurse was a male working in a hospital and that the patient was over 80 years of age. Table 3 shows the incidence of euthanasia and medical assistance in dying in different subgroups of patients in 2001 and 2005. The 1990 and 1995 rates were comparable to those in 2001. The highest rates of euthanasia use were observed among cancer patients: in 2005, 5.1% of all cancer deaths were preceded by euthanasia or physician-assisted suicide. This partly explains the higher incidence of euthanasia and physician-assisted suicide among younger patients. In addition, general practitioners performed euthanasia or physician-assisted suicide in a higher proportion of deaths than clinical specialists and nursing home physicians. This is because euthanasia is usually performed as part of a long-standing doctor-patient relationship, which is typical of the type of contact GPs have with their patients. After the euthanasia debate began, some doctors were willing to report euthanasia cases and therefore be held accountable. However, until the mid-1980s, very few cases were reported. In 1990, the Ministry of Justice – in collaboration with the Royal Netherlands Medical Association – agreed to proclaim a formal and uniform notification procedure aimed at transparency, accountability and harmonization of regional law enforcement policies.
Physicians who meet the criteria for euthanasia due diligence would not be prosecuted. The reporting process was also intended to eliminate practices perceived as impeding physicians` willingness to report. Examples include doctors who are treated as murder suspects, police officers who interrogate relatives shortly after a euthanasia patient`s death, or doctors who were brought from their offices to patients for questioning, but later turned out to have done nothing wrong. Although suicide and attempted suicide have been decriminalized in the United States, assisted suicide remains a legal offense in most states. Euthanasia is illegal throughout the United States. In New Mexico, a lower court decision allowed medical assistance in dying, but was overturned; Like all appellate courts, the New Mexico Supreme Court has ruled that there is no right to physician-assisted suicide. Elsewhere in the world, the British Parliament voted 330-118 against a medically assisted suicide bill in 2015, and Canada legalized physician-assisted suicide and euthanasia. In 2016, the South Australian Parliament rejected a euthanasia bill. Medical assistance in dying and euthanasia are legal in the Netherlands, Belgium and Luxembourg; Euthanasia is legal in Colombia; and Switzerland has decriminalized assisted suicide.
Chambaere K, Bilsen J, Cohen J, Onwuteaka-Philipsen BD, Mortier F, Deliens L. Physician-assisted deaths under the euthanasia law in Belgium: a population-based survey. CMAJ. 2010;182(9):895-901. On the one hand, different opinions about when suffering becomes unbearable could be interpreted as problematic. From a patient`s perspective, it may be partly a matter of chance that a request for euthanasia is granted. However, it is likely that this problem exists mainly in borderline cases, which represent a minority of euthanasia cases in the Netherlands (Onwuteaka-Philipsen et al. 2007). On the other hand, performing euthanasia is not part of “normal medical practice” and a physician is not obliged to perform euthanasia if a patient wishes to do so (although he must refer the patient to another doctor) and a patient does not have a “right to euthanasia”. From this point of view, difficulties are to be expected in determining whether the suffering is unbearable and the possible differences between doctors (and patients) and are in accordance with the legal system of euthanasia in the Netherlands.
The 2005 study found that the main reason for non-reporting was that the physician did not consider the intervention to be euthanasia or physician-assisted suicide and therefore did not see the need to legally report the case (Onwuteaka-Philipsen et al., 2007). This was strongly related to the type of drugs used. In cases where physicians used drugs recommended by the Royal Netherlands Association for the Advancement of Pharmacy, i.e. a barbiturate followed by a muscle relaxant for euthanasia or barbiturates for physician-assisted suicide, the percentage of reports in 2005 was 99%. In cases where other drugs were used to end a patient`s life with the express intention of ending life at the patient`s request, which are primarily opioids, the reporting rate was 2%. In Belgium, rates of involuntary and involuntary euthanasia have decreased; Together, they accounted for 3.2%, 1.5% and 1.8% of all deaths in 1998, 2001 and 2007 (1800, 840 and 990 people, respectively, 30). In the Netherlands, the rate increased from 0.7% in 2001 to 0.4% in 2005 7.