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End-of-life decision making in the Netherlands.

A new research report out in The Lancet examined end-of-life decisions (the rate of voluntary euthanasia, non-voluntary euthanasia and continuous deep sedation) made by patients and physicians in the Netherlands in 2010. Voluntary euthanasia (where the physician directly ends the life of the patient at their request) was legalised in the Netherlands in 2002. Patients who have an incurable condition, face unbearable suffering and are mentally competent may be eligible for this. Theoretically, this practice was previously allowed but the law now regulates practice. Dignity in Dying only campaigns for the legalisation of assisted dying for terminally ill adults.


For the study, data from the death registry was examined in 2010, identifying cases where an end-of-life decision was made by the patient or physician. A questionnaire was then sent to the physicians involved in the cases, asking them whether they had made decisions such as withholding medication or administering drugs to hasten a patient’s death. Similar studies have been carried out in the Netherlands over the years, which allows for comparison of data.


The proportion of ending of life without an explicit patient request has decreased significantly over the years from 0.8% of deaths in 1990 to 0.2% in 2010. Evidence of a slippery slope and relaxing of practice is not supported by the report.


The total number of voluntary euthanasia cases in 2010 was around 4,050 (just under 3% of all deaths). Nearly 80% of these had been reported to a Regional Euthanasia Review Committee. This reporting rate of voluntary euthanasia by physicians is similar to that in 2005 and, crucially, higher than the reporting rate before the euthanasia law came into force.


The research also reports that there has been an increase in continuous deep sedation (whereby very distressed end-of-life patients are sedated to keep them comfortable), with the practice occurring in 12.3% of cases in 2010 and 8.2% in 2005. However, research from the UK published in 2010 found that that 18.7% of doctors attending a dying patient reported the use of continuous deep sedation. Research is currently underway across Europe to examine this particular practice and how decisions on its use are made.


In conclusion, this data reinforces that legalising assistance to die does not initiate a slippery slope; rather it provides a regulatory framework for transparent and open discussion and reporting. Figures demonstrate that cases of voluntary and non-voluntary euthanasia have not sky-rocketed since legislation; in fact the opposite is true. Furthermore, in 2011 a report was published by the European Association for Palliative Care which examined palliative care in countries where legal assistance to die is practised, including the Netherlands. This report found that palliative care is at least as well developed in these countries as in the comparator countries of Germany, France and Spain. This allays fears that legal assistance to die practices have a negative impact on the delivery and development of palliative care.