Dutch Euthanasia Rates Steady After Legalization

WEDNESDAY, May 9 (HealthDay News) -- Since euthanasia and physician-assisted suicide were legalized by the Dutch in 2002, use of the practices has dropped slightly and now has stabilized, a new report finds.

That marks an abrupt turnaround from trends during the last 10 years, say the authors of a study in the May 10 New England Journal of Medicine.

In the United States, physician-assisted suicide is legal only in the state of Oregon, while euthanasia is not legal in any state.

"One lesson is there's not a big slippery slope in this area, that the practice will be used relatively infrequently and that it's generally a good thing to have an open conversation," said Dr. Timothy Quill, director of the Center for Ethics, Humanities and Palliative Care at the University of Rochester Medical Center in Rochester, N.Y. He also wrote a related perspective article in the journal.

Dr. Nancy W. Dickey, president of the Texas A&M Health Science Center and vice chancellor for health affairs for the Texas A&M System, agreed. "Neither Oregon nor the Netherlands appear to have started down a slippery slope," she said. "Also, physicians have become better equipped to offer a wide variety of palliative care, leading them to become more effective at it and very rarely having to resort to assisted death," she said.

In the Netherlands, euthanasia is defined as death resulting from medication administered by a physician with the intention of hastening death at the request of the patient. In assisted suicide, the patient hastens death by giving him or herself medication prescribed by a physician.

Although neither procedure was legal in the Netherlands in the early 1990s, physicians were generally not prosecuted if they had adhered to certain requirements.

"The passing of the law was a formalization of a practice that the Netherlands freely admitted occurred on a less-than-rare basis," Dickey said.

In 1990, the reporting rate for euthanasia and physician-assisted suicide was 18 percent. An official reporting procedure was established in 1993, after which the reporting rate climbed to almost 41 percent.

"An important goal of the euthanasia law in the Netherlands is to achieve public control of this practice," said study co-author Bregje Onwuteaka-Philipsen, associate professor at the VU University Medical Center in Amsterdam, EMGO Institute/Department of Public and Occupational Health. "The increase in the reporting of euthanasia and physician-assisted suicide to the review committees, from 18 percent in 1990, through 41 percent in 1995 and 54 percent in 2001 to 80 percent in 2005, shows that that goal of the law is met."

According to Onwuteaka-Philipsen, approximately 8,400 people per year explicitly request euthanasia or physician-assisted suicide, at which point physicians must determine whether or not to grant the request according to legal criteria. This results in approximately 2,300 cases of euthanasia and 100 cases of physician-assisted suicide per year which, together, make up 1.8 percent of all deaths in the Netherlands.

For this study, researchers mailed questionnaires to doctors who had attended 6,860 deaths. More than three-quarters (77.8 percent) of physicians responded.

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