Asking to Die: Inside the Dutch Debate about Euthanasia

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David C. Thomasma, Thomasine Kimbrough Kushner, G.L Kimsma, C. Ciesielski-Carlucci
Springer Science & Business Media, Oct 31, 1998 - Medical - 584 pages
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claim was that he had faced a conflict of duties pitting his legal duty not to kill against his duty as a physician to relieve his patient’s unbearable suffering. He was acquitted on the important grounds of conflict of duty. These grounds are based on a concept in Dutch law called "force majeure" 4 which recognizes extenuating circumstances such as conflicts of duty. The acquittal was upheld by the Lower Court of Alkmaar, but revoked by an Amsterdam court of appeal. The case went on to the Supreme Court, but before the Supreme Court's decision was issued, the Royal Dutch Medical Association (RDMA) attempted to clarify the criteria for euthanasia that many within the profession already accepted. The RDMA proposed that physicians be permitted to perform euthanasia provided that a set of procedures had been met. Variously stated, the guidelines contain the following central provisions: Voluntary, competent, explicit, and persistent requests on the part of the • patient; Requests based on full information; • The patient is in a situation of intolerable and hopeless suffering (either • physical or mental); No further acceptable alternatives to euthanasia. All alternatives • acceptable to the patient for relief of suffering having been tried; Consultation with at least one other physician whose judgment can be • 5 expected to be independent. Indirectly, these guidelines became the criteria prosecutors used to decide whether or not to bring charges.
 

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Contents

PROLOGUE
1
DUTCH DEFINITION OF EUTHANASIA
3
Toward a Dutch Compromise Perspectives from Government Law Medicine and Academia
5
Reexamining Thou Shalt Not Kill
7
Structuring the Public Policy Debate
17
TwentyFive Years of Dutch Experience and Policy on Euthanasia and Assisted Suicide An Overview
19
Creating a Legal Opening 19731984
20
Defining Criteria for Euthanasia 19731994
21
Philosophical Objections Based on the Legal Precedents
231
Human Life is Sacred
233
Some Possible Responses to Euthanasia
236
Catholic Healthcare and the Dutch National Character
241
The Dutch Compared to Other Countries
242
Dying Today
245
The Autonomy Emphasis
246
The Future
251

Reporting Cases and Accountability 19851997
23
Legislation 19841994
24
Blurring the Debate 19911994
26
Conclusion
31
Euthanasia and Assisted Suicide in the Netherlands and the USA Comparing Practices Justifications and Key Concepts in Bioethics and Law
35
Issues in the Spring of 1997
37
Historical Notes
40
Definitions
42
Conditions
46
The Dutch Position from the Point of View of Public Policy
50
Euthanasia and PAS Between Crime and Care
53
Arguments and Moral Justifications of VAE and PAS in the Netherlands and in the USA
55
Concluding Remarks
63
Physician Assisted Suicide in Psychiatry An Analysis of Case Law and Professional Opinions
71
Case Law
72
Reports and Statements on Physician Assisted Suicide in Psychiatry
82
Concluding Remarks
87
The Slippery Slope Are the Dutch Sliding Down or Are They Clambering Up?
93
Keowns Argument
95
The Dutch Data
97
International Comparison
99
The Character of Dutch Legal Developments
101
Teaching Euthanasia The Integration of the Practice of Euthanasia into Grief Death and Dying Curricula of PostGraduate Family Medicine Training
105
Conclusion
112
Comparing Two Euthanasia Protocols The Free University of Amsterdam Academic Hospital and the Medical Center of Alkmaar
115
Formal Aspects
116
Collegial Consultation
117
Declaration of the Executive Council Board of Directors and Management of the Free University Concerning Euthanasia
118
Medical Center of Alkmaar
124
Euthanasia Protocol Checklist
130
Euthanasia Drugs in the Netherlands
135
Reflecting on the Use of Drugs
140
Euthanasia versus Physician Assisted Suicide
142
Medical Practical Issues
143
Conclusion
145
Empirical Research on Euthanasia and Other Medical EndofLife Decisions and the Euthanasia Notification Procedure
149
Methods
150
Results
155
Discussion
164
Current Commentary
185
Palliative Care Dutch Hospice and Euthanasia
187
Category B Patients
189
Category D Patients
190
Category E Patients
194
Hospice and Euthanasia
195
Suffering
197
Educational Issues
198
Hospice Consults versus Euthanasia
200
Exporting the Dutch Experience
202
Conclusion
203
Euthanasia and the Power of Medicine
205
The Notion of Legally Justified Motive
206
Suffering
207
Personhood
208
Not Having Boundaries
211
Future Euthanasia Discussion
213
Religious and Cultural Background
215
Summary
220
A Religious Argument in Favor of Euthanasia and Assisted Suicide
221
The Range of Objections to Euthanasia
227
NonVoluntary Euthanasia
228
Living with Euthanasia Physicians and Families Speak for Themselves
255
Reexamining Do No Harm
257
Unexplored Territory
262
Physician Stories
267
Euthanasia at Home
269
Annie Asked Are You Going to Help Me?
271
A Refusal Revisited
275
Euthanasia and the DoctorPatient Relationship
277
In Death He Achieved a Stature that He Never Had in Life
281
The Moment Will Come When I Will Have to Kill Him
293
Killing is Always Bad But Not Always the Worst Alternative
303
A Tragedy
309
The Euthanasia Mountain Gets Higher and Higher
313
I Will Not Leave You Alone
321
Complications in Communication
327
Euthanasia and the DoctorPatient Relationship
329
Euthanasia in an Institutional Setting
335
The Worst Moments of My Life
337
Euthanasia is Not So Much About Shortening Life But More Directly About Shortening Suffering
345
Euthanasia in the Nursing Home We Had a Problem Not to Let the Other Patients Know What Was Happening
349
Just What Are We Doing?
355
Public Cases and Issues
365
I Was the First Physician in the Netherlands Prosecuted for Performing Euthanasia on a Patient Who Was Not a Relative
367
Arlene Judith Klotzko and Dr Chabot Discuss Assisted Suicide in the Absence of Somatic Illness
373
About Mrs B
374
Attitude Toward Assisted Suicide
376
The PsychiatristPatient Relationship
379
The Court Case
381
Selections Translated by Dr Chabot From Two Letters Quoted in Zelf Beschikt
385
What Kind of Life? What Kind of Death? An Interview with Dr Henk Prins
389
Interview
392
Family Stories
407
What Is There to Be Frightened About? After All Its Not Like I Am Going to the Dentist
409
The Story of Laurens
417
I Walked Out Into The Kitchen I Could Not Endure It
421
He Was Dead Before He Even Passed Away
425
We Will Have to Make of Life What We Can
431
A Double Life
439
You Will Do Well With the Children
449
As Soon As Possible Please
455
What Life Was Left to Live?
463
I Dont Want to be Put Away Like a Dog
471
We Are Living in a House of Death Everyone Who Enters Here Will Die
481
Euthanasia Promises and Perils
485
The Hard Unanswered Questions Issues That Continue to Divide the Dutch and Fuel Debate
487
What Counts as Suffering?
488
Should There Be a Waiting Period?
490
Sliding Down the Slippery Slope?
491
What Safe Guards Are Safe?
492
Should Euthanasia Be Legalized?
496
Ending Life with Regard to Incompetent Persons?
500
Is the Dutch Model Exportable?
501
New Directions
505
Means and Methods
506
Rites of Passage
507
Teaching Euthanasia
508
Toward More Adequate Controls
510
Final Thoughts
515
INDEX
517
Copyright

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About the author (1998)

Edmund D. Pellegrino, M.D., is John Carroll Professor of Medicine and Medical Ethics at Georgetown University. David C. Thomasma, Ph.D., is director of the Medical Humanities Program at Loyola University of Chicago.

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