Part I. Definitions: 1. Euthanasia and physician-assisted suicide 2. Intended v. foreseen life-shortening Part II. The Ethical Debate: Human Life, Autonomy, Legal Hypocrisy, and the 'Slippery Slope' 3. The value of human life 4. The value of autonomy 5. Legal hypocrisy? 6. The slippery slope arguments Part III. The Dutch Experience: 7. The guidelines 8. The first survey: the incidence of 'euthanasia' 9. Breach of the guidelines 10. The slide towards NVAE 11. The second survey 12. The Dutch in denial? 13. The Euthanasia Act and the Code of Practice 14. Effective control since 2002? 15. Continuing concerns 16. A right to physician-assisted suicide by stopping eating and drinking? 17. Assisted suicide for the elderly with 'completed lives' Part IV. Belgium: 18. The Belgian Legislation 19. The lack of effective control Part V. Australia: 20. The Northern Territory: ROTTI Part VI. The United States: 21. The United States: Oregon and six other jurisdictions 22. The US Supreme Court: Glucksberg and Vacco Part VII. Canada: 23. The Supreme Court of Canada: the Carter case 24. Canada's euthanasia legislation 25. Conclusion.

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Euthanasia, ethics and public policy : an argument against legalisation

Euthanasia, Ethics and Public Policy

The Limits of Rationality: Suicidality, Affectivity, and the Rational

On 7 May 2015 the Legislative Council agreed to the following motion: That pursuant to Sessional Order 6 this House requires the Legal and Social Issues Committee to inquire into, consider and report, no later than 31 May 2016, on the need for laws in Victoria to allow citizens to make informed decisions regarding their own end of life choices and, in particular, the Committee should — assess the practices currently being utilised within the medical community to assist a person to exercise their preferences for the way they want to manage their end of life, including the role of palliative care; review the current framework of legislation, proposed legislation and other relevant reports and materials in other Australian states and territories and overseas jurisdictions; and consider what type of legislative change may be required, including an examination of any federal laws that may impact such legislation

Inquiry into end of life choices: final report

Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). Introduction While the use of advance care planning (ACP) is a widespread recommendation for those patients who have life limiting illnesses, the evidence base for taking this approach needs expanding. A systematic review in 2014 found some positive impact in the use of ACP.1 A further systematic review in 20162 of randomised controlled trials suggested that the evidence was open to bias and that higher quality trials are needed to be able to demonstrate scientific evidence of effectiveness. Part of the problem lies in differing outcome measures and lack of differentiation between Do-Not-Resuscitate orders, Preferred Place of Care, Preferred Place of Death and Treatment Escalation Plans.

https://journals.sagepub.com/doi/pdf/10.1177/2632352420934491

Advance care planning re-imagined: a needed shift for COVID times and beyond

Although it is often recommended that general practitioners (GPs) initiate advance care planning (ACP), little is known about their experiences with ACP. This study aimed to identify GP experiences when conducting ACP conversations with palliative patients, and what factors influence these experiences. Dutch GPs (N = 17) who had participated in a training on timely ACP were interviewed. Data from these interviews were analysed using direct content analysis. Four themes were identified: ACP and society, the GP’s perceived role in ACP, initiating ACP and tailor-made ACP. ACP was regarded as a ‘hot topic’. At the same time, a tendency towards a society in which death is not a natural part of life was recognized, making it difficult to start ACP discussions. Interviewees perceived having ACP discussions as a typical GP task. They found initiating and timing ACP easier with proactive patients, e.g. who are anxious of losing capacity, and much more challenging when it concerned patients with COPD or heart failure. Patients still being treated in hospital posed another difficulty, because they often times are not open to discussion. Furthermore, interviewees emphasized that taking into account changing wishes and the fact that not everything can be anticipated, is of the utmost importance. Moreover, when patients are not open to ACP, at a certain point it should be granted that choosing not to know, for example about where things are going or what possible ways of care planning might be, is also a form of autonomy. ACP currently is a hot topic, which has favourable as well as unfavourable effects. As GPs experience difficulties in initiating ACP if patients are being treated in the hospital, future research could focus on a multidisciplinary ACP approach and the role of medical specialists in ACP. Furthermore, when starting ACP with palliative patients, we recommend starting with current issues. In doing so, a start can be made with future issues kept in view. Although the tension between ACP’s focus on the patient’s direction and the right not to know can be difficult, ACP has to be tailored to each individual patient.

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Advance care planning conversations with palliative patients: looking through the GP's eyes.

During the past four decades, the Netherlands played a leading role in the debate about euthanasia and assisted suicide. Despite the claim that other countries would soon follow the Dutch legalization of euthanasia, only Belgium and the American state of Oregon did. In many countries, intense discussions took place. This article discusses some major contributions to the discussion about euthanasia and assisted suicide as written by Nigel Biggar (2004), Arthur J. Dyck (2002), Neil M. Gorsuch (2006), and John Keown (2002). They share a concern that legalization will undermine a society’s respect for the inviolability and sanctity of life. Moreover, the Report of the House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill (2005) is analyzed. All studies use ethical, theological, philosophical, and legal sources. All these documents include references to experiences from the Netherlands. In addition, two recent Dutch documents are analyzed which advocate further liberalization of the Dutch euthanasia practice, so as to include infants (Groningen Protocol, NVK 2005) and elderly people “suffering from life” (Dijkhuis Report, KNMG 2004).

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1467-9795.2007.00318.x

Recurring themes in the debate about euthanasia and assisted suicide

Worldwide the Netherlands has the broadest experience with organizing voluntary euthanasia and assisted suicide. Roughly, three phases may be distinguished: in 1968–1985 euthanasia was vividly deba...

Dialectics of lead: fifty years of Dutch euthanasia and its lessons

Background The annual incidence of euthanasia in the Netherlands as a percentage of all deaths rose from 1.9% in 1990 to 4.4% in 2017. Scarce literature on regional patterns calls for more detailed insight into the geographical variation in euthanasia and its possible explanations. Objectives This paper (1) shows the geographical variation in the incidence of euthanasia over time (2013–2017); (2) identifies the associations with demographic, socioeconomic, preferential and health-related factors; and (3) shows the remaining variation after adjustment and discusses its meaning. Design, setting and methods This cross-sectional study used national claims data, covering all healthcare claims during 12 months preceding the death of Dutch insured inhabitants who died between 2013 and 2017. From these claims all euthanasia procedures by general practitioners were selected (85% of all euthanasia cases). Rates were calculated and compared at three levels: 90 regions, 388 municipalities and 196 districts in the three largest Dutch cities. Data on possibly associated variables were retrieved from national data sets. Negative binomial regression analysis was performed to identify factors associated with geographical variation in euthanasia. Results There is considerable variation in euthanasia ratio. Throughout the years (2013–2017) the ratio in the three municipalities with the highest incidence was 25 times higher than in the three municipalities with the lowest incidence. Associated factors are age, church attendance, political orientation, income, self-experienced health and availability of voluntary workers. After adjustment for these characteristics a considerable amount of geographical variation remains (factor score of 7), which calls for further exploration. Conclusion The Netherlands, with 28 years of legal euthanasia, experiences large-scale unexplained geographical variation in the incidence of euthanasia. Other countries that have legalised physician-assisted dying or are in the process of doing so may encounter similar patterns. The unexplained part of the variation may include the possibility that part of the euthanasia practice may have to be understood in terms of underuse, overuse or misuse.

https://spcare.bmj.com/content/bmjspcare/early/2021/01/12/bmjspcare-2020-002573.full.pdf

Euthanasia in the Netherlands: a claims data cross-sectional study of geographical variation.

"When a country legalizes active euthanasia, it puts itself on a slippery slope from where it may well go further downward." If true, this is a forceful argument in the battle of those who try to prevent euthanasia from becoming legal. The force of any slippery slope argument, however, is by definition limited by its reference to future developments which cannot empirically be sustained. Experience in the Netherlands--where a law regulating active euthanasia was accepted in April 2001--may shed light on the strengths as well as the weaknesses of the slippery slope argument in the context of the euthanasia debate. This paper consists of three parts. First, it clarifies the Dutch legislation on euthanasia and explains the cultural context in which it originated. Second, it looks at the argument of the slippery slope. A logical and an empirical version are distinguished, and the latter, though philosophically less interesting, proves to be most relevant in the discussion on euthanasia. Thirdly, it addresses the question whether Dutch experiences in the process of legalizing euthanasia justify the fear of the slippery slope. The conclusion is that Dutch experiences justify some caution.

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Theo A. Boer

Papers

Advance care planning conversations with palliative patients: looking through the GP's eyes.

Recurring themes in the debate about euthanasia and assisted suicide

Dialectics of lead: fifty years of Dutch euthanasia and its lessons

Euthanasia in the Netherlands: a claims data cross-sectional study of geographical variation.

After the Slippery Slope: Dutch Experiences on Regulating Active Euthanasia