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Previous Volume 335:1706-1712 November 28, 1996 Number 22

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ABSTRACT

Background In the Netherlands, a notification procedure for physician-assisted death has been in use since 1991. It requires doctors to report each case to the coroner, who in turn notifies the public prosecutor. Ultimately, the Assembly of Prosecutors General decides whether to prosecute. Although physician-assisted death remains technically illegal, doctors are extremely unlikely to be prosecuted if they comply with the requirements for accepted practice. In 1995, the ministers of health and justice commissioned an evaluation to determine the adequacy of the notification procedure.

Methods A random sample of 405 physicians were interviewed. We also interviewed 147 physicians who had reported cases of physician-assisted death and 116 coroners, and we reviewed 353 judicial files of reported cases. In addition, we interviewed 48 public prosecutors and reviewed the minutes of the Assembly of Prosecutors General for 1991 to 1995 and all published court decisions from 1981 through 1995.

Results In 1995, about 41 percent of all cases of euthanasia and physician-assisted suicide were reported. There were no major differences between reported and unreported cases in terms of the patients' characteristics, clinical conditions, or reasons for the action. Most patients had cancer and were described as suffering "unbearably" and "hopelessly." Of the 6324 cases reported during the period from 1991 through 1995, only 13 involved prosecution of the physician. The majority of respondents in the groups interviewed thought that all cases of physician-assisted death should be reviewed, although most doctors thought the review should be performed by other doctors, and there was substantial concern about the burden associated with the reporting procedure.

Conclusions Substantial progress in the oversight of physician-assisted death has been achieved in the Netherlands. The reporting procedure could be more streamlined and less threatening.

Source Information

From the Institute for Research in Extramural Medicine (G.W., J.M.B., B.D.O.-P., D.L.W., I.H., P.J.K.), the Department of General Practice, Nursing Home, and Social Medicine (G.W.), and the Department of Epidemiology and Biostatistics (P.J.K.), Vrije Universiteit Amsterdam, Amsterdam; and the Department of Public Health, Erasmus University, Rotterdam (P.J.M.) — both in the Netherlands.

Address reprint requests to Dr. van der Wal at Vrije Universiteit, EMGO Institute, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.

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