Asking to die : inside the Dutch debate about euthanasia

573 Pages·1998·2.4 MB·English

by  Thomasma, David C., 1939-

ASKING TO DIE:
INSIDE THE DUTCH DEBATE ABOUT EUTHANASIA
ASKING TO DIE:
INSIDE THE DUTCH DEBATE
ABOUT EUTHANASIA
Edited by
DAVlD C. THOMASMA
Loyola University Chicago,
Stritch School of Medicine, Maywood, IL, U.S.A.
THOMASINE KIMBROUGH-KUSHNER
University of California,
Berkeley, School of Public Health, Berkeley, CA, U.S.A.
GERRIT K. KIMSMA
Vrije Universiteit Amsterdam,
Medical Faculty, Amsterdam, The Netherlands
and
CHRIS CIESIELSKI-CARLUCCI
Stanford University,
Medical Center, Stanford CA, U.S.A.
KLUWER ACADEMIC PUBLISHERS
NEW YORK / BOSTON / DORDRECHT / LONDON / MOSCOW
eBookISBN: 0-306-46863-8
Print ISBN: 0-792-35185-1
©2002 Kluwer Academic Publishers
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Dedication
To the families and physicians of patients who have chosen the time and
circumstances of their own death.
Table of Contents
Acknowledgments ..................................................... xv
About the Editors ...................................................... xvii
Contributors ........................................................... xix
PROLOGUE............................................................1
DUTCH DEFINITION OF EUTHANASIA .......................... 3
PART I:Toward A Dutch Compromise: Perspectives from
Government, Law, Medicine, and Academia
INTRODUCTION: Reexamining "Thou Shalt Not Kill" ............7
SECTION ONE: Structuring the Public Policy Debate
CHAPTER ONE: Twenty-Five Years of Dutch Experience and
Policy on Euthanasia and Assisted Suicide: An Overview ......19
Johan Legemaate
Introduction .......................................................19
Creating a Legal Opening (1973-1984)..................................20
Defining Criteria for Euthanasia (1973-1994) ...........................21
Reporting Cases and Accountability (1985-1997).........................23
Legislation (1984-1994) ................................................ 24
Blurring the Debate (1991-1994) ............................................26
Conclusion ...................................................... 31
CHAPTER TWO : Euthanasia and Assisted Suicide in the Netherlands
and the USA: Comparing Practices, Justifications and Key Concepts in
Bioethics and Law .......................................35
Gerrit K. Kimsma and Evert van Leeuwen
Introduction .................................................... 35
IssuesintheSpringof1997 ......................................37
HistoricalNotes ................................................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
CHAPTER THREE: Physician Assisted Suicide in Psychiatry:
An Analysis of Case Law and Professional Opinions.............. 71
Sjef Gevers and Johan Legemaate
Assisted Suicide in Psychiatry: Case Law. ............................. 72
Reports and Statements on Physician Assisted Suicide in Psychiatry ........ 82
Concluding Remarks ................................................ 87
CHAPTER FOUR: The Slippery Slope: Are the Dutch Sliding Down
or Are They Clambering Up? ..................................... 93
John Griffiths
Introduction: The Nature of the Claim .............................. 93
Keown’s Argument ............................................... 95
The Dutch Data .................................................. 97
International Comparison ........................................ 99
The Character of Dutch Legal Development ........................... 101
CHAPTER FIVE: Teaching Euthanasia: The Integration of
the Practice of Euthanasia into Grief, Death, and Dying
Curricula of Postgraduate Family Medicine Training ............105
GerritK. KimsmaandB.J. vanDuin
Introduction and Justification ...................................... 105
Conclusion .................................................... 112
CHAPTER SIX:Comparing Two Euthanasia Protocols:
The Free University of Amsterdam Academic Hospital and
the Medical Center of Alkmaar ...................................115
Gerrit K. Kimsma and Evert van Leeuwen
Introduction ..................................................115
Formal Aspects ............................................... 116
Material Aspects ............................ ....................... 116
Collegial Consultation.................................................117
Declaration of the Executive Council, Board of Directors,
And Management of the Free University Concerning Euthanasia ........ 118
Euthanasia Protocol: Medical Center of Alkmaar .................... 124
Euthanasia Protocol Checklist ...............................130
CHAPTER SEVEN: Euthanasia Drugs in the Netherlands ............135
GerritK. Kimsma
Introduction .....................................................135
Information On Drugs ......................................... 135
viii
Reflecting on the Use of Drugs ...................................... 140
Euthanasia versus Physician Assisted Suicide ........................... 142
Medical Practical Issues ............................................. 143
Conclusion ........................................................ 145
CHAPTER EIGHT: Emperical Research on Euthanasia and Other
Medical End-of-Life Decisions and the Euthanasia Notification
Procedure ........................................................ 149
Gerrit van der Wal and P.J. van der Maas
Introduction........................................................ 149
Methods........................................................... 150
Results............................................................ 155
Discussion......................................................... 164
SECTIONTWO: CurrentCommentary
CHAPTER NINE: Palliative Care: Dutch Hospice and Euthanasia . . . 187
Zbigniew Zylicz
Category A Patients .................................................. 187
Category B Patients .............................................. 189
Category C 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
CHAPTER TEN: Euthanasia and the Power of Medicine............. 205
Henk ten Have
The Notion of Legally Justified Motive .............................. 206
Overtreatment ..................................................... 206
Nature and Intervention............................................. 206
Suffering.......................................................... 207
Mourning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Personhood....................................................... 208
Not Having Boundaries ......................................... 211
Future Euthanasia Discussion ....................................... 213
Religious And Cultural Background...................................... 215
Summary.......................................................... 220
ix
CHAPTER ELEVEN: A Religious Argument in Favor of
Euthanasia and Assisted Suicide.................................. 221
Harry Kuitert with Evert van Leeuwen
CHAPTER TWELVE: The Range of Objections to Euthanasia .........2.27
Henk Jochemsen
Objections to Euthanasia .......................................... 227
Non-Voluntary Euthanasia ......................................... 228
Philosophical Objections Based on the Legal Precedents................ 231
Theological Objections: Human Life is Sacred ....................... 233
Some Possible Responses to Euthanasia............................ 236
CHAPTER THIRTEEN: Catholic Healthcare and the Dutch
National Character.............................................. 241
Martien A. M. Pijnenburg
Human Dignity .................................................. 241
The Dutch Compared to Other Countries .......................... 242
Dying Today ...................................................... 245
The Autonomy Emphasis ......................................... 246
The Catholic Tradition ............................................ 246
The Future ................................................... 251
PART II: Living with Euthanasia: Physicians and Families Speak for
Themselves
INTRODUCTION: Reexaming "DoNo Harm" ....................257
Unexplored Territory............................................ 262
SECTION ONE: Physician Stories
Euthanasia at Home
CHAPTER ONE: Annie Asked, "Are You Going to Help Me?". . . . . . . 271
Annie: A Model Patient, A Model Death .......................... 271
A Refusal Revisited ............................................ 275
Euthanasia and the Doctor/Patient Relationship .................. 277
CHAPTER TWO: "In Death He Achieved a Stature that
He Never Had in Life." .......................................... 281
CHAPTER THREE: "The Moment Will Come When
I Will Have to Kill Him."........................................ 293
x
CHAPTER FOUR: "Killing is Always Bad, But Not Always
the Worst Alternative." ............................................... 303
CHAPTER FIVE: "A Tragedy" ........................................... 309
CHAPTER SIX: "The Euthanasia Mountain Gets Higher
and Higher." ......................................................... 313
CHAPTER SEVEN: "I Will Not Leave You Alone." ..................... 321
Changing the System .................................................. 321
Complicationsin Communication......................................... 327
Euthanasia and the Doctor-Patient Relationship............................ 329
Euthanasia in an Institutional Setting
CHAPTER EIGHT: "The Worst Moments of My Life." ................... 337
CHAPTER NINE: "Euthanasia is Not So Much About Shortening Life,
But More Directly About Shortening Suffering."...................... 345
CHAPTER TEN: Euthanasia in the Nursing Home: "We Had a Problem
Not to Let the Other Patients Know What Was Happening."............ 349
CHAPTER ELEVEN: "Just What Are We Doing?"....................... 355
Public Cases and Issues
CHAPTER TWELVE: "I Was the First Physician in
the Netherlands Prosecuted for Performing Euthanasia
on a Patient Who Was Not a Relative." ............................... 367
CHAPTER THIRTEEN: Arlene Judith Klotzko and Dr. Chabot
Discuss Assisted Suicide in the Absence of Somatic Illness ............ 373
Background............................................................ 373
About Mrs.B.......................................................... 374
Attitude Toward Assisted Suicide ........................................ 376
The Psychiatrist-Patient Relationship ..................................... 379
The Court Case ........................................................ 381
Selections Translated by Dr. Chabot from Two Letters Quoted in Zelf Beschikt . 385
CHAPTER FOURTEEN: What Kind of Life? What Kind
of Death? An Interview with Dr. Henk Prins........................... 389
Arlene Judith Klotzko
Introduction ........................................................... 389
Interview ............................................................. 392
xi