Netherlands Law Sets Guidelines for Euthanasia

The Netherlands on Tuesday adopted a euthanasia law establishing one of the world’s most liberal guidelines for mercy killings in a move that legally acknowledges a widespread practice that has been quietly accepted for years.

The 91-45 vote in the lower house of Parliament promised immunity to physicians who follow official euthanasia guidelines but stopped short of the full legalization that liberals had advocated. The law is to take effect early next year.

“This law brings the practice out of the dark and into the open,” said Vincent van de Burg, a member of the country’s largest party, the Christian Democrats.

The Hague government has determined that about 2,300 people die by euthanasia each year and that 400 more commit suicide with the help of their physicians. A 1991 government report found that euthanasia accounts for one in every 50 deaths in the Netherlands.

Around 80% of the Dutch people approve of euthanasia for the terminally ill, according to a recent opinion poll.

The statistics alarm conservative religious groups who argue that tacit government approval of the practice devalues human life.

“Man does not have the right to take life,” said Hert Schutte, a deputy from the tiny Christian Reformed Political Party.

“This is a terrible law, and I fear that we’ll become an international model for euthanasia,” Schutte said in a telephone interview. “The controls are not strong enough. It’s all up to the doctor. There’s no independent review.

“It’s one thing to trust your doctor, but trust is different than control.”

While experts said that euthanasia is not legal in any country in the world, Tuesday’s parliamentary vote reaffirms the Dutch policy as among the most liberal in Europe and around the globe.

In Japan, a 1962 court ruling on a mercy killing by a patient’s son set a precedent similar to but not as extensive as the Dutch guidelines, the Associated Press said. The court ruled that euthanasia is permissible if patients are terminally ill and in pain, with death imminent. They also must be alert and give consent, the court in Nagoya ruled.

Last November, California voters rejected Proposition 161--the “Death With Dignity Act”--which would have made the Golden State the first in America to legalize doctor-assisted suicide. Prop. 161 would have let doctors in California give lethal injections to terminally ill patients who had less than six months to live and who had asked to die.

The measure was staunchly opposed by the California Medical Assn., nursing groups and the Catholic Church; it was supported by some influential doctors and groups representing some patients with AIDS.

Meantime, in Michigan, Dr. Jack Kevorkian, a retired pathologist, has been helping terminally ill people to die since 1990, despite threats of prosecution. On Monday, Kevorkian helped a third person in less than five days commit suicide. It was the 12th suicide in which he has been involved.

In Oakland County, Mich., where most of the suicides that Kevorkian assisted occurred, prosecutors have been forced to drop charges against him because of the lack of a state law prohibiting assisted suicide. But a new Michigan law making such actions punishable by up to four years in prison and a $2,000 fine is scheduled to take effect April 1.

The 28-step Dutch guidelines require that physicians report all cases of euthanasia, which is normally performed by lethal injection. Among the requirements are that patients must:

* Make the request repeatedly and “entirely of (their) own free will.” The doctor must talk to the patient alone to ensure that the patient is not under duress.

* Be well-informed about their condition and advised of alternatives.

* Have a “lasting longing for death. Requests made on impulse or based on temporary depression cannot be considered.”

* “Experience (their) suffering as perpetual, unbearable and hopeless.”

The guidelines also say that a second physician must be consulted to confirm that all requirements are met. Doctors must submit a fully documented report on each case to the district coroner after carrying out euthanasia.

If an administrative review finds that all the requirements were satisfied and no malpractice was evident, the prosecutor will consider the case closed.

But physicians who fail to satisfy the guidelines could still face criminal charges and be sentenced to up to 12 years in prison.

“I am a Roman Catholic and I’m against euthanasia, but I voted for that law because it gives the prosecutor a chance to control the practice,” Van de Burg said in a telephone interview. “We want to keep it forever in the penal law so there will be no possibility of sons or daughters pressuring their elderly parents or their old aunt to ask for euthanasia. This doesn’t mean old people are just going to be put away in the Netherlands.”

Emil Bode, political correspondent for the daily De Telegraaf, predicted that euthanasia will eventually become as ordinary a practice in the Netherlands as legal abortions.

“Euthanasia is very common in our country,” he said in a telephone interview. “If a cancer patient has six months to live, the doctor might agree to take that life after three months, because there’s no point in extending the patient’s suffering.”

The new law would take effect in early 1994 after being approved by the upper house of Parliament and receiving the crown seal, both considered formalities.

Officially, the guidelines--drawn up over the years by the Royal Dutch Medical Assn.--will be appended to the 1955 Disposal of the Dead Act.

Guidelines for Dutch Euthanasia (Southland Edition, A8)

Guidelines, or “carefulness requirements,” for euthanasia, approved Tuesday by the Dutch Parliament:

Voluntary Nature--The request for euthanasia must be made “entirely of the patient’s own free will” and not under pressure from others. Patient must be spoken to alone to ensure decision is voluntary.

* Alternatives Considered--The patient must be well informed about his or her situation and must have been able to consider the alternatives.

* Certain Decision--The patient should have a “lasting longing for death. Requests made on impulse or based on a temporary depression cannot be considered.”

* Unacceptable Suffering--”The patient must experience his or her suffering as perpetual, unbearable and hopeless. Although these criteria will always contain an element of subjectivity . . . the physician must reasonably be able to conclude that the suffering is being experienced as unbearable.”

* Consultation--Physician must consult at least one colleague on patient’s request.

* Reporting--Well-documented written report must be drawn up stating history of patient’s illness and meeting of “carefulness requirements.”

Source: Times wire reports