bulletMEPs try to mobilise public opinion against extension of euthanasia
bulletDutch Approve Law on Mercy Killings, Protests Start 
bulletDutch GP found guilty of murder faces no penalty
bulletDoctor sets up "how to die" workshops in New Zealand

bulletMEPs try to mobilise public opinion against extension of euthanasia

BMJ 2001;322638 ( 17 March )

MEPs try to mobilise public opinion against extension of euthanasia Rory Watson Brussels European politicians are being urged to oppose plans to extend the practice of euthanasia in the Netherlands and Belgium. The controversial issue is currently on the parliamentary agenda in both countries.

The Dutch Senate is due to decide on the bill, which already has the support of the parliamentís second chamber (the equivalent of the House of Commons). At stake are proposals to liberalise existing legislation, in particular to allow children aged 12-16 years to ask for euthanasia and for those aged 16-18 to do so without requiring parental consent.

The new bill places euthanasia outside the Dutch penal code when doctors follow a specified administrative procedure. This would be supervised, not as in the past by the public prosecutor, but by a public committee consisting of a doctor, a lawyer, and an ethics expert (BMJ 2000;3211433). Shortly after the Netherlands' consideration of its new bill, Belgium will consider legalising euthanasia for the first time. In some areas it is planning to go even further than its Dutch neighbours. Whereas in the Netherlands a second doctor must review any decision, in Belgium he or she would only need to consider the diagnosis that had been made.

Two German MEPs are now trying to mobilise European public opinion against the new legislation. Dr Peter Liese, the chairman of the Christian Democratic working group for bioethics in the European parliament, and his compatriot, Hiltrud Breyer, the Green partyís spokeswoman on the temporary committee for human genetics, are calling for alternative treatment for people at the end of their lives.

They support each patientís right to reject life prolonging measures such as artificial respiration. But they insist that this is totally different from active euthanasia. "If the state starts to allow medical doctors to give pills or an injection to their patients with the sole aim of killing the patients, the misuse of this method is inevitable," they pointed out.

Instead, they want increased EU and national funds for research into effective pain relief and improved palliative care. They are also looking for political support from the European parliament to put pressure on national authorities to provide more> hospices.  

Source:  http://www.bmj.com/cgi/content/full/322/7287/638/c

bulletDutch Approve Law on Mercy Killings, Protests Start

THE HAGUE--The Netherlands, which has turned a blind eye to so-called mercy killings for decades, took a decisive step on Tuesday toward being the first country in the world to legalize euthanasia. The lower chamber of parliament voted 104 to 40 to approve a bill allowing doctors to help patients die under strict conditions.

The law is expected to be put to a vote in the upper chamber next year. Approval there is seen as a formality. Australia's Northern Territory legalized medically assisted suicide for terminally ill patients in 1996, but repealed the law the following year. 

Supporters of the Dutch bill, including many doctors, say it champions patients' rights and brings a long-standing practice into the open. But the vote in parliament touched off a storm of protest. "Again, we are faced with a law of the state which opposes the natural law of human conscience," Vatican spokesman Joaquin Navarro-Valls told Reuters. Opponents in the Netherlands, including small Calvinist opposition parties, say they fear the proposed law could be abused. 

Some drew parallels with Nazi Germany. "The same line of reasoning is being used as in Germany in 1935...In the Netherlands, your life is no longer safe," said Bert Dorenbos of the Scream for Life group. "If doctors are not hesitating to kill people then they will not hesitate to withdraw medical treatment from people they do not like," he added. 


A series of court rulings and government guidelines since the 1970s has given more leeway to Dutch doctors to help a patient die, but the criminal code was never amended. That gray area left open the possibility of doctors being prosecuted for murder. The new law sets out strict guidelines, demanding that adult patients must make a voluntary, well-considered and lasting request to die and face a future of continuous and unbearable suffering. The doctor must have informed patients about their prospects and reached the firm conclusion there was no reasonable alternative. A second physician must be consulted. Sensitive to the controversy surrounding the law, the justice ministry warned that any doctors who did not follow the rules would be subject to prosecution. The Dutch Roman Catholic Church said the law would make it too easy for people to give up. "People who are ill but consider themselves a burden to their family, that's the problem," said Peter van Zoest, spokesman for the Bishops Conference. The main opposition Christian Democrats (CDA) and smaller Calvinist parties also opposed the law. A doctor at the German hospice foundation said the Dutch plan was "appalling." "...The Netherlands is the first country to legalize euthanasia since the Nazis," Monika Schweihoff said in a statement. "Euthanasia is not the only option -- qualified hospice staff can also help terminally ill patients slip away painlessly." . . . ."

bulletSOURCE: Tuesday, November 28, 2000   Dutch Approve Law on Mercy Killings, Protests Start By ERIC ONSTAD, Reuters  http://www.latimes.com/business/microsoft/20001128/tCB00a8261.html

BMJ 2001;322:509 ( 3 March )News  

bulletDutch GP found guilty of murder faces no penalty

 Tony Sheldon, Utrecht  A Dutch GP, found guilty of murdering a dying 84 year old patient, has not been penalised for his action. The Amsterdam court that tried him said that Dr Wilfred van Oijen had made an "error of judgment" but had acted "honourably and according to his conscience," showing compassion, in what he considered the interests of his patient. 

Van Oijen, who featured in the 1994 euthanasia television documentary, Death on Request (BMJ 1994;309:1107), argued that he chose "to let his patient die in the most ethical manner." 

The Royal Dutch Medical Association (KNMG) has defended his action as having "complete integrity," claiming a "huge emotional gulf" between it and the offence of murder.  The case turned on whether the injection of 50 mg of the anaesthetic drug alloferine into the patient, soon after which she died, could be considered part of palliative treatment. Expert witnesses said that it could not. Observers suggest that had the GP chosen a different drug this could have been considered normal medical practice.  The condition of Van Oijen's patient, for whom he had been a GP for 17 years, was described in court as "wretched."

 She was in "the very last stage of dying." She lay in a coma in a bed soaked in urine, her room stinking from bed ulcers and necrosis in her heel.  Both her daughters had urged Van Oijen to end their mother's suffering. She had had heart problems and osteoporosis for a long time, and during the last year was increasingly bedridden. Van Oijen had encouraged her to try to remain mobile while he relieved her pain with increasing doses of morphine. 

The court accepted there were "special circumstances," describing the treatment as "death shortening" but that the "criteria of care" required to avoid prosecution in euthanasia cases had not been followed. She had made no request for euthanasia and had said that she did not want to die.  Moreover, there had been no second medical opinion. Van Oijen also incorrectly reported that her death was from natural causes, for which he was also found guilty and given a suspended fine of 5000 guilders (£1430; $2140).

The public prosecution service had called for Van Oijen to be given a nine month suspended prison sentence.  Johan Legemaate, professor of health law at Rotterdam's Erasmus University, commenting on the case, said that the court recognised that the doctor had crossed a border between what is an entirely acceptable medical practice of relieving pain and what is legally defined as murder.  "It wrestled with that and finally decided that from a legal point of view this is murder, although entirely different from the normal criminal intention to kill." 

SOURCE: http://www.bmj.com/cgi/content/full/322/7285/509/a

bullet Doctor sets up "how to die" workshops in New Zealand

 BMJ 2001;322:315 ( 10 February ) News   Christopher Zinn, Sydney  The controversial Australian voluntary euthanasia advocate Dr Philip Nitschke is planning to extend his activities abroad by setting up clinics and "how to die" workshops in New Zealand.  But Dr Nitschke, who helped four terminally ill patients to legally kill themselves before the euthanasia laws in Northern Territory were overturned in 1997, is not leaving Australia.

 He is also setting up a laboratory in Darwin to which people can send samples of out of date prescription drugs such as barbiturates to find out if they are lethal. "It is a common thing for people to be stockpiling drugs in case they come in handy one day, to end their lives peacefully should the occasion arise," he said.  Dr Nitschke, who qualified in medicine at the age of 42 after an earlier doctorate in physics, is back in the news after Sydney police said they wanted to interview him about the apparent overdose of a 72 year old woman with cancer.  

Norma Hall, a member of the Voluntary Euthanasia Society, reportedly died after drinking a bottle of morphine prescribed by palliative care staff. Dr Nitschke, who was with her, has denied assisting her suicide, which is illegal.   Dr Nitschke said that he would apply for New Zealand medical registration and merely be advising patients on questions that they wanted answered. Counselling, aiding, or abetting suicide is illegal and has the same penalty as manslaughter.  "I won't be advising people to commit suicide at all," he said of his initial two week visit, when he will hold consultations with 16 patients. 

The New Zealand Medical Association, which is opposed to euthanasia, said there was nothing it could do to stop him. But the Doctors For Life group is seeking legal advice. "If we know he is giving specific advice to people then there will be grounds to move," said the group's president, Dr Kevin Fitzsimons. 

SOURCE: http://www.bmj.com/cgi/content/full/322/7282/315/a


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