The 2018 official euthanasia figures in the Netherlands are down by 7% for the first time since 2003. Given the size of the elderly population, this is an astonishing trend.
Until the Ministry of Health, Welfare and Sport publishes its report, several hypotheses are being put forward. Although Jacob Kohnstamm – chairman of the Dutch regional euthanasia review committees –cites an influenza outbreak in early 2018, which may have counterbalanced requests for euthanasia, other reasons are given.
The first, which is very widely accepted, is linked to legal proceedings for negligence brought by the Ministry of Justice and Security against doctors who have carried out euthanasia (see The Netherlands – first doctor sued for euthanasia of dementia patient). This had not happened since 2002 and has created quite a stir at home and abroad. These proceedings and investigations have alarmed doctors, who had not considered the potential legal consequences of their actions. Steven Pleiter, director of the End of Life Clinic, said the announcement was “a terrible shock for doctors” (see Reduction in the number of euthanasias performed in the Netherlands: doctors are “increasingly suspicious”). Moreover, the clinic’s website explains that “for fear of criminal prosecution, doctors have become even more cautious”.
Another explanation is floating around in conversations. A 2015 government study shows that 19% of euthanasia cases were not officially reported. The reason given is that all cases are apparently not considered by doctors to constitute euthanasia or assisted suicide. With the use of morphine, for example, they believe it is not always possible to determine whether or not it has shortened life.
It has been shown that doctors are more likely to report euthanasia if a second doctor was consulted during the patient’s lifetime. In 93% of undeclared euthanasia cases, no second doctor was consulted. In addition, 10% of doctors regard the reporting process as time-consuming, 5% consider it cumbersome, and 8% are reportedly in favour of abolishing it.
Now that doctors may face legal consequences, it is also in their interests not to file a report.
Whatever the explanation for this decrease, it does not seem to have brought about a change of culture in the Netherlands. Demand remains high. Figures for the first quarter of 2019 actually show a 9% increase in reported cases of euthanasia. For Kohnstamm, 2018 “may well be an exception”.
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