New penalties proposed for Dutch doctors who flout euthanasia law
http://www.100md.com
《英国医生杂志》
Doctors could face a wider range of penalties in future for breaking the Netherlands?legal guidelines on euthanasia and assisted suicide, as part of a package of government measures designed to tighten its policy on "life-ending treatment."
The government is worried that although research indicates doctors carry out about 3500 cases of euthanasia a year they only report about half that number to the authorities.
At the moment the public prosecution service makes a distinction between cases where doctors disregard "procedural" guidelines, such as failing to consult an independent second doctor, and cases where doctors ignore more weighty "material" guidelines, such as the need for a voluntary and well considered request. The service thinks that criminal action is "disproportionate" for the first category.
Health minister Cl閙ence Ross wishes to introduce a "medical disciplinary" approach for doctors in the first category. Under the new approach the Healthcare Inspectorate will be able to reprimand, suspend, or fine doctors who disregard procedural guidelines. Ms Ross is to hold talks with the Healthcare Inspectorate on how it can deal with these cases.
Further measures will "promote transparency" and "create clarity" over the guidelines. The judgments of the regional euthanasia committees of doctors, lawyers, and ethicists, to whom doctors must report their actions, are to be published anonymously in a databank.
The national network of 500 general practitioners who have been specially trained to act as expert consultants on euthanasia will be strengthened. Hospitals and other healthcare institutions are to be urged to appoint a euthanasia consultant and to establish clear policies so that difficult "medical decisions at the end of patients?lives" can be discussed more openly.
Research will be launched as soon as possible to discover whether the falling number of reported cases reflects a genuine decline in the number of cases.
Meanwhile discussions are continuing with the medical profession over questions of "ending life without a request"—in cases of terminal sedation, for example, where a dying patient is given pain relief that induces a permanent coma.
The government has taken a year to evaluate its policy after research it commissioned from a team headed by Paul van der Maas, professor of social policy at Rotterdam抯 Erasmus Medical Centre, and Gerrit van der Wal, professor of social medicine at Amsterdam Free University Medical. Their study, which was based on questionnaires sent to doctors concerning 5500 deaths and on confidential interviews with about 600 doctors, showed that since 1996 reporting of euthanasia cases had increased, but only from 41% to 54%. Overall, researchers estimate that 3500 cases of euthanasia and 300 cases of assisted suicide took place in 2001, compared with 3200 cases of euthanasia and 400 of assisted suicide in 1995 (BMJ 2003;326:1164).
In May this year the euthanasia testing committees announced that for the fourth successive year Dutch doctors have reported fewer cases of euthanasia and assisted suicide. The number of reported cases fell from 2123 in 2000 to 1815 cases in 2003 (5 June, p1336). In 2001, when researchers estimate that about 3800 cases of euthanasia and assisted suicide took place, only 2054 cases (54%) were reported.
With regard to the belief that doctors are not fulfilling their legal obligations Ms Ross stressed that doctors "must report." Her new proposals, she argued, will create "greater clarity around euthanasia decisions for doctors and patients."(Utrecht Tony Sheldon)
The government is worried that although research indicates doctors carry out about 3500 cases of euthanasia a year they only report about half that number to the authorities.
At the moment the public prosecution service makes a distinction between cases where doctors disregard "procedural" guidelines, such as failing to consult an independent second doctor, and cases where doctors ignore more weighty "material" guidelines, such as the need for a voluntary and well considered request. The service thinks that criminal action is "disproportionate" for the first category.
Health minister Cl閙ence Ross wishes to introduce a "medical disciplinary" approach for doctors in the first category. Under the new approach the Healthcare Inspectorate will be able to reprimand, suspend, or fine doctors who disregard procedural guidelines. Ms Ross is to hold talks with the Healthcare Inspectorate on how it can deal with these cases.
Further measures will "promote transparency" and "create clarity" over the guidelines. The judgments of the regional euthanasia committees of doctors, lawyers, and ethicists, to whom doctors must report their actions, are to be published anonymously in a databank.
The national network of 500 general practitioners who have been specially trained to act as expert consultants on euthanasia will be strengthened. Hospitals and other healthcare institutions are to be urged to appoint a euthanasia consultant and to establish clear policies so that difficult "medical decisions at the end of patients?lives" can be discussed more openly.
Research will be launched as soon as possible to discover whether the falling number of reported cases reflects a genuine decline in the number of cases.
Meanwhile discussions are continuing with the medical profession over questions of "ending life without a request"—in cases of terminal sedation, for example, where a dying patient is given pain relief that induces a permanent coma.
The government has taken a year to evaluate its policy after research it commissioned from a team headed by Paul van der Maas, professor of social policy at Rotterdam抯 Erasmus Medical Centre, and Gerrit van der Wal, professor of social medicine at Amsterdam Free University Medical. Their study, which was based on questionnaires sent to doctors concerning 5500 deaths and on confidential interviews with about 600 doctors, showed that since 1996 reporting of euthanasia cases had increased, but only from 41% to 54%. Overall, researchers estimate that 3500 cases of euthanasia and 300 cases of assisted suicide took place in 2001, compared with 3200 cases of euthanasia and 400 of assisted suicide in 1995 (BMJ 2003;326:1164).
In May this year the euthanasia testing committees announced that for the fourth successive year Dutch doctors have reported fewer cases of euthanasia and assisted suicide. The number of reported cases fell from 2123 in 2000 to 1815 cases in 2003 (5 June, p1336). In 2001, when researchers estimate that about 3800 cases of euthanasia and assisted suicide took place, only 2054 cases (54%) were reported.
With regard to the belief that doctors are not fulfilling their legal obligations Ms Ross stressed that doctors "must report." Her new proposals, she argued, will create "greater clarity around euthanasia decisions for doctors and patients."(Utrecht Tony Sheldon)