Dutch doctors call for new approach to reporting "mercy killings"
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《英国医生杂志》
Dutch paediatricians are urging that all decisions taken to hasten the death of babies born with severe multiple handicaps should be reported initially to committees of doctors and lawyers after the child抯 death rather than directly to the coroner抯 office, as currently required under Dutch law.
The Dutch Paediatric Society believes this approach would be less threatening than the current requirement, and thinks it would encourage the more frequent reporting of cases, thus achieving greater transparency and supervision of what currently remains a largely secretive practice.
Mercy killing of new born babies, along with any patient deemed incompetent to express their wishes, is not covered by Dutch law permitting euthanasia, as a key requirement of the law on euthanasia is a request from the patient.
Research suggests that in about 100 cases each year paediatricians make decisions that result in the death of babies with severe multiple handicaps. Most decisions involve instituting palliative care only, or withholding treatment, but in about 20 of these cases the paediatrician will, after consultation with both parents, choose to end the child抯 life with a fatal injection.
Only two or three cases are reported each year to a local coroner, even though the current law requires all such cases to be reported. In 10 years, only two cases have reached the courts.
The Dutch Society of Paediatrics believes that its proposed approach would be less threatening and would encourage reporting of what remains a largely secretive practice. This would provide greater transparency, permitting external supervision.
Louis Koll閑, professor of paediatrics at the University Medical Centre Saint Radboud, Nijmegen, chairs the society抯 ethics committee and fears that currently all forms of life ending treatment are 搃nvisible.?
Professor Koll閑 believes that decisions are taken carefully but that they are made by doctors, nurses, and parents: 揥e think society also has a right to know what is happening. Such societal control can guarantee the quality of decisions.?
The proposal, which embraces withdrawing or withholding treatment and increasing pain relief as well actively ending life, is contained in a letter from the Royal Dutch Medical Association抯 chairman, Dr Peter Holland, to the state secretary for health, Cl閙ence Ross.
Dr Holland argues that an 揳dequate procedure?for judging all 搇ife ending treatment without a request?is lacking. Over the past 15 years the Royal Dutch Medical Association and the Dutch Society of Paediatrics have developed guidelines for careful practice in this area. But without greater transparency the profession cannot ensure they are applied or brought up to date, he says.
The association believes a multidisciplinary committee of doctors, lawyers, and ethicists could achieve this transparency. Professor Koll閑 says that if all cases went through such a committee, which in turn anonymously published its decisions, it could act as an important point of reference both for doctors and parents. 揥e don抰 want to change the law. The public prosecutor can always have the last word. We just want to screen cases so that doctors stick to the requirements of good medical practice,?he argued.
The government is committed to reviewing its whole policy regarding doctors 揺nding life without a request?before the end of the year. Research commissioned by the government into its euthanasia policy indicates about 900 such cases year. These include all patients not able to make a request, such as coma patients or elderly people who are terminally ill with hours to live, as well as severely handicapped newborn babies (Lancet 2003;263:395-9).(Utrecht Tony Sheldon)
The Dutch Paediatric Society believes this approach would be less threatening than the current requirement, and thinks it would encourage the more frequent reporting of cases, thus achieving greater transparency and supervision of what currently remains a largely secretive practice.
Mercy killing of new born babies, along with any patient deemed incompetent to express their wishes, is not covered by Dutch law permitting euthanasia, as a key requirement of the law on euthanasia is a request from the patient.
Research suggests that in about 100 cases each year paediatricians make decisions that result in the death of babies with severe multiple handicaps. Most decisions involve instituting palliative care only, or withholding treatment, but in about 20 of these cases the paediatrician will, after consultation with both parents, choose to end the child抯 life with a fatal injection.
Only two or three cases are reported each year to a local coroner, even though the current law requires all such cases to be reported. In 10 years, only two cases have reached the courts.
The Dutch Society of Paediatrics believes that its proposed approach would be less threatening and would encourage reporting of what remains a largely secretive practice. This would provide greater transparency, permitting external supervision.
Louis Koll閑, professor of paediatrics at the University Medical Centre Saint Radboud, Nijmegen, chairs the society抯 ethics committee and fears that currently all forms of life ending treatment are 搃nvisible.?
Professor Koll閑 believes that decisions are taken carefully but that they are made by doctors, nurses, and parents: 揥e think society also has a right to know what is happening. Such societal control can guarantee the quality of decisions.?
The proposal, which embraces withdrawing or withholding treatment and increasing pain relief as well actively ending life, is contained in a letter from the Royal Dutch Medical Association抯 chairman, Dr Peter Holland, to the state secretary for health, Cl閙ence Ross.
Dr Holland argues that an 揳dequate procedure?for judging all 搇ife ending treatment without a request?is lacking. Over the past 15 years the Royal Dutch Medical Association and the Dutch Society of Paediatrics have developed guidelines for careful practice in this area. But without greater transparency the profession cannot ensure they are applied or brought up to date, he says.
The association believes a multidisciplinary committee of doctors, lawyers, and ethicists could achieve this transparency. Professor Koll閑 says that if all cases went through such a committee, which in turn anonymously published its decisions, it could act as an important point of reference both for doctors and parents. 揥e don抰 want to change the law. The public prosecutor can always have the last word. We just want to screen cases so that doctors stick to the requirements of good medical practice,?he argued.
The government is committed to reviewing its whole policy regarding doctors 揺nding life without a request?before the end of the year. Research commissioned by the government into its euthanasia policy indicates about 900 such cases year. These include all patients not able to make a request, such as coma patients or elderly people who are terminally ill with hours to live, as well as severely handicapped newborn babies (Lancet 2003;263:395-9).(Utrecht Tony Sheldon)