The Regulation of Euthanasia and Related Medical Procedures that Shorten Life in the Netherlands

The Dutch political discussion concerning euthanasia has concentrated on whether there are situations in which euthanasia should be legalised and how these should be defined. An equally important question has been largely ignored: under what conditions is legal regulation of euthanasia likely to be effective? Looked at from this perspective of effective control, the available empirical data lead to a rather different interpretation and to rather different concerns from those that so far have played a role in the political discussion. Euthanasia does not seem to deserve the attention that has been lavished on it. Neither in terms of its frequency nor in terms of the procedural safeguards with which it is surrounded does it seem to pose a substantial problem of control. On the other hand, other medical procedures which, like euthanasia, intentionally shorten a patient's life surely warrant more attention than they have received. These other procedures are much more frequent than euthanasia and, because they are deemed ‘normal medical practice’, are attended by more limited procedural safeguards. Furthermore, because a given procedure can often be constructed either as ‘euthanasia’ or as one of the related procedures, effective regulation of euthanasia in isolation from the others is not possible. Given an encompassing regulation of all medical procedures that shorten life, control can best be entrusted, at least in the first instance, to the medical profession itself and the substantive norms that govern euthanasia can perhaps largely be left to the patient and his or her family and doctor.