The Netherlands and Euthanasia

Please allow me to react to some remarks about the Netherlands policy on euthanasia in "Oregon Revisits Assisted Suicide Debate" (Aug. 19).

In the Netherlands, both euthanasia and assisted suicide are considered a crime under the penal code. Only when a physician follows a strict set of criteria can the public prosecutor decide not to prosecute:

* The patient made voluntary, carefully considered, repeated, and explicit requests for euthanasia or assisted suicide.

* The physician and the patient had a long-term relationship of trust.

* The patient's suffering, according to prevailing medical opinion, was unbearable and without prospect of improvement.

* The physician and the patient had considered and discussed alternatives to euthanasia and assisted suicide.

* The physician consulted at least one other physician for a second opinion about the diagnosis and prognosis.

Critics of euthanasia and assisted suicide often use the Netherlands experience to claim that euthanasia and assisted suicide will always lead to abuses. Unfortunately, these comments on the Netherlands policy are often inaccurate, incomplete, and sometimes even misleading.

In the Netherlands two large empirical studies on medical decisions concerning the end of life have been conducted. The last report, published in November 1996, finds that in the Netherlands there are about 135,000 deaths a year, of which more than 96 percent occur from natural causes. Medical actions to terminate life caused 3.4 percent of deaths, of which 2.4 percent involved euthanasia and 0.3 percent assisted suicide.

Most criticism to the Netherlands policy arises from the 0.7 percent of cases in which the life of the patient is terminated without a (recent) explicit request. But that criticism often overlooks important background information. In 75 percent of these cases, euthanasia and assisted suicide have been discussed with the patient and family. Circumstances, most often a speedy and irreversible deterioration of the patient's health, precluded the patient from making an explicit request. In more than 90 percent of these cases, life was shortened by a few hours or days at most.

It is clear that Dutch physicians make medical decisions concerning the end of life with the utmost care and that there is no increase in actions to terminate life among vulnerable categories of patients or less seriously ill patients.

In fact, the New England Journal of Medicine concluded in a November 1996 editorial that there is no scientific basis to assert that the Netherlands policy has led to abuses.

Herbert Barnard


Counselor for Health and Welfare

Royal Netherlands Embassy

Common sense, not regulation

Regarding the opinion-page article "The Right Way to Accommodate Religion at Work" (Aug. 19): The president's guidelines for religious speech and behavior in the federal workplace are atrocious. Has he (or the guidelines' authors) any idea of what a supervisor and manager face in the workplace?

The workplace, particularly at government levels, is loaded with restrictions and guidelines that greatly hamper the supervisor from accomplishing the task at hand.

Whatever happened to common sense? Tell the supervisor to use his. When an employee objects, he has the option to appeal to the manager or his union representative.

Religious discussion should be treated by a supervisor no differently than any other discussions, the criterion being: What adverse effect is this having on the task of the work group? The same "rights" and "obligations" of the employee apply regardless of the nature of the conversation or behavior.

Bring back common sense, not a whole passel of regulations.

Richard P. Schneider

Springfield, Va.

Your letters are welcome. Letters should be mailed to "Readers Write," One Norway St., Boston, MA 02115, faxed to 617-450-2317, or e-mailed (200 words maximum) to oped@csps.com.

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