van der Wal G, van der Maas P J, Bosma J M, Onwuteaka-Philipsen B D, Willems D L, Haverkate I, Kostense P J
Institute for Research in Extramural Medicine, Vrije Universiteit Amsterdam, the Netherlands.
N Engl J Med. 1996 Nov 28;335(22):1706-11. doi: 10.1056/NEJM199611283352228.
In the Netherlands, a notification procedure for physician-assisted death has been in use since 1991. It requires doctors to report each case to the coroner, who in turn notifies the public prosecutor. Ultimately, the Assembly of Prosecutors General decides whether to prosecute. Although physician-assisted death remains technically illegal, doctors are extremely unlikely to be prosecuted if they comply with the requirements for accepted practice. In 1995, the ministers of health and justice commissioned an evaluation to determine the adequacy of the notification procedure.
A random sample of 405 physicians were interviewed. We also interviewed 147 physicians who had reported cases of physician-assisted death and 116 coroners, and we reviewed 353 judicial files of reported cases. In addition, we interviewed 48 public prosecutors and reviewed the minutes of the Assembly of Prosecutors General for 1991 to 1995 and all published court decisions from 1981 through 1995.
In 1995, about 41 percent of all cases of euthanasia and physician-assisted suicide were reported. There were no major differences between reported and unreported cases in terms of the patients' characteristics, clinical conditions, or reasons for the action. Most patients had cancer and were described as suffering "unbearably" and 'hopelessly." Of the 6324 cases reported during the period from 1991 through 1995, only 13 involved prosecution of the physician. The majority of respondents in the groups interviewed thought that all cases of physician-assisted death should be reviewed, although most doctors thought the review should be performed by other doctors, and there was substantial concern about the burden associated with the reporting procedure.
Substantial progress in the oversight of physician-assisted death has been achieved in the Netherlands. The reporting procedure could be more streamlined and less threatening.
自1991年起，荷兰开始实施医生协助死亡的通报程序。该程序要求医生将每一起病例报告给验尸官，验尸官再通知检察官。最终，总检察长会议决定是否进行起诉。尽管从技术层面上讲，医生协助死亡仍然是非法的，但如果医生符合公认做法的要求，被起诉的可能性极小。1995年，卫生部长和司法部长委托进行了一项评估，以确定通报程序是否充分。
对405名医生进行了随机抽样访谈。我们还采访了147名报告过医生协助死亡病例的医生和116名验尸官，并查阅了353份已报告病例的司法档案。此外，我们采访了48名检察官，查阅了1991年至1995年总检察长会议的会议记录以及1981年至1995年所有已公布的法院判决。
1995年，所有安乐死和医生协助自杀病例中约41%被报告。在患者特征、临床状况或采取行动的原因方面，已报告病例和未报告病例之间没有重大差异。大多数患者患有癌症，被描述为“无法忍受地”和“绝望地”受苦。在1991年至1995年期间报告的6324例病例中，只有13例涉及对医生的起诉。接受访谈的大多数受访者认为，所有医生协助死亡的病例都应接受审查，尽管大多数医生认为应由其他医生进行审查，并且人们对报告程序带来的负担深感担忧。
荷兰在医生协助死亡的监督方面取得了重大进展。报告程序可以更加简化，威胁性更小。
