The person from Porlock. Ethical issues in terminal care: the Dutch perspective

In the Netherlands medical decisions concerning end of life (MDEL) play a role in 38% of all deaths. Euthanasia, defined as an intentional termination of life by somebody else at an individual's request, is done in 1.8% of deaths. Only 4% of Dutch physicians would never perform or refer for euthanasia, and over 50% have performed euthanasia. Around 25,000 Dutch patients per year bring up euthanasia as a possibility in case suffering becomes unbearable; around 10% will finally have euthanasia performed. On the basis of these opinions and data the Dutch legislation has recently been reformed. Euthanasia remains a crime and each case will be reviewed by the district attorney. Court decisions, however, have confirmed the view that in some cases of euthanasia the physician may be confronted with conflicting obligations and therefore will not be punished. As a consequence, cases fulfilling a number of requirements will not be prosecuted. In conclusion, MDEL including euthanasia are considered ethically justifiable and legally permissible if they are part of an open, honest and careful approach to patients with unbearable suffering, in particular in the case of cancer.