The open practice of euthanasia in The Netherlands stood alone in the world until the government of the Northern Territories in Australia accepted the possibility of physician-assisted suicide. Even though the active ending of lives in The Netherlands is still a crime by law, the current practice allows it and acquits physicians if certain conditions have been met. Of the many facets of euthanasia, the teaching of this practice represents a further logical step. In this contribution, we intend to describe (...) the comprehensive teaching program of euthanasia of the Free University of Amsterdam's Postgraduate Family Medicine Program. Here students receive university-based training for 1 day a week in a cohort of 12 and on the job training for 4 days with individual family physicians for 2 consecutive years. We especially intend to portray the integration of euthanasia into the wider teaching of the process of counseling and aid of the dying. (shrink)

Hospital ethics committees in The Netherlands have had the unique responsibility of developing euthanasia policies for their institutions. Although each policy necessarily reflects a particular facility, family resemblances necessarily remain. In the interest of ethics committees outside The Netherlands that may soon face the same challenge, two such policies are presented here accompanied by commentary high-lighting their similarities and differences.

Important bioethcs changes are underway in the Netherlands that carry, for better or worse, far-reaching social consequences. The two major areas of change involve economics and containing soaring health costs and end-of-life care as reflected in several high-profile cases: in a decision handed down by the Dutch Supreme Court on reviewing the procedures for the termination of life, in the discussion surrounding The Groningen Protocol and the active ending of lives in neonatology, and in a report of a Royal Dutch (...) Medical Society's Committee on the role of physicians in ending life in cases of requests to die outside the area of terminal diseases. (shrink)

This book is the first comprehensive report and analysis of the Dutch euthanasia experience over the last three decades. In contrast to most books about euthanasia, which are written by authors from countries where the practice is illegal and therefore practised only secretly, this book analyzes empirical data and real-life clinical behavior. Its essays were written by the leading Dutch scholars and clinicians who shaped euthanasia policy and who have studied, evaluated and helped regulate it. Some of them have themselves (...) practised euthanasia. The book will contribute to the world literature on physician-assisted death by providing a comprehensive examination of how euthanasia has been practised and how it has evolved in one specific national and cultural context. It will greatly advance the understanding of euthanasia among both advocates and opponents of the practice. (shrink)

The debate on the ethical permissibility of euthanasia in medicine has a corollary in the ethical application of drugs. The overall moral limits of medical treatment apply evenly to the moral acceptability of the pharmacological aspect of the act of euthanasia. The pharmacological aspect of the act is of ethical importance not only for the person requesting an active ending of his or her life, but also for the grieving family. Keywords: effectivity, ideal euthanaticum, patient's/family's interest, pharmacology of euthanasia, routes (...) of application CiteULike Connotea Del.icio.us What's this? (shrink)

The approach to AIDS as a disease and a threat for social discrimination is used as an example to illustrate a conceptual thesis. This thesis is a claim that concerns what we call a medical issue or not, what is medicalised or needs to be demedicalised. In the friction between medicalisation and demedicalisation as discursive strategies the latter approach can only be effected through the employment of discourses or discursive strategies other than medicine, such as those of the law and (...) of economics. These discourses each realise different values, promote a different subject, and have a different concept of man. The concept of discourse is briefly outlined against concepts such as the linear growth concept of science and the growth model of science as changes in paradigm. The issue of testing for AIDS shows a conflict between the medical and the legal discourse and illustrates the title of our contribution: the human body as field of conflict between discourses. (shrink)

The approach to AIDS as a disease and a threat for social discrimination is used as an example to illustrate a conceptual thesis. This thesis is a claim that concerns what we call a medical issue or not, what is medicalised or needs to be demedicalised. In the friction between medicalisation and demedicalisation as discursive strategies the latter approach can only be effected through the employment of discourses or discursive strategies other than medicine, such as those of the law and (...) of economics. These discourses each realise different values, promote a different subject, and have a different concept of man. The concept of discourse is briefly outlined against concepts such as the linear growth concept of science and the growth model of science as changes in paradigm. The issue of testing for AIDS shows a conflict between the medical and the legal discourse and illustrates the title of our contribution: the human body as field of conflict between discourses. (shrink)

In pursuit of my ultimate objective of being in control of my self-deliverance at the time when my physical condition no longer warrants continuance, I have joined the Hemlock Society of Los Angeles. The Society urges its members to explore with their personal physicians this subject well in advance of the actual moment of necessity, and in particular the problem of acquiring a lethal dose of a drug that will provide a release consistent in quality with the degree of peace (...) and serenity sought in life. It is my hope that we can find a process commensurate with your moral and professional concerns which will allow us to collaborate. (shrink)

As the issue of assisted dying continues toward more expanded legal standing, we shift our primary focus from questions of patients' rights to the largely overlooked challenges that face physicians who elect to assist patients in ending their lives. Dr. Howard Grossman, a Manhattan internist and plaintiff in the unsuccessful New York lawsuit to the Supreme Court, came forward to say, “Anybody who has done it knows that it is a tremendous decision that you carry with you forever.”1 We focus (...) our attention on the psychological experience and philosophical conflicts faced by physicians engaged in physician-assisted dying. Based on those potential conflicts, we argue for a new model of the physician and patient relationship in assisted dying: a medical friendship. a. (shrink)

In spite of the seminal work A Philosophical Basis of Medical Practice, the debate on the task and goals of philosophy of medicine still continues. From an European perspective it is argued that the main topics dealt with by Pellegrino and Thomasma are still particularly relevant to medical practice as a healing practice, while expressing the need for a philosophy of medicine. Medical practice is a discursive practice which is highly influenced by other discursive practices like science, law and economics. (...) Philosophical analysis of those influences is needed to discern their effect on the goals of medicine and on the ways in which the self-image of man may be changed. The nature of medical practice and discourse itself makes it necessary to include different philosophical disciplines, like philosophy of science, of law, ethics, and epistemology. Possible scenario's of euthanasia and the human genome project in the USA and Europe are used to exemplify how philosopy of medicine can contribute to a realistic understanding of the problems which are related to the goals of medicine and health care. (shrink)

The growth of knowledge and its effects on the practice of medicine have been issues of philosophical and ethical interest for several decades and will remain so for many years to come. The outline of the present volume was conceived nearly three years ago. In 1987, a conference on this theme was held in Maastricht, the Netherlands, on the occasion of the founding of the European Society for Philosophy of Medicine and Health Care (ESPMH). Most of the chapters of this (...) book are derived from papers presented at that meeting, and for the purpose of editing the book Stuart Spicker, Ph. D., joined two founding members of ESPMH, Henk ten Have and Gerrit Kimsma. The three of them successfully brought together a number of interesting contribu tions to the theme, and ESPMH is grateful and proud to have initiated the production of this volume. The Society intends that annual meetings be held in different European countries on a rotating basis and to publish volumes related to these meetings whenever feasible. In 1988, the second conference was held in Aarhus, Denmark on "Values in Medical Decision Making and Resource Allocation in Health Care". In 1989, a meeting was held in Czestochowa, Poland, on "European Traditions in Philosophy of Medicine. From Brentano to Bieganski". It is hoped that these conferences and the books to be derived from them, will initiate a new European tradition, lasting well into the 21 st century! P. J. (shrink)

On April 10, 2001, after extensive committee deliberations, the Second Chamber of the Dutch Parliament passed a bill that was introduced in August 1999 legalizing physician-assisted death. The bill is officially called It was passed by a majority vote in the Second Chamber of Parliament and was supported by the majority parties constituting the present coalition government (i.e., liberals and socialists). Opposition to the law came mainly from a minority of Christian parties. In this report we explore the meaning of (...) this bill and describe some of its problematic and paradoxical items. (shrink)

This case is both an excellent as well as a sad illustration of the complexities, intensities, and foibles of the issue of sick people to die. Although the reaction expressed here is that of a student, it is also, sadly, the reaction of many an experienced physician in being emotional, irrational, and hasty. The description is a perfect example of the student's dilemma: —altruism versus egocentric motivation.

I disagree with what Reidar Lie has presented here, not because his presentation is deficient, but because the philosophy of the relationship between physician and patient is too narrow. First of all he paints a one-sided and distorted picture of American formulations and descriptions of the concept of autonomy, especially one aspect of it: informed consent. He concludes that autonomy is not an adequate basis for understanding the medical relationship. And then he ends his paper in a vacuum: a proposal (...) to actively explore and experiment with new ways of seeing and modelling this relationship without a program or a script, based on Foucault’s description of the relationship between knowledge and power. That statement causes some suspicion, because it is this relationship that was part of the abuse of patients and research subjects in the first place. (shrink)

Voluntary active euthanasia (VAE) and physician-assisted suicide (PAS) remain technically illegal in the Netherlands, but the practices are openly tolerated provided that physicians adhere to carefully constructed guidelines. Harsh criticism of the Dutch practice by authors in the United States and Great Britain has made achieving a balanced understanding of its clinical, moral, and policy implications very difficult. Similar practice patterns probably exist in the United States, but they are conducted in secret because of a more uncertain legal and ethical (...) climate. In this manuscript, we plan to compare end-of-life care in the United States and the Netherlands with regard to underlying values, justifications, and practices. We will explore the risks and benefits of each system for a real patient who was faced with a common end-of-life clinical dilemma, and close with challenges for public policies in both countries. (shrink)

ABSTRACT In 1991 the Dutch government released the results of the first national investigation into the nature and extent of decisions concerning end of life including euthanasia. A significant finding was that most cases of euthanasia were not reported. This prompted us to ask what effect, if any, not reporting caused. More specifically, we asked whether reporting has a positive or negative impact on the experiences of friends or relatives of patients who have received euthanasia. In cases of euthanasia, complications (...) of both process and experience can deter from a minimally complicated death. These difficulties arise when either the family or physician does not perceive the freedom to disclose euthanasia openly. On the basis of interviews with family members and patients, we illustrate that they generally benefit from reporting. Our premise is that reporting fosters open discussion of euthanasia. We further suggest physicians and society benefit from a milieu of openness initiated by reporting cases of euthanasia. (shrink)

Dutch developments on euthanasia have drawn much attention over the years. Defenders and opponents have been telling very different stories about the practice of euthanasia and the frequency of cases, and the Dutch government has been struggling with the legal and moral problems involved. Concern about the procedures followed by physicians as well as questions on the “real” figures led the government to decide to organize an epidemiological study on the extent and the decision making. The results of the study (...) were published in November 1991. Interpretation of the data may lead to a final settlement of the debate on euthanasia and has inevitably led to a revival of the moral debate of the 1970s. For the moment it has been decided that euthanasia will remain officially illegal under the Penal Code. However, in cases where euthanasia does occur, Attorneys General will continue to check the procedures followed by physicians to ensure no abuses have occurred and to safeguard physicians against prosecution. In this contribution, we discuss the development and intertwinement of legal, medical, and moral aspects of euthanasia in The Netherlands and the effects of the empirical studies of 1991, both on definitions and procedures for medical decisions at the end of life. (shrink)

ABSTRACTIn 1991 the Dutch government released the results of the first national investigation into the nature and extent of decisions concerning end of life including euthanasia. A significant finding was that most cases of euthanasia were not reported. This prompted us to ask what effect, if any, not reporting caused. More specifically, we asked whether reporting has a positive or negative impact on the experiences of friends or relatives of patients who have received euthanasia. In cases of euthanasia, complications of (...) both process and experience can deter from a minimally complicated death. These difficulties arise when either the family or physician does not perceive the freedom to disclose euthanasia openly. On the basis of interviews with family members and patients, we illustrate that they generally benefit from reporting. Our premise is that reporting fosters open discussion of euthanasia. We further suggest physicians and society benefit from a milieu of openness initiated by reporting cases of euthanasia. (shrink)

In this article I intend to describe an issue of the Dutch euthanasia practice that is not common knowledge. After some general introductory descriptions, by way of formulating a frame of reference, I shall describe the effects of this practice on patients, physicians and families, followed by a more philosophical reflection on the significance of these effects for the assessment of the authenticity of a request and the nature of unbearable suffering, two key concepts in the procedure towards euthanasia or (...) physician-assisted suicide. This article does not focus on the arguments for or against euthanasia and the ethical justification of physician-assisted dying. These arguments have been described extensively in Kimsma and Van Leeuwen (Asking to die. Inside the Dutch debate about euthanasia, Kluwer Academic Publishers, Dordrecht, 1998). (shrink)

Voluntary active euthanasia and physician-assisted suicide remain technically illegal in the Netherlands, but the practices are openly tolerated provided that physicians adhere to carefully constructed guidelines. Harsh criticism of the Dutch practice by authors in the United States and Great Britain has made achieving a balanced understanding of its clinical, moral, and policy implications very difficult. Similar practice patterns probably exist in the United States, but they are conducted in secret because of a more uncertain legal and ethical climate. In (...) this manuscript, we plan to compare end-of-life care in the United States and the Netherlands with regard to underlying values, justifications, and practices. We will explore the risks and benefits of each system for a real patient who was faced with a common end-of-life clinical dilemma, and close with challenges for public policies in both countries. (shrink)

The prelims comprise: Death and Democracy Political Philosophy and Choosing Death Historical Roots Brain Death Abortion and Decisions for Neonates and Other Children Letting Die and Terminal Sedation Euthanasia and Physician‐Assisted Suicide Conclusion Notes.

The development of neonatology and the establishment of neonatal intensive care units has led to a vast array of new medical ethical problems and dilemmas centered around discontinuing treatment or nontreatment decisions. Neonatology has become one of the fields that has made clear that medical success is only rarely nonproblematic. The new technology can be a blessing for some, but it may also become a sad experience to others, with life-long repercussions.The ethical problems of neonatology transcend national boundaries. Nevertheless, there (...) are differences in approach among various countries. In The Netherlands, the ethical deliberations have been a matter of public debate, but most of the decision making is left to the medical profession; these decisions are considered too harsh for the general public. Recently, two developments have emerged. The Royal Dutch Medical Association and the Dutch Pediatrics Society have published reports with guidelines and ethical reflections. Over the same period of time, cases have been brought to court for legal analysis and the development of case precedence. (shrink)

This chapter appeared in: G. J. van Nes et al. (eds.), Relational Anthropology for Contemporary Economics. Dordrecht: Springer, 121-132. -/- Abstract: This chapter is a comment on the contribution of Rebecca Klein in this volume, preceded by a conceptual analysis of the argument that is developed in the Homo Amans position paper. The main question that is raised is twofold and concerns the relation between science and worldview on the one hand, and between science and economic life on the other. (...) With respect to the science – worldview relationship, it is doubted that science can play the role the authors of the Homo Amans project expect it can have. What they have in mind is that science helps in validating and legitimizing a biblically informed concept of love. This author disagrees, to a large extent. Science can indeed orient itself on ideas and intuitions that are based on one’s worldview. But it cannot prove the truth of these intuitions and ideas. To think so, is to commit a naturalistic fallacy. With respect to the relationship between science and economic life, the author is also not convinced that science and philosophy as academic disciplines will by themselves be able (and should be expected to be able) to transform deeply ingrained, institutionally anchored economic practices. New theories, concepts, and paradigms are a precondition for change, but they do not bring about change by themselves. What is needed is a change in the practices themselves, a change that is both personal and comprehensive. What is needed is a clear, succinct, and encompassing view on the intrinsic normativity of economic interactions between relevant stakeholders in what we call ‘the’ economy. This is a huge undertaking, that requires painstaking ‘phenomenological’ analyses of a wide variety of economic practices. The chapter agrees with most of Klein’s observations and concerns with respect to the position paper. These observations and concerns gain even more depth and relief given the conceptual distinctions that are made in the chapter. (shrink)

Der Einladung von Bernard Tschumi folgend kommt es in den Jahren 1985 bis 1987 zu einer engen Zusammenarbeit zwischen Jacques Derrida und Peter Eisenman für ein Teilareal des Parc de la Villette in Paris. Wenige Jahre später gilt Derrida als meistzitierter Philosoph in der Architektur. Dieser hohen Präsenz im allgemeinen Diskurs steht die wissenschaftliche Auseinandersetzung bislang nach. Der vorliegende Band zum Philosophischen Entwerfen setzt sich zum Ziel, die Bedeutung der Architektur in Derridas Schriften systematisch aufzuarbeiten. Ausgangspunkt hierfür bildet die eingehende (...) Lektüre der Gesamtheit dieser Schriften. Darauf aufbauend wird nachgezeichnet, inwieweit Derrida sich der Architektur annähert, sich mit dieser auseinandersetzt und davon ausgehend Möglichkeiten eines Weiterdenkens aufzeigt. Fordert Derrida gegenüber Eisenman bisweilen eine Rückbesinnung auf ein grundlegendes Denken ein, wie er es beispielhaft bei Vitruv aufgreift, wendet er seinen Blick zugleich voraus und formuliert den Anspruch, nicht mehr allein konzeptuell, sondern im Stein zu denken: ohne Nostalgie, der lebendigste Gedächtnisakt! (shrink)

The development and management of the Covid-19 outbreak in the Netherlands is described. The “intelligent lockdown” was aimed at minimizing new infections and limiting the number of deaths, while keeping the economy running as much as possible. Changes in consumer behavior, exit strategy, and lessons learned are considered.

1. Cornelius Valerius en Sebastianus Foxius Morzillus als bronnen van Coornhert.