Little change in Dutch euthanasia post-legality

AMSTERDAM – The frequency of doctor-assisted euthanasia in the Netherlands has changed little since the longstanding practice was legalized in 2002, according to a new study.

A summary published Wednesday on The Lancet magazine's website said that "in 2010, of all deaths in the Netherlands, 2.8 percent were the result of euthanasia. This is higher than the 1.7 percent in 2005, but comparable with (levels seen) in 2001 and 1995."

Under Dutch law, a person who asks to die may be administered a lethal mixture of sedatives and muscle relaxants if two doctors agree he or she is suffering "unbearable" pain with no prospect for recovery. Most cases involve cancer victims.

The Lancet study used data from the country's death registry and sent confidential questionnaires to doctors, extrapolating results to represent a cross-section of deaths in different social, medical and geographical areas. Researchers used the same methodology as in previous studies in 1990, 1995, 2001 and 2005.

Dutch doctors are also required to report all euthanasia cases on a non-confidential basis to the country's Euthanasia Commission, but that yields numbers that are widely believed to underreport the total number of euthanasia cases in the country.

All cases sent to the Euthanasia Commission are reviewed by a panel of experts, and some cases each year lead to official sanctions for doctors who fail to follow the rules, or even criminal prosecutions in a handful of cases.

According to commission data, there were 3,136 euthanasia cases in 2010, out of 136,000 deaths countrywide recorded by the Central Bureau for Statistics. That suggests a euthanasia rate of about 2.3 percent, less than the 2.8 percent found in the Lancet study. The total Dutch population is around 16.3 million.

"In the Netherlands, the euthanasia law resulted in a relatively transparent practice," wrote the Lancet study's lead author Bregje Onwuteaka-Philipsen. "Although translating these results to other countries is not straightforward, they can inform the debate on legalization of assisted dying in other countries."

One other noteworthy finding of the Lancet study was that the number of cases of "palliative sedation" — where a person is kept deeply sedated to relieve suffering until he or she dies of natural causes — has risen since 2005. Such deaths, which are very common in medical settings in countries where euthanasia is not allowed, made up 12.3 percent of Dutch deaths in 2010, compared to 8.2 percent in 2005.