Dutch perspectives on palliative care in the Netherlands

Issues in Law & Medicine, Fall, 2002 by Raphael Cohen-Almagor

As for the second-phase of my research, seven of the interviewees answered the two queries via electronic or regular mail. Four other interviewees discussed these questions with me over the phone for ten to twenty minutes while in the Netherlands. Six of the other interviewees I met in Amsterdam for discussions that lasted from forty to 120 minutes each. The meetings took place either in the interviewees' offices or in restaurants. During these discussions some of the interviewees raised further issues of concern, one of them was the current improvement in palliative care.

The Question and Interviewees' Responses

The question was posed as follows: It has been argued that the policy and practice of euthanasia in the Netherlands is the result of undeveloped palliative care. What do you think? I also mentioned the fact that there are only a few hospices in the Netherlands.

This is, of course, a loaded, critical question. It speaks of a possible link between the euthanasia practice and the lack of adequate palliative care treatment. Many interviewees agreed with the critical tone. (25) Almost all of those agreeing with it said that only during the late 1990s were people beginning to admit that there was a need to improve palliative care. Today there are pain specialists in nursing homes and hospitals. Despite the increased investment in palliative care on the part of the government, the interviewees argued that still more attention should be paid to it, especially in medical schools and hospitals. Some interviewees insisted that doctors first need to explore other options for helping the patient prior to choosing the course of euthanasia. (26)

Arie van der Arend, a nurse and medical ethicist from Maastricht, argues that there is a balance between cases of euthanasia and the quality of palliative care. If there is poor palliative care, then the number of euthanasia cases will increase, and vice versa. Van der Arend suggests including in the Guidelines a requirement to provide good palliative care before considering euthanasia. He maintains that the quality of palliative care in the Netherlands is not high enough and that physicians are lacking the information on how to give palliative care because it is not part of medical education. There is also a need to increase the number of hospices in the country.

Henk Jochemsen, Director of the Professor Lindeboom Institute, notes that only the Catholic University of Nijmegen has a professor for pain relief. (27) Jochemsen, a Calvinist bioethicist, also sees this as an indication of the place of palliative care in the Netherlands. He argues that when the discussion on euthanasia evolved during the 1970s and 1980s, the field of palliative care was developed in many parts of the world. In the Netherlands, there was no room for both concepts to develop simultaneously and as euthanasia became an accepted practice, palliative care was pushed aside. Jochemsen maintained that the Guidelines are not precise enough, explaining that the KNMG (Royal Dutch Medical Association) statement depicts the performance of euthanasia only as a last resort. If we follow this statement seriously, then it means that the general practitioners performing euthanasia need to consult a palliative care expert prior to the mercy killing. But GPs are not equipped to decide on the various alternatives designed to alleviate suffering. (28) Furthermore, if the patient is suffering mentally, then the GP has to consult a psychiatrist. Jochemsen thinks that the government and the KNMG have recently put more emphasis on palliative care. (29)