Dutch perspectives on palliative care in the Netherlands

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

Ruud ter Meulen, Director of the Institute for Bioethics at the University of Maastricht, argues that the criticisms are correct: Euthanasia is practiced too quickly because palliative care is not a real option. The acceptance of euthanasia has led to the undermining of palliative care. (30) There are only two or three hospices in the Netherlands, and palliative care in nursing homes remains undeveloped. Hospitals, though somewhat more advanced than nursing homes, still have a long way to go. In comparison, Belgium, for instance, boasts a far better practice of palliative care.

The most vocal critic of euthanasia was G.F. Koerselman, a renowned psychiatrist, (31) who asserted that with adequate palliative care, euthanasia becomes unnecessary. Good palliative care enables people to continue living and coping with suffering without opting for euthanasia. Koerselman stated that "palliative care is absolutely under-developed. None of our medical faculties has a professor of palliative care. There are no palliative care experts in academic hospitals." (32)

Evert van Leeuwen, Chairperson of the Department of Metamedicine at the Free University of Amsterdam, and Egbert Schroten, Director of the Center for Bioethics and Health Law at Utrecht University, explained that until the 1980s it was argued that specialists in palliative care were not needed. (33) Consequently, new developments in the field were not adopted, and the issue was left quite neglected. During the 1990s, the idea of using palliative care experts became increasingly accepted, but there remains much to do in this area. James Kennedy, (34) an historian who studies the origins of the euthanasia policy, clarified that there are very few hospices in the Netherlands because home care is the prevalent phenomenon and the role of the GP in providing care is conceived to be sufficient. (35) It should be noted that Paul van der Maas contests this view. He wrote in his comments that the low number of hospices in the Netherlands is attributable not to the specific role of the GP, but to the fact that many nursing homes have specialized departments for end-of-life care. (36)

Likewise, Ron Berghmans, a medical ethicist at Maastricht, argued that palliative care is well-developed in nursing homes, where care for spiritual and psychological needs is provided in addition to care for physical needs. (37) In contrast, palliative care is less developed in the practice of individual GPs. Berghmans did not believe that palliative care would eliminate euthanasia. At most, it might decrease the number of requests. He also doubted whether the policy and practice of euthanasia had actually frustrated the development of palliative care. Berghmans confirmed that recently the government had stimulated the development of palliative care by making available large amounts of money for universities to develop units and expertise in the field. It is intended that these trained experts will provide consultation to GPs who deal with terminal patients. (38)