Dutch perspectives on palliative care in the Netherlands

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

The Ministry of Health, Welfare and Sport announced that the government has set aside NLG 7 million a year for a period of five years to improve palliative care. Some of this money is used for research and some of it to find ways of increasing the scope for its use in the closing stages of life. Six teaching hospitals have set up centers for the development of palliative care. Some of these centers have expert teams of consultants who can answer questions from GPs, nurses and home care providers about patient care. (54)

Conclusions

The interviewees revealed mixed views on the place of palliative care in the Netherlands. Some think that the field is not adequately developed, whereas others seemed quite content with the situation. Evert van Leeuwen is a member of one of the regional committees whose role is to review reported euthanasia cases and to see that the rules of carefulness were observed. His committee had reviewed some three hundred cases by the time of the interview, and in most of these cases the Guidelines had been observed. In a small number of cases (between four and eight), the requests were very clear, the physicians could do nothing to help, and the patients were suffering, but were not on the verge of death; they still had four to six months to live. Van Leeuwen felt that these were cases in which palliative care could have helped. (55)

It seems that the developed practice of euthanasia came at the expense of developing adequate palliative care. Only during the last few years, the Netherlands has started to invest in this sphere. This is a very positive development. Many times patients may contemplate ending their lives because they are unable to cope with their pain. Once good palliative care is developed we may expect that the number of euthanasia requests will be reduced, this is provided that general practitioners will offer this option first and not euthanasia, and that they are able to provide good palliative care to their patients, or at least refer them to palliative care experts. Even when cure of the underlying disease is not possible, there is still much that medical teams can do to relieve physical and psychological suffering. (56) The entire euthanasia practice could be transformed for the better once nursing-home doctors, specialists, and especially general practitioners will be aware of the positive consequences of good palliative care at the end of life.

Appendix

Interviews in the Netherlands (summer 1999)

Professor John Griffiths, Dep't of Legal Theory, Faculty of Law, University of Groningen (Groningen, July 16, 1999).

Professor Evert van Leeuwen, Dep't of Metamedicine, Free University of Amsterdam (Amsterdam, July 19, 1999; Haarlem, July 28, 1999).

Dr. Dick Willems, Institute for Research in Extramural Medicine, Dep't of Social Medicine, Free University of Amsterdam (Amsterdam, July 20, 1999).

Professor Bert Thijs, Medical Intensive Care Unit, VU Hospital, Amsterdam (Amsterdam, July 20, 1999).

Professor H.J.J. Leenen, formerly Professor of Social Medicine and Health Law, Medical Faculty and Faculty of Law, University of Amsterdam (Amsterdam, July 21, 1999).