Death and Medical Power : An Ethical Analysis

Since the 1970s, euthanasia has been a topic of continual debate worldwide. This book presents a detailed description of the debate as well as a critical analysis of the most salient aspects of euthanasia practice in the Netherlands. The authors argue that euthanasia should be understood within a historical context as a protest against medical power. The book explores many of the arguments about the Dutch "experiment" that are relevant to other countries currently considering legislation in this area.

Henk ten Have is based at UNESCO in Paris.

Jos Welie is an associate professor at the Center for Health Policy and Ethics at Creighton University, Nebraska.

Series editor's preface

ix

Introduction

1

(4)

1 Euthanasia and medical power

5

(17)

The Postma case

5

(1)

The Dutch euthanasia debate

6

(2)

Beginnings of the euthanasia movement

8

(1)

The verdict

9

(1)

Expansion of the debate

10

(3)

The lack of a theoretical foundation for euthanasia

13

(2)

Dutch euthanasia as a contradiction of respect for patient autonomy

15

(2)

Euthanasia as hindrance to a good death

17

(2)

A framework of queries

19

(3)

2 The growth of medical power

22

(35)

Victims of medical power

22

(3)

Medical—ethical uncertainty

25

(1)

Normative stability

26

(1)

The postwar period

27

(4)

The changing medical scene

31

(8)

Secularization

39

(1)

The power of medicine

40

(3)

A new focus on death and dying

43

(3)

Development of the practice of euthanasia

46

(4)

The issue of public control

50

(1)

Public debate and the politics of compromise

51

(6)

3 The medical practice of euthanasia

57

(34)

Introduction

57

(1)

General description of Dutch euthanasia cases

58

(1)

Incidence of medically procured death (MPD)

59

(11)

Who practises euthanasia?

70

(5)

The doctor–patient relationship

75

(2)

The physician's role in the decision-making process

77

(6)

Evaluation of the practice of euthanasia

83

(6)

Why physicians?

89

(2)

4 The response of the law

91

(42)

Introduction

91

(1)

The relevance of the Dutch legal developments for other countries

92

(1)

The law of 1886

93

(3)

Force majeure

96

(3)

Jurisprudential developments

99

(6)

Why physicians?

105

(5)

Who can speak on behalf of the medical profession?

110

(1)

Requirements of due care

110

(9)

Guilty but no punishment

119

(4)

The role of the prosecutor

123

(2)

Legalization of euthanasia

125

(6)

Why a new law?

131

(2)

5 Justifying the practice of euthanasia

133

(36)

Introduction

133

(1)

The importance of distinctions

134

(1)

Euthanasia versus letting go

135

(6)

Euthanasia versus palliative treatment

141

(7)

Euthanasia versus PAS

148

(3)

Voluntary versus nonvoluntary MPD

151

(1)

Different methods of ethical reasoning

152

(3)

The Model of Double Effect

155

(3)

Patient autonomy

158

(3)

Unbearable suffering and the patient's quality of life

161

(4)

Shifts in argumentation

165

(4)

6 Lessons to be learned

169

(18)

Introduction

169

(2)

Medicalization of end-of-life care

171

(2)

Medical interventions and control over human death

173

(3)

Inevitability of judgements about patients' quality of life

176

(3)

Powerlessness of the law, public debate and policy

179

(1)

The importance of distinctions

180

(3)

Towards a broader array of end-of-life care options

183

(4)

Appendix I: Digest of Dutch jurisprudence

187

(24)

Appendix II: 2001 Law on Euthanasia and PAS

211

(9)

Notes

220

(7)

References

227

(8)

Index

235

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Death and Medical Power : An Ethical Analysis of Dutch Euthanasia Practice

Summary

Author Biography

Table of Contents

Supplemental Materials