Dutch become the first to legalise euthanasia

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THE DUTCH parliament voted yesterday by 91 to 45 to legalise the long-tolerated practice of euthanasia, making the Netherlands the only jurisdiction giving doctors legal licence to kill.

The new law, due to take effect early next year, virtually guarantees doctors immunity from prosecution if they follow a 28-point checklist showing that patients are terminally ill and in unbearable pain and have repeatedly asked to die. But euthanasia remains officially a criminal offence carrying a maximum 12-year jail sentence, and doctors who perform it without consent will be punished.

The guidelines specify that euthanasia can be applied only to a patient suffering a 'perpetual, unbearable and hopeless' condition who requests it repeatedly and while lucid. A second medical opinion must be obtained.

The physician must document the entire decision-making process - including why euthanasia was chosen and how it was carried out - and submit it to the district coroner's office after the death. If there is no evidence of malpractice, a prosecutor will take no further action.

The legislation, culmination of 20 years' heated debate, gives a legal basis to what has become accepted practice. Case law from 1973 has established that doctors can avoid prosecution by following informal guidelines similar to those approved by parliament. There are about 2,300 cases of voluntary euthanasia a year in the Netherlands.

In 1991 a government report revealed that more than 1,000 people die every year when physicians provide lethal injections without patients requesting it.

The doctors said that the most important considerations influencing their decisions to terminate life without an explicit request from the patient were 'low quality of life' (31 per cent) and the belief that 'the family could no longer take it' (32 per cent).

The Dutch Paediatric Association has also lobbied the government to allow euthanasia of infants when their expected quality of life was deemed too low.

Opinion polls show that nearly 80 per cent of the Dutch approve of voluntary euthanasia for the terminally ill; polls in the US give about two-thirds support.

But some elderly people, fearing that doctors will make decisions on their behalf, carry cards expressly stating that they do not want euthanasia.

Removal of life-support systems in cases considered futile is accepted practice in the Netherlands.

In Britain, the Law Lords have ruled that doctors may withdraw treatment, including feeding, from Tony Bland, 24, who has been in a persistent vegetative state since being crushed in the 1989 Hillsborough disaster.

Life-sustaining treatment is being withdrawn from terminally ill patients 'every day', according to the consultant treating Mr Bland. Dr Jim Howe said in a letter published in the Guardian today that such decisions were made in consultation with the patient.