Third ‘Remmelink’ Report

On the 23rd May 2003, Professors Van der Wal and Van der Maas presented their long awaited third report on euthanasia in the Netherlands (also known as the Remmelink report). Please note, the report’s findings, some of which are listed below, are for 2001, and therefore do not reflect on the Netherland’s new law which has been effective since April 2002.

The Lancet published an abbreviated copy of the report, entitled ‘Euthanasia and other end-of-life decisions in the Netherlands in 1990, 1995, and 2001’, on the 17th June (and a hyperlink to this report is provided below). However, VES UK have prepared a full English translation of the executive summary of the report which is provided in a separate attachment. The following quotations are taken from VES’ translation of the report.

A key finding of the report was:

“there is no empirical support for the supposition that the Netherlands are “going downhill” with regard to life-terminating treatment by physicians.”

The rate of euthanasia and assisted suicide and “the practice of medical decision-making relating to the end of life in the Netherlands appears to have stabilised in recent years”:

“Both life-terminating treatment on explicit request, and life-terminating treatment without an explicit request are no more frequent than six years ago.” The report estimates the number of cases of euthanasia for 2001 at approximately 3,500 (2.5% of all cases of death - please note: this statistic varies slightly between reports, as does the number of cases of euthanasia. The correct statistic is 2.59%, but this has been rounded down to 2.5% in the English translation provided). The number of cases of assisted suicide is estimated at approximately 300, (0.2% of all cases of death). In both the previous studies, the figure was 0.3%. “The total percentage of cases of euthanasia and assisted suicide in 2001/2002 therefore seems to be effectively unaltered relative to 1995/1996, namely 2.7%.”

The report for 2001/2002 contained a new section giving special attention to the connection between social-economic status and the occurrence of medical decisions concerning the termination of life. It found:

“There are no signs indicating an increase in life-terminating treatment among vulnerable patient groups”

and:

“The influence of the social-economic status of patients on medical decisions concerning the termination of life… seems to be very limited.”

1. Non-treatment decisions slightly more frequent and euthanasia was slightly more frequently implemented in the group with highest social-economic status
   
2. As in previous investigations, it found that “life-terminating treatment occurs relatively little” among more elderly people, and people in care. 85% of all cases of euthanasia happen in people with cancer, and cancer is a disease that occurs most frequently in the 50-60 years age group.
   
3. Physicians only granted requests for euthanasia from patients who were “finished with” or “tired of” life an estimated 5-15 times a year.
   
4. Euthanasia amongst children occurs relatively seldom (0.7% for cases of death in the 1-16 years group compared to 2.7% for all age groups). Life termination in children mainly relates to children with cancer.
   
5. The numbers for the practice of euthanasia amongst dementia patients were so low that the report concluded that a reliable estimate of annual cases was not available. The authors wrote: “It is a reasonable assumption that, if it happens, it is almost always a question of serious suffering as a result of an additional condition, and that euthanasia because of dementia alone effectively never happens.”
   

Professors Van der Wal and Van der Maas found that inadequate palliative care was not a factor in decisions to end life:

“With regard to the treatment of complaints and symptoms, no grounds were found for assuming a difference in treatment of severe or very severe complaints as between cancer patients who had or had not made an explicit request. Almost all physicians in both groups found, with the benefit of hindsight, that there was no reduction in medical, caring, psycho-social, spiritual or domestic care.

Also 9 out of 10 relations of patients in whom euthanasia was implemented found that adequate care was provided in the last phase of life.”

Reporting rates had also improved:

1. In 2001, 54% of all cases of euthanasia and assisted suicide were reported to a Regional Review Commission (RRC), compared to 1995, when 41% of all cases were reported.
   
2. The greatest increase in reporting rates was amongst general practitioners. The authors noted that: “The professionalisation of consultation, as it has taken place in the project (up to now effectively only aimed at general practitioners) for Support and Consultation in the Netherlands (SCEN) seems to be in line with the increase of the reporting percentage among the general practitioners.”
   
3. They also speculated that the improvement in turnaround times, whereby the RRCs have processed cases more quickly, has “increased the willingness to report such cases.”
   

Significantly: “in 2001/2002, physicians reported more often than in previous years that they had become more restrictive about euthanasia, and less often that they had become more permissive.”

The report also found: “The requirements of due care are being met more extensively than previously, and public control has increased further.”

NVVE are awaiting an official government reaction to the Remmelink report findings of this report. This project is part of a European Union financed survey spanning six European countries (the results of which are also published in The Lancet). See above for details of this survey.

To access a copy of ‘Euthanasia and other end-of-life decisions in the Netherlands in 1990, 1995, and 2001’ go here .