EVALUATION OF THE NOTIFICATION PROCEDURE FOR PHYSICIAN-ASSISTED DEATHIN THE NETHERLANDS

Background In the Netherlands, a notification procedure for physician- assisted death has been in use since 1991. it requires doctors to repo rt each case to the coroner, who in turn notifies the public prosecuto r. Ultimately, the Assembly of Prosecutors General decides whether to prosecute. Although physician-assisted death remains technically illeg al, doctors are extremely unlikely to be prosecuted if they comply wit h the requirements for accepted practice. In 1995, the ministers of he alth and justice commissioned an evaluation to determine the adequacy of the notification procedure. Methods A random sample of 405 physicia ns were interviewed. We also interviewed 147 physicians who had report ed cases of physician-assisted death and 116 coroners, and we reviewed 353 judicial files of reported cases. In addition, we interviewed 48 public prosecutors and reviewed the minutes of the Assembly of Prosecu tors General for 1991 to 1995 and all published court decisions from 1 981 through 1995. Results in 1995, about 41 percent of all cases of eu thanasia and physician-assisted suicide were reported. There were no m ajor differences between reported and unreported cases in terms of the patients' characteristics, clinical conditions, or reasons for the ac tion. Most patients had cancer and were described as suffering ''unbea rably'' and ''hopelessly.'' Of the 6324 cases reported during the peri od from 1991 through 1995, only 13 involved prosecution of the physici an. The majority of respondents in the groups interviewed thought that all cases of physician-asssisted death should be reviewed, although m ost doctors thought the review should be performed by other doctors, a nd there was substantial concern about the burden associated with the reporting procedure. Conclusions Substantial progress in the oversight of physician-assisted death has been achieved in the Netherlands. The reporting procedure could be more streamlined and less threatening. ( C)1996, Massachusetts Medical Society.