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Sedation vs Euthanasia in the Netherlands

The number of Dutch euthanasia cases fell to 2,325, or 1.7 percent of all deaths in 2005, from 2.6 percent in 2001. Though it only became legal in 2002, euthanasia has long been an accepted practice in the Netherlands and doctors avoided prosecution if they met certain conditions.

Those conditions were formalized in legislation: patients must face a future of “unbearable suffering” and make a voluntary, well-considered request to die. Another physician must be consulted and an expert panel examines each case.

The Dutch Health Ministry says the fall in euthanasia cases is partly due to improvements in care for the dying and a rise in the number of terminally ill patients who are given sedatives to render them unconscious until death.

Palliative sedation rose to account for 7.1 percent of deaths in the Netherlands in 2005, up from 6 percent in 2001.

Those undergoing euthanasia are usually given a lethal injection that acts within minutes.

Patients who receive palliative sedation are those expected to die within days. To mitigate distressing symptoms they are heavily sedated, life-prolonging treatment and hydration is withheld and they die without regaining consciousness.

A study in the British Medical Journal in March confirmed the trend towards sedation and away from euthanasia.

“It is more than a coincidence that euthanasia has gone down and palliative sedation has gone up,” said Rob Jonquière, director of the Dutch Right to Die society.

“We hear anecdotal evidence from families that patients actually wanted euthanasia but the doctor instead gave palliative sedation,” he said, adding he had struggled with euthanasia requests when he practiced medicine.

“Patients say: ‘I don’t want to be cuddled to death. I’m going to die anyway. Let me die now’.”

A survey published this year in the Journal of Medical Ethics showed almost half the Dutch doctors questioned tried to avoid euthanasia because it was against their own values or difficult to deal with.

“There was a concern that once doctors started using euthanasia they would do it more and more easily. What we see is the opposite because they need emotional rest,” Jonquière said.