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Physician-Assisted Suicide and Euthanasia in the Netherlands: Lessons From the Dutch-Reply

Herbert Hendin, MD; Chris Rutenfrans, PhD; Zbigniew Zylicz, MD
JAMA. 1997;278(10):817-818. doi:10.1001/jama.1997.03550100043023.
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In Reply.  —If, as Dr O'Connor suggests, our article was able to convey that legally sanctioning guidelines for assisted suicide and euthanasia in the Netherlands does not work, we feel gratified. Dr Cheng's humorous insight would require no response if it were not for the fact that the "answers" in this case have serious consequences.Some of the seeming discrepancy in viewpoints comes from an idiosyncratic way of classifying and counting cases used by the Dutch investigators. On the surface, it seems simple enough; euthanasia is regarded by the Dutch as, by definition, voluntary. Since there can then be no "involuntary euthanasia," if patients are put to death without their consent (approximately 1000 cases a year1,2), the Dutch refer to it as "termination of patients without explicit request." Odd terminology, but at least consistent and understandable.In a much larger number of cases—an estimated 1350 in 19901(p73) and 1896 in


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