Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands

N Engl J Med 2000; 342:551-556 February 24, 2000 DOI:10.1056/NEJM200002243420805

Johanna H. Groenewoud, M.D., Agnes van der Heide, M.D., Ph.D., Bregje D. Onwuteaka-Philipsen, Ph.D., Dick L. Willems, M.D., Ph.D., Paul J. van der Maas, M.D., Ph.D., and Gerrit van der Wal, M.D., Ph.D.

Background and Methods

The characteristics and frequency of clinical problems with the performance of euthanasia and physician-assisted suicide are uncertain. We analyzed data from two studies of euthanasia and physician-assisted suicide in the Netherlands (one conducted in 1990 and 1991 and the other in 1995 and 1996), with a total of 649 cases. We categorized clinical problems as technical problems, such as difficulty inserting an intravenous line; complications, such as myoclonus or vomiting; or problems with completion, such as a longer-than-expected interval between the administration of medications and death.


In 114 cases, the physician’s intention was to provide assistance with suicide, and in 535, the intention was to perform euthanasia. Problems of any type were more frequent in cases of assisted suicide than in cases of euthanasia. Complications occurred in 7 percent of cases of assisted suicide, and problems with completion (a longer-than-expected time to death, failure to induce coma, or induction of coma followed by awakening of the patient) occurred in 16 percent of the cases; complications and problems with completion occurred in 3 percent and 6 percent of cases of euthanasia, respectively. The physician decided to administer a lethal medication in 21 of the cases of assisted suicide (18 percent), which thus became cases of euthanasia. The reasons for this decision included problems with completion (in 12 cases) and the inability of the patient to take all the medications (in 5).


There may be clinical problems with the performance of euthanasia and physician-assisted suicide. In the Netherlands, physicians who intend to provide assistance with suicide sometimes end up administering a lethal medication themselves because of the patient’s inability to take the medication or because of problems with the completion of physician-assisted suicide. [Full text]

Canadian Pharmacists Association re: conscientious objection

A report from Life Site News referred to an article in the January edition of the Canadian Pharmacy Practice journal. With respect to the drug ‘Preven’ (‘morning after pill’), Jeff Poston, executive director of the Canadian Pharmacists Association (CPhA), was reported to have commented that while the CPhA “supports the use of the new drug, it also recognizes the pharmacist’s right to refuse to fill [a prescription] based on moral or religious beliefs.”


New advisor joins Project

News Release

Protection of Conscience Project

Janet Ajzenstat, Professor of Political Science at McMaster University in Hamilton     Ontario, has joined the advisory board of the Protection of Conscience Project.
Professor Ajzenstat teaches public law and political philosophy.  Her most recent     books are Canada’s Founding Debates (edited with Paul Romney, Ian Gentles and     William D. Gairdner [Stoddart, 1999], and Canada’s Origins (edited with Peter J.     Smith [Carleton University Press, 1995]).  She is associated with the Centre for     Renewal in Public Policy and the Dominion Institute.  In 1988-89 she was Executive     Director of the Human Life Research Institute (now the Barrie de Weber Institute). Her  most recent contribution to reports for the Institute is Going it Alone (co-authored with Elizabeth Cassidy, Elise Carter and Gerald Bierling), a study of pregnant, unmarried women who have chosen to continue their pregnancies.

The Protection of Conscience Project is a non-denominational, non-profit group of     individuals consisting of a project team and advisory board.  The Project

  •  advocates for protection of conscience legislation;
  • provides information on protection of conscience legislation worldwide;
  • promotes clarification and understanding of the issues involved to assist in reasoned public discussion;
  • acts as a clearing house for reports from people who have been discriminated against for reasons of conscience.

Canada Safeway orders pharmacists to dispense abortifacients

In a policy statement that included reference to dispensing euthanasia drugs, RU486 and the ‘morning after pill’, Canada Safeway advised pharmacists who have conscientious objections to dispensing certain drugs that they would be required to do so if a non-objecting pharmacist was not available.