Voluntary euthanasia in the Netherlands.

SIR

We broadly welcome Dr van Delden's constructive response[1] to our paper.[2] He nowhere seeks to question our central contention that the guidelines regulating voluntary euthanasia in the Netherlands have been widely breached and have failed to ensure effective control.

He rightly identifies three of our major concerns which support that contention: first, the practice of non-voluntary euthanasia; secondly, the use of euthanasia when palliative care could have provided an alternative; and, thirdly, the under-reporting of euthanasia by doctors.

He shares our first concern and agrees that non-voluntary euthanasia is "a very serious problem".

As for our second concern, Van Delden does not dispute the frequent performance of euthanasia in cases where palliative care could have alleviated the suffering. His view that this "shift" (his word) is due to an increasing emphasis on patient autonomy is interesting. But whether or not this explanation is accurate, it in no way detracts from the force of our point, which is that, whereas the guidelines require euthanasia to be applied only as a "last resort" in cases of "unbearable …