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11 December 2003
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News
A Little Princess
The birth of Prince Willem-Alexander‘s and Maxima‘s daughter Catherina-Amalia has also sparked many joyous reactions at Leiden University. Student Club Minerva, which has included members of royal blood, organised a large party.
The Board of Governors sent a telegram with congratulations to the royal parents immediately after the birth on Sunday afternoon around five o‘clock. The text read: ‘Congratulations on the birth of your daughter. We wish both you and your daughter much happiness.’ It was signed by the Chairman of the Board, AW Kist, the rector-magnificus Douwe Breimer and the Vice-Chairman of the Board, Joris Van Bergen.
On the Monday after the birth, flags with orange pennons were flying from almost all university buildings. A flag was also flying from the Student Club Minerva.
Although it will be approximately eighteen years before it is known whether the new princess will study in Leiden, it is certainly a possibility. Both her father, Willem-Alexander (History) and Queen Beatrix (Law) studied in Leiden, while Princess Juliana followed a special two-year study programme here. Naturally, they chose Leiden because Leiden University was established by their ancestor and pater patriae, William of Orange, in gratitude for the heroic resistance during the siege of Leiden, 1573 to 1574. Since then, the university has been an Orange stronghold.
Economising
Leiden University is threatened by heavy weather: millions must be saved during the coming years. This can read in the draft-budget 2004-2007.
Due to cutbacks by Balkenende I and II cabinets, Leiden will receive much less money from the Ministry of Education and Science. Structurally, the cutbacks will increase from 8.9 million euros in 2004 to 14.8 million in 2007. This means bad news for Vice-Chairman of the Board, Van Bergen, who, over the last few years, had just managed to make Leiden University completely healthy again. Now he has a new task set for him.
This will cause problems. ‘In 2004, we will be able to deal with the largest problems concerning the budget but from 2005 onwards there will be some troubling developments,’ reads the text of the budget. The management bureau is currently investigating solutions to deal with this. ‘Due to the cutbacks which have been enforced in the past and the calculation of those in the university allocation (Basic Infrastructure Model), the faculties already receive a low budget for education and research.’
Leiden international
The University Council has in principal reached an agreement: the objectives in the report by the Steering Group Internationalisation and Education are too ambitious. However, a start will be made at the beginning of 2004 to implement it.
Leiden University wants a place among the international top institutes as a research university. Important steps have already been taken towards the formation of an alliance with eleven other top European universities in the League of European Research Universities (LERU). By raising the standard for the level the of education (more research), enrolling many foreign students and furnishing the International Office in a ‘new style’, the university hopes to become more attractive and give the ‘Leiden Certificate’ an international air.
Euthanasia: a last resort
Being the first country to decriminalize euthanasia, the Netherlands shocked the world. Opponents worldwide feared ‘death tourism‘: patients flying to Amsterdam on a one-way ticket. ‘Nonsense,’ says Dorothea Touwen, medical ethics lecturer at Leiden University. ‘Dutch physicians would never set up a clinic where just anyone can get a lethal shot.’
Floor Ligtvoet
When it comes to legalising euthanasia, the Dutch have some explaining to do. For many foreigners, Holland‘s Termination of Life on Request Act seems chilling and horrifying. What complicates the discussion is that for the Dutch the meaning of the term ‘euthanasia‘ is restricted to cases in which patients request their lives to be ended, whereas abroad ‘euthanasia‘ is used as a synonym for doctors killing their patients without their consent. Opponents fear that by legalizing euthanasia, the Dutch put a new responsibility into the hands of medical staff: determining whether a person‘s life is still worth living. This law will have gruesome consequences, critics argue. Yet, they forget that in Holland euthanasia is strictly bound to rules of due care. If a physician performs euthanasia on a patient without having his or her written or oral consent and without consulting with colleague physician for a second opinion, the acting physician will still be guilty of a crime, according to the Dutch Criminal Code.
‘One other requirement is that patients should be suffering unbearably,’ Dorothea Touwen explains. She admits that this notion of suffering is liable to subjectivity, but she says, ‘a physician can make an estimate of the pain on the basis of a patient‘s medical condition.’ Furthermore, before agreeing to perform euthanasia a doctor must be convinced that there is no prospect of improvement. ‘Mind you, no one thinks lightly about euthanasia in the Netherlands. For our physicians it‘s a burden too. Euthanasia will always remain a last resort,’ Touwen ensures. Although a law on euthanasia exists, the Dutch have no legal right to euthanasia nor do doctors have a duty to administer euthanasia. Touwen: ‘A physician can always refuse and refer his patient to a colleague.’ Even though euthanasia has been the subject of public debate for the past 30 years, it remains difficult to talk about. ‘Of course, no physician would like to be known for performing euthanasia regularly,’ Touwen states. Since the new law was introduced, the percentage of people dying from euthanasia has not changed significantly. ‘Some 140,000 people die every year in the Netherlands, of which 3,600 from euthanasia. Most are patients suffering from cancer or AIDS.’ Official figures state that two thirds of all euthanasia requests are refused by doctors.
Opponents expect that the Dutch euthanasia law will trigger an avalanche of new controversial laws, such as, for example, a law allowing doctors to kill prematurely born babies. ‘Their slippery-slope argument has always scared people off,’ Touwen replies. She believes the criticism is unfounded: ‘Just because the Dutch agree on euthanasia, it doesn‘t necessarily mean that they‘ll legalise other taboo issues too.’ Touwen is convinced that doctors, living in countries where euthanasia is forbidden by law, struggle with the boundaries of medical possibilities as well: ‘Nowadays, it‘s possible to extend a patient‘s life beyond what is sufferable. This forces us to answer another question: Does our medical performance lead to a better situation for the patient?’ All around the world physicians are trying to find ways to relieve the suffering and hasten death, Touwen explains. ‘Only most of them have to do it in secret.’ And sometimes without taking proper care criteria into consideration. Terminally ill patients are often given high doses of morphine to end their lives. ‘Yet, morphine is not a reliable medium to hasten death. Sometimes it does indeed hasten death but it could also produce an undesirable side-effect such as delirium,’ Touwen says
At the Leiden University Medical Centre (LUMC), Touwen discusses various moral and ethical medical issues - including euthanasia - with her students. Every year she invites a patient to explain in front of three hundred medical students why he or she has chosen to die with euthanasia. Through subsequent lectures and self-study exercises students learn about the various due care criteria. Personally, Touwen is in favour of the current legislation; except for the part that permits elderly people to sign a directive (called a ‘euthanasia declaration‘) in advance, while still healthy, and then to be euthanised later in life if and when they are suffer from senile dementia. ‘It makes the law fuzzy,’ Touwen believes. ‘I mean, does a declaration drafted ten years ago still express the wish of the patient today?’ Furthermore certain stages of dementia do not cause patients to suffer unbearably. Touwen: ‘Many elderly people with Alzheimer‘s disease can still enjoy life in a way. Therefore, it is rare for a physician to perform euthanasia on a patient suffering from dementia.’ Still, it places family members in the tragic position of having to watch their relative‘s medical condition slowly deteriorate. ‘Especially,’ Trouw says, ‘if the children had promised their parents explicitly that they would never let them end up like this.’
Facts about Dutch euthanasia
In 2001, the Criminal Code was amended to exempt physicians from criminal liability if they reported their actions and proved that they had satisfied the due care criteria formulated in the Termination of Life on Request Act. When dealing with a patient‘s request for euthanasia, the physician must be satisfied that the patient‘s request is voluntary and well considered, that the patient‘s suffering is unbearable and that there is no prospect of improvement. Furthermore, the patient must be informed of his or her condition and further prognosis. The physician and his patient must then discuss the situation and come to a joint conclusion that there is no other reasonable solution. The attending physician is required to consult with at least one other physician who has no connection to the case; this consultant physician must then examine the patient and state in writing that the attending physician has satisfied the due care criteria.
After the patient has died, the attending physician is obliged to notify the municipal pathologist and compile a report. The pathologist also then writes a report establishing that the patient‘s death was due to non-natural causes. He sends this to the Public Prosecutor, who must give consent for burial. Then, the two reports are sent to a regional euthanasia review committee, consisting of at least one physician, a legal expert and an expert on ethical issues. Together with the statement from the independent consultant physician and any written directive by the deceased, the committee assesses whether the physician had acted in accordance with the due care criteria. If the committee concludes that the physician has properly, no further action is taken. If the physician is found to have acted improperly, the committee reports its finding to the Public Prosecution Service and the regional health inspector. These agencies will then consider what legal actions to take against the offending physician.
For more information, www.minbuza.nl , then select ‘euthanasia‘.
