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Bulletin of the History of Medicine 77.2 (2003) 480-482



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Bert Gordijn and Henk ten Have, eds. Medizinethik und Kultur: Grenzen medizinischen Handelns in Deutschland und den Niederlanden. Medizin und Philosophie, no. 5. Stuttgart-Bad Cannstatt: Frommann-Holzboog, 2000. 507 pp. €51.50, Sw. Fr. 90.00 (paperbound, 3-7728-2028-X).

Since April 2002, the Netherlands is the first country in the world with a legal arrangement concerning euthanasia and physician-assisted suicide. The new law is the outcome of a political discussion of almost three decades, in which euthanasia became ever-more-accepted as a medical intervention, on the patient's request, in cases of unendurable suffering. Ethical and legal developments concerning euthanasia in the Netherlands have been followed closely by other countries. One country that was highly interested, but also very skeptical, was Germany. For the Germans, the notion of euthanasia is linked to the history of the Second World War. The concept itself is not used in public debate—the preferred term is "aktive Sterbehilfe" (active assistance in dying). Most politicians and medical doctors regard this type of intervention as an improper medical action. They often refer to "the Dutch example" as a way of dealing with end-of-life issues that is not at all suitable for the German situation.

The German discussion of the developments in the Netherlands is mostly driven by ideological motives, rather than by genuine interest in the ethical and [End Page 480] legal background of Dutch policy. Likewise, Dutch responses to German criticism are often defensive, and show little openness to concerns about the consequences of the legal arrangement in the Netherlands. Medizinethik und Kultur is a welcome exception to this rule: it is the result of two scientific conferences in which Dutch and German ethicists, lawyers, philosophers, and theologians discussed current end-of-life practices in the two countries, the cultural and historical backgrounds, and ethical assessment of the different practices.

The first part of the book contains studies about the current ethical, legal, and practical arrangements regarding euthanasia and physician-assisted suicide, reanimation, and palliative care. Concerning the relation between euthanasia and physician-assisted suicide, there are some striking dissimilarities between the two countries. In Germany, physician-assisted suicide and euthanasia are legally distinct: the former is not forbidden, the latter is. Yet this does not mean that physician-assisted suicide is regarded as a part of standard medical practice; it is explicitly declared not to be so by, for example, the Bundesärztekammer. In the Netherlands, euthanasia and physician-assisted suicide are considered as morally and legally equivalent. In theory, physician-assisted suicide is sometimes declared to be morally preferable (for instance, by the Dutch Royal Academy of Medicine), but in practice, euthanasia is much more often performed. Concerning reanimation, the two countries are more similar—yet there are differences, for instance with regard to the status of advance directives: in Germany, advance directives are regarded as indices of the patient's wishes, which have to be taken into account but which lack legal force; in the Netherlands, advance directives concerning refusal of treatment are legally binding. Concerning pain treatment and palliative care, the two countries share a combination of theoretical interest in pain (in the tradition of anthropological medicine, focusing on the meaning of illness for the individual patient) and a comparatively slow development of hospice care. Currently, hospice care is becoming more and more important in both countries.

Part 2 is devoted to historical and cultural explanations of the convergences and divergences between the developments in Germany and the Netherlands. The German contributions go back to classical authors in medicine and philosophy; the Dutch studies refer to cultural phenomena—for example, the Dutch history of Calvinism. The differences between the types of explanation are more striking than the outcomes of these studies.

Part 3 contains an ethical appraisal of the differences between the practices of the two countries. The focus is on euthanasia and physician-assisted suicide. The German contributions are opposed to one another. The philosopher Dieter...

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