A Comparative Study of the Law of Palliative Care and End-of-Life Treatment

Vacco v. Quill, 521 U.S. 793 (1997); Washington v. Glucksberg, 521 U.S. 702 (1997); Cruzan v. Missouri Dept. of Health, 497 U.S. 261 (1990).

Cantor N.L. , “Twenty-Five Years after Quinlan: A Review of the Jurisprudence of Death and Dying,” Journal of Law, Medicine & Ethics, 29 (2001): 182–194.

See, e.g., “Symposium: The Undertreatment of Pain — Legal, Regulatory, and Research Perspectives and Solutions,” Journal of Law, Medicine & Ethics, 29 (2001); “Symposium: Legal and Regulatory Issues in Pain Management,” Journal of Law, Medicine & Ethics, 26 (1998); “Symposium: Appropriate Management of Pain,” Journal of Law, Medicine & Ethics, 24 (1996).

European Convention on Human Rights and Fundamental Freedoms, Rome (November 4, 1950), T.S. 71 (1953) (Cmd. 8969).

Den Exter A.P. , “Legal Reforms of the Polish Health Care System in View of Accessing the European Union,” European Journal of Health Law, 8 (2002): 5–25.

See, e.g., England: Re M.B. (Medical Treatment) [1997] 2 F.L.R. 426 at 437; Ms. B. v. An N.H.S. Hospital Trust [2002] E.W.H.C. 429 (Fam.) [104]; Australia: Secretary, Department of Health and Community Services (N.T.) v. J.W.B. and S.M.B. (Marion's Case) (1992) 175 C.L.R. 218; Boughey v. The Queen (1986) 60 A.L.J.R. 422 at 428; France: Article 36 of the 1995 Code of Medical Deontology: “In every case, the consent of the person examined or attended should be sought. When the patient, in a condition to express his will, refuses the investigations or the proposed treatment, the doctor should respect this refusal having informed the patient of all its consequences.”

See, e.g., Canada: Mallette v. Shulman, (1990) 67 D.L.R. 4th 321, at 328, per Robins, J. See also Nancy B. v. L'Hotel Dieu de Quebec (1992), 69 C.C.C. (3d) 450; the United Kingdom: Sidaway v. Board of Governors of the Bethlem Royal Hospital [1985] A.C. 871 at 904–05; Re T. (An Adult) (Consent to Medical Treatment) [1993] Fam. 95 at 102; Re MB. (Medical Treatment) [1997] 2 F.L.R. 426 at 437; R. (Pretty) v. the D.P.P. [2001] U.K.H.L. 61 at [55] per Lord Steyn, citing St. George's Health Care Trust v. S. [1999] Fam. 26; Ms. B. v. An N.H.S. Hospital Trust [2002] E.W.H.C. 429 (Fam.) [104].

Pretty v. the United Kingdom , The European Court of Human Rights (Fourth Section), Strasbourg, April 29, 2002 (Application no. 2346/02).

Id. at [611. Article 8 states: “(1) Everyone has the right to respect for his private and family life … and that (2) There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society….”

R. v. Adams [1957] Crim. L.R. 365.

Devlin P. , Easing the Passing: The Trial of Dr John Bodkin Adams (London: Faber and Faber, 1986): At 71.

See Wilson W.C. , “Ordering and Administration of Sedatives and Analgesics During the Withholding and Withdrawal of Life Support from Clinically 111 Patients,” JAMA, 267 (1992): 949–53. In this study, patients who were given large doses of opioids by way of palliation following the withdrawal of life supports lived on average as long as patients who were not so treated. The study suggests that the determining factor of the time of death is the underlying disease, rather than opioid medication.

See, e.g., England: Re J. [1991] Fam. 33; Airedale N.H.S. Trust v. Bland [1993] A.C. 789.

Airedale N.H.S. Trust v. Bland [1993] A.C. 789; R. (Pretty) v. the D.P.P. [2001] U.K.H.L. 61.

Rodriguez v. Attorney General of Canada, [1994] 2 L.R.C. 136; R. v. Latimer, [2001] 1 S.C.R. 3.

Vacco v. Quill, 521 U.S. 793 (1997); Washington v. Glucksberg, 521 U.S. 702 (1997).

Consent to Medical Treatment and Palliative Care Act (1995), § 17(1).

Id. § 17(3)(a).

Law Hospital N.H.S. Trust v. Lord Advocate (1996) S.L.T. 848.

Oates Laurence , Practice Note (Official Solicitor: Declaratory Proceedings: Medical and Welfare Decisions for Adults Who Lack Capacity) [2001] 2 F.L.R. 158 [7.2].

Airedale N.H.S. Trust v. Bland [1993] A.C. 789 at 805.

Airedale N.H.S. Trust v. Bland [1993] A.C. 789.

Marshall v. Curry (1933) 3 D.L.R. 260 at 60.

Airedale N.H.S. Trust v. Bland [1993] A.C. 789 at 867.

N.H.S. Trust A. v. M.; N.H.S. Trust B. v. H. [2001] 1 All E.R. 801; 1 F.C.R. 406; 2 W.L.R. 942; 2 F.L.R. 367.

Following the enactment of the Human Rights Act (1998) (U.K.), previous English decisions, such as that in the Bland case, have became subject to the European Convention on Human Rights and Fundamental Freedoms. By virtue of § 6(6) of the Human Rights Act, public authorities are bound in relation to their omissions as well as their actions.

Secretary, Department of Health & Community Services (N.T.) v. J.W.B. and SMB. (Marion's Case) (1992) 175 C.L.R. 218 (sterilization).

To date, there have been no reported cases in Australia regarding withdrawal or withholding of treatment in the terminal stages of life, though in 2000 the Master of the Supreme Court of New South Wales granted an injunction, requested by the patient's family, to restrain the hospital from withdrawing artificial hydration and alimentation until a firm diagnosis could be obtained.

Consent to Medical Treatment and Palliative Care Act (1995) (S.A.), § 17(2). The Northern Territory's Natural Death Art (1989) (N.T.) stated that withholding or withdrawal of “extraordinary measures” at the direction of a person suffering from a terminal illness does not constitute a cause of death. For the provision to be operative, the patient must have been diagnosed as “terminally ill” (Natural Death Act (1989) (N.T.), § 6).

Consent to Medical Treatment and Palliative Care Act (1995) (S.A.), § 17(3)(b).

Child and Family Services of Central Manitoba v. R.L. and S.L.H., (1997) 123 Man. R. (2d) 35. The plaintiff in this case had claimed that there exists a positive right that obliges a physician to provide treatment that is requested by the patient or surrogate. The court denied such a right by ruling that a patient (or a family member) cannot enforce a demand for treatment considered by the physician to be futile. See also Sawatzky v. Riverview Health Centre Inc. , (1998) 133 Man. R. (2d) 41 (Q.B.).

Rodriguez v. British Columbia (Attorney General), (1993) 3 S.C.R. 519.

Criminal Code (1985) (Can.), ch. C-46, § 241 provides: “Every one who (a) counsels a person to commit suicide, or (b) aids or abets a person to commit suicide, whether suicide ensues or not, is guilty of an indictable offence and liable to imprisonment for a term not exceeding fourteen years.”

Rodriguez v. British Columbia (Attorney General), (1993) 3 S.C.R. 519 at 521.

Senate of Canada, Of Life and Death: Report of the Senate Special Committee on Euthanasia and Assisted Suicide (1995). In 1997, the Parliament of Alberta enacted the Personal Directives Act, ch. P-4.03 (1997) (Alberta), the Preamble to which states that Albertans “should be able to provide advance personal instructions regarding their own personal matters while recognizing that such instructions cannot include instructions relating to aided suicide, euthanasia or other instructions prohibited by law.”

R. (Pretty) v. the D.P.P. [2001] U.K.H.L. 61.

Mrs. Pretty had virtually no decipherable speech, but apparently her intellect and capacity to make decisions remained unimpaired, including the ability to instruct her lawyers (her husband acted as her interpreter).

Suicide Act (1961) (9 & 10 Eliz. 2, c. 60), § 2.

Pretty v. the United Kingdom , The European Court of Human Rights (Fourth Section), Strasbourg, April 29, 2002 (Application no. 2346/02): At [39].

Id. at [74]. Both the House of Lords and the European Court of Justice in Pretty adopted the reasoning of the majority in Rodriguez v. British Columbia (Attorney General), (1993) 3 S.C.R. 519 at 521, which stated that the long-standing blanket statutory prohibition against assisted suicide fulfills the government's objective of protecting the vulnerable, is grounded in the state interest in protecting life, and reflects the policy of the state that human life should not be depreciated by allowing life to be taken.

Crimes Act (1900) (A.C.T.), §§ 17–18; Crimes Act (1900) (N.S.W.), §§ 31A–31C; Criminal Code (Qld.), § 311; Criminal Law Consolidation Act 1935 (S.A.), § 13A; Criminal Code (Tas.), § 163; Crimes Act 1958 (Vic), §§ 6A–6B; Criminal Code (WA.), §288.

Received assent by the Administrator on June 16, 1995.

§ 4 of RTIA provided that “a patient who, in the course of a terminal illness, is experiencing pain, suffering and/or distress to an extent unacceptable to the patient” could request “the patient's medical practitioner to assist the patient to terminate the patient's life.” Part 1, § 3, defined the medical practitioner's assistance “in relation to death or proposed death of a patient” as involving “the prescribing of a substance, the preparation of a substance and the giving of a substance to the patient for self administration, and the administration of the substance to the patient.” By virtue of Part 4, § 18(2), this kind of “assistance” was to be “taken to be medical treatment for the purposes of the law.”

The Euthanasia Laws Act (1997) (Cth), Schedule (1). Additionally, the Commonwealth Parliament disempowered the Legislative Assembly of the Northern Territory from enacting “laws which permit or have the effect of permitting (whether subject to conditions or not) the form of intentional killing of another called euthanasia (which includes mercy killing) or the assisting of a person to terminate his or her life.”

R. v. Latimer, [2001] 1 S.C.R. 3.

Latimer was convicted of murder in two trials: (1997) 121 C.C.C. (3d) 326 (Sask. Q.B.); (1998) 131 C.C.C. (3d) 191.

Latimer pleaded that the conviction should not stand because the trial judge erred in removing the defense of necessity from the jury. The necessity consisted of the pain his daughter was thought to experience during seizures, which she suffered daily, and additional pain that was due to weight loss caused by a lack of nutrients in her spoon-feeding regimen. The final aspect of “necessity” was the recommendation of hospital doctors that in order to relieve pain caused by a dislocated hip, Tracy should undergo surgery to remove her upper thigh bone. Latimer perceived this procedure as mutilation, and “formed the view that his daughter's life was not worth living.” R. v. Latimer, [2001] 1 S.C.R. 3 at 13.

Id. at 12. The Supreme Court rejected all three arguments, and determined that the defense of necessity was misconceived. Latimer himself did not face any peril, and Tracy's ongoing pain did not constitute an emergency. The court emphasized that though severely disabled, Tracy was not terminally ill. She “enjoyed music, bonfires, being with her family and the circus. She liked to play music on a radio, which she could use with a special button. Tracy could apparently recognize family members and she would express joy at seeing them Tracy also loved being rocked gently by her parents.” For further discussion of Tracy's chronic pain, see id. at 24.

Id. at 26.

Medical Profession Act (Ustawa o Zawodzie Lekarza of December 5, 1996; consolidated on August 30, 2002), available at <http://www.rzeczpospolita.pl/prawo/doc/2>.

Health Services Institutions Act (Ustawa o Zakładach Opieki Zdrowotnej of August 30, 1991) (Dziennik Ustaw Nr 91, poz. 408).

Ustawa o Izbach Lekarskich of May 17, 1989 (Dziennik Ustaw Nr 30, poz. 158 ze zm).

Penal Code (Kodeks Karny) of June 6, 1997 (Dziennik Ustaw Nr 88 zdn. 2.08.1997).

Konstytucja Rzeczypospolitej Polskiej of July 16, 1997 (Constitution of the Polish Republic).

Opinion of October 7, 1992 (U. 1/92).

According to the Opinion of October 7, 1992, deontological norms per se do not have a legal character, because only nominated medical associations (izby), and not the legislature or state administrative organs, have the power to define deontological principles on the basis of the system of values recognized by these medical corporations.

Zielonka T.M. , “Na marginesie Kodeksu Etyki Lekarskiej,” Gazeta Lekarska, Numer 10/2001.

Żelichowski M. , “Kodeks Etyki Lekarskiej,” MP OnLine, available at <http://www.mp.pl/prawo/show.php?aid=116436cPHPSESSID=774E4A57B83C485D9157CFC77EB63942&_tc=A2FA152C344C467D8DE4B597BFDEA1EC> (last visited December 6, 2002).

Polish Constitutional Tribunal Opinion of March 17, 1993 (W 16/92), available at <http://www.mp.pl/prawo/show.php?aid=116438cPHPSESSID=774E4A57B83C485D9157CFC77EB63942&_tc=1671BBE14697414F9A356C6729138ECD>.

The provision entrenches the autonomy of medical practitioners' decisions regarding treatment options. It also imposes on medical practitioners an obligation to inform patients of alternative medical treatments. However, the parenthetical clause, which is an exception relating to the necessity for prompt medical intervention, makes it unclear whether medical discretion extends to instances of withholding or withdrawal of life-saving or life-sustaining treatment.

“The physician may decide to discontinue or not institute a treatment (unless prompt medical intervention is necessary), but is obliged to inform the patient before doing so and suggest other factual opportunities for obtaining medical treatment. If the physician is employed at an institution, the consent of his/her superior must be obtained.”

Medical practitioners have a duty to render medical help in each case where a delay would cause a risk of loss of life or serious physical or mental injury or in other cases of emergency. Medical Profession Act of December 5, 1996 (Ustawa o Zawodzie Lekarza).

See also Penal Code, Article 162.2: “No offense will arise where a private person does not render help to another, if the latter must undergo a medically necessary procedure, or where it is possible to obtain immediate help from an institution or a person under a duty to help” (emphasis provided).

Żelichowski , supra note 59. Consequently, a medical practitioner who infringes Article 162 of the Penal Code or Article 30 of the Medical Profession Act, while adhering to Article 32 of the Code of Medical Ethics, will be punished.

Penal Code (Kodeks Karny of June 6, 1997; Dziennik Ustaw Nr 88 zdn. 2.08.1997).

“A medical practitioner must not practice euthanasia.”

Article 38 of the Constitution provides that “the Polish Republic guarantees each person a legal right to protection of life.”

Żelichowski , supra note 59.

France ratified the European Convention on Human Rights and Fundamental Freedoms in 1974. Consequently, under Article 55 of the French Constitution, the international law embodied in the provisions of the ECHR prevails over domestic legislation.

French appellate courts have the power to make decisions as arrêts de principe, which lay down new principles of law for application in subsequent cases. Boyron B.J. Whittaker S. , Principles of French Law (Oxford: Oxford University Press, 1998): At 19.

European Convention on Human Rights and Fundamental Freedoms, supra note 4.

Conseil de l'Europe, Assemblée Parlementaire, Commission des Questions Sociales, de la Santé et de la Famille, Protection des Droits de l'Homme et de la Dignité des Malades Incurables et des Mourants, Rapport, Doc. 8421 (1999).

Loi no 99–477 of June 9, 1999, Visant à Garantir le Droit à l'Accès aux Soins Palliatifs (JO 10 06 99: 8487). See also Article L-711-4 of the Code of Public Health, which provides that “health care establishments give preventive, curative, or palliative care to patients as required by their state of health and ensure the continuity of such care once they are discharged.”

The Code of Medical Deontology sets normative standards for medical practice, the violation of which exposes medical practitioner to disciplinary sanction by the French Order of Physicians. French courts of law use provisions contained in the Code both to define legal obligations and as a guide to understanding the ethical nature of the doctor-patient relationship.

See also the first clause of Article 37 of the Code of Medical Deontology, which states: “In any circumstances, the physician should do his utmost to alleviate the sufferings of his patient, and give him moral solace.”

Article 32 of the Code of Medical Deontology states: “the doctor undertakes to personally provide the patient with conscientious care, devoted to and based on the acquired scientific data….”

Duguet A.M. , “Euthanasia and Assistance to End of Life Legislation in France,” European Journal of Health Law, 8 (2001): 109–23, at 114. In its report on End of Life, Ending Life, Euthanasia, the French National Consultative Ethics Committee for Health and Life Sciences pointed out: “a medical decision to abstain from resuscitation, to refrain from prolonging or initiating deep sedation … on occasion described by some as being passive euthanasia … is not a deliberate ending of life; it is simply recognizing that ensuing death is the consequence of the disease or of certain therapeutic decisions which it may have prompted. In fact, these situations when therapeutic procedures are curtailed are consistent with a rejection of futile and aggressive therapy and should not be criticised on ethical grounds.” French National Consultative Ethics Committee for Health and Life Sciences (CCNE), Report No 63 (January 27, 2000), available at <http://www.ccne-ethique.Org/english/avis/a_063.htm#deb>.

According to Article 36 of the Code of Medical Deontology: “In every case, the consent of the person examined or attended should be sought. When the patient, in a condition to express his will, refuses the investigations or the proposed treatment, the doctor should respect this refusal having informed the patient of all its consequences.” The right to refuse medical treatment is reinforced under the palliative care law of June 9, 1999, which states that “a sick person may refuse to submit to investigation or therapy of whatever kind.” The burden of proving a patient's consent to treatment rests on the doctor. The Council of State [le Conseil d'Etat] law of January 5, 2000.

Article 36.3 of the Code of Medical Deontology.

Ferrand E. , “Withholding and Withdrawal of Life Support in Intensive-Care Units in France: A Prospective Survey,” The Lancet, 357, no. 9249 (2001): 9–14.

See, e.g., Mazeaud H. Mazeaud L. Tunc A. , Traité Théorique et Pratique de la Responsabilité Civile (Paris: Montchrestien, 1965): At 524–25; Terré F. Simler P. Lequette Y. , Droit Civil, Les Obligations, 6th ed. (Paris: Dalloz, 1996): At 688.

“Any one who has intentionally (volontairement) failed to render or to obtain assistance for an imperilled person (une personne en peril) when such was possible without danger to himself or others, shall be subject to like punishments [specified in paragraph 1 as up to 5 years of imprisonment and 75,000 euros].” Article 223–6(2) of the Criminal Code.

“Every doctor, who is in the presence of a patient or of a wounded person in danger, or informed that a patient or a wounded person is in danger, must provide assistance or make sure that that person receives the necessary care.”

Dadamo C. Farran S. , French Substantive Law: Key Elements (London: Sweet & Maxwell, 1997): At 212.

Rouen Court of Appeal, March 6, 1996, discussed in Nys H. , “Physician Involvement in a Patient's Death: A Continental European Perspective,” Medical Law Review, 7 (1999): 208–46, at 225.

Cour de Cassation, Criminal Chamber, February 19, 1997, discussed in Nys, supra note 86, at 225.

Editions Dalloz (1998), 236 comments of B. Legros; Jurisclasseur pèriodique, Semaine Juridique (1997), II, 22.889, comments of R.-M. Chevallier.

The uncontrolled sale of medicines over the Internet makes it relatively easy to obtain lethal medicines. The Economic and Social Committee of the Commission of the European Communities has suggested that Articles 2 and 3 of Council Directive 92/28/EEC of March 31, 1992, which ban advertising of medical products for human use that can only be supplied by medical prescription, be updated by national authorities in light of the promotion and distribution of these drugs over the Internet. Opinion of the Economic and Social Committee of the Commission of the European Communities, “The Role of the European Union in Promoting a Pharmaceutical Policy Reflecting Citizens' Needs: Improving Care, Boosting Innovative Research and Controlling Health Spending Trends,” Official Journal, C 014, 16/01/2001 P. 0122–0132 (January 16, 2001): § 10. However, it is up to the member states to ensure that the market is monitored in terms of advertising in accordance with the provisions of the directive. Article 223–14 of the Criminal Code might be regarded as imposing a penalty for a very serious infringement of the directive.

Article 121–3(1) provides that intention is an essential element of major crimes. Article 121–3 of the Criminal Code (Loi no 96–393 of May 13, 1996; Loi no 2000–647 of July 10, 2000, art. 1, the Official Journal of the French Republic of July 11, 2000).

Article 221–5.

Cour de Cassation, Criminal Chamber, June 22, 1994, Bull. Crim., No. 248.

Duguet , supra note 78, at 110.

Code of Medical Deontology, Decret no 95–1000 of September 6, 1995.

See Scherer J.M. Simon R.J. , Euthanasia and the Right to Die, A Comparative View (Lanham: Rowman and Littlefield Inc., 1999): At 68; Sass H.-M. , “Images of Killing and Letting Die, of Self-Determination and Beneficence,” in Sass H.-M. Veatch R.M. Kimura R. , eds., Advance Directives and Surrogate Decision Making in Health Care (Baltimore: Johns Hopkins Unversity Press, 1998): At 154–56.

Article 2, ¶ 1.

Article 2, ¶ 2.

Article 1, ¶ 1.

Bundesgerichtshof decision, November 28, 1957.

Bundesgerichtshof decision, 5 St. R. 474/00, judgment of February 7, 2001 (LG Berlin).

St. G.B. § 216. Killing another at that person's “express and serious request” is a lesser offense than murder or manslaughter, punishable by 6 months to 5 years in prison, compared to 1 to 10 years for manslaughter.

Bundesgerichtshof decision, 5 St. R. 474/00, judgment of February 7, 2001 (LG Berlin).

Nys , supra note 86, at 232.

Id. at 233.

See a description of the case in Nys , supra note 86, at 228–29, and in Koch H.-G. , “The Decision to Aid Dying and Related Legal Issues,” in Sass Veatch Kimura , eds., supra note 95, at 114, 119–121.

See Meran J.G. Poliwoda H. , “Clinical Perspectives on Advance Directives and Surrogate Decision Making,” in Sass Veatch Kimura , eds., supra note 95, at 95–113; Koch, supra note 105, at 124–31.

See Bundesärtekammer , Handreichungen für Ärzte zum Umgang mit Patienttenverfuegungen, October 13, 1999.

This possibility has existed for some time, but was expressly recognized in amendments to § 1904 of the Bürgerliches Gesetzbuch in 1999.

Gesetzbuch Bürgerliches , § 1904, ¶ 1.

Bundesärztekammer , supra note 107, at ¶ 1.2.

See Bundesärztekammer , Grundsätze der Bundesärzterkammer zur ärztlichen Sterbebegleitung, September 11, 1998, § IV.

Kurzer K. (Chief Judge, German Supreme Court), Pain Therapy from the Legal Perspective, Saarland Pain Forum, October 20, 2001, available at <www.soziaIes.saarland.de/medien/inhalr/StatemenrKutzer.pdf>.

Nys , supra note 86, at 232, citing Bundesgerichtshof decision of November 15, 1996, Bundesgerichtshof St. 42, 301. See also Kutzer K. , “Rechtliche Aspekte der Behandlung Schwerstkranker bei irreversiblen Schädigungen,” Europäishes Akademie Newsletter (June 2001): At 2.

Kutzer , supra note 112.

See Sohn W. , “Care for the Dying between the Right to Self-Determination and the Obligation to Provide Treatment,” in Sohn W. Zenz M. , eds., Euthanasia in Europe (Stuttgart: Schattauer, 2001): 67–70; Csef H. , “Euthanasia as an Ethical Problem,” in id. at 71–80, at 78.

See generally Scherer Simon , supra note 95, at 85–89.

Takeda v. State, 54(2) Minshu 582, 1710 Hanrei Jiho 97, 1031 Hanrei Taimuzu 158 (Sup. Ct., Feb. 29, 2000).

See Leflar R.B. , “Informed Consent and Patients' Rights in Japan,” Houston Law Review, 33 (1996): 1–112. See also Hayashi M. Kitamura T. , “Euthanasia Trials in Japan: Implications for Legal and Medical Practice,” International Journal of Law and Psychiatry, 25 (2002): 557–71.

Kimura R. , “Death, Dying and Advance Directives in Japan: Sociocultural and Legal Points of View,” in Sass Veatch Kimura , eds., supra note 95, at 189.

Id. at 192.

See id. at 195–97.

Id. at 197.

By way of analogy to the United States, a decision from the district court level in Japan is somewhat greater than a respected federal district court decision in the United States. An English translation of the case by Robert Leflar can be found in TS. Jost, ed., Readings in Comparative Law and Bioethics (Durham: Carolina Academic Press, 2000): At 354. A commentary on the case can be found in Yamazaki F. , “A Thought on Terminal Care in Japan,” in Hoshio K. , ed., Japanese and Western Bioethics (Dordrecht: Kluwer Academic Publishers, 1997): 131–34, and in Gutierrez E. , “Debate on Euthanasia Encouraged in Japan,” The Lancet, 349 (1997): 409. A similar case from Kawasaki, south of Tokyo, was widely reported in the Japanese press in the spring and summer of 2002, though that case has not yet been reported in legal reports.

Kimura , supra note 119, at 193–94.

Hayashi Kitamura , supra note 118, at 564–65.

Kimura , supra note 119, at 189.

Articles 293 (taking the life of another on request); 287 (manslaughter); 289 (murder); and 294 (assisting in suicide).

A translation of the Schoonheim decision, Nederlandse Jurisprudence 1985, no. 106, is found in Griffiths J. Bood A. Weyers H. , Euthanasia and the Law in the Netherlands (Amsterdam: Amsterdam University Press, 1998): At 322.

Translation from id. at 307.

The court rejected alternative arguments that the prohibition against taking life did not extend to medical situations or that the defendant's conduct had only amounted to an insubstantial violation of the law. See id.

See Kimsma G. van Leeuwen E. , “The New Dutch Law on Legalizing Physician-Assisted Death,” Cambridge Quarterly of Healthcare Ethics, 10 (2001): 445–50.

An English translation of the Act is available at <http://www.minbuza.nl/OriginalDocuments/c_55024.pdf> (last visited December 6, 2002).

Burial and Cremation Act, as amended (2001), § 7.

Id. § 10.

Id. § 8.

id. § 9. The Committee must inform the physician of its decision within 6 weeks (with one possible 6-week extension).

Failure to report is in fact a separate offense under the Criminal Code, Article 228(1).

Griffiths Bood Weyers , supra note 128, at 236–40.

Nys , supra note 86.

Burial and Cremation Act, § 2(3).

Id. § 2(4).

Id. §2(2).

Chabot, Nederlandse Jurisprudence 1994, no. 656, is reproduced in Griffiths, Bood, and Weyers, supra note 128, at 329. See also Cohen-Almagor R. , “The Chabot Case: Analysis and Account of Dutch Perspectives,” Medical Law International, 5 (2001): 141–59.

The Dutch reject terms like “passive euthanasia” or “indirect euthanasia,” used elsewhere, reserving the term “euthanasia” to mean only the taking of another's life in response to that person's request.

Nys , supra note 86, at 233.

Id. at 234.

This practice was approved of in the Stinissen case in 1976. Nys , supra note 86, at 234–35.

Nys , supra note 86, at 236. In the Netherlands, euthanasia tends to be defined as a form of palliative care: Keown J. , “Euthanasia in the Netherlands: Sliding Down the Slippery Slope?,” in Keown J. , ed., Euthanasia Examined (Cambridge: Cambridge University Press, 1997): 261–97, at 269.

Griffiths Bood Weyers , supra note 128, at 210.

Sheldon T. , “Dutch GP Found Guilty of Murder Faces No Penalty,” British Medical Journal, 322 (2001): 509.

Griffiths Bood Weyers , supra note 128, at 131–33.

Cohen-Almagor R. , “An Outsider's View of Dutch Euthanasia Policy and Practice,” Issues in Law & Medicine, 17 (2001): 35–68.