Countries that care

Sir, Claire Mullarkey’s statement (letter, June 9) that “wherever euthanasia has been legalised, palliative care has diminished, as can be seen by the experience of the Netherlands and Oregon” is entirely unsupported by evidence (letter, June 11). In the Netherlands palliative care provisions have multiplied since that country regulated and legalised euthanasia. In 2002, Belgium was the next country to legalise euthanasia. That Bill was passed by Parliament together with a Palliative Care Bill extending palliative care to all hospitals and districts and doubling its public funding. Luxembourg acted similarly in 2008. Physicians trained in palliative care practise more assisted deaths than their untrained colleagues and most cases of euthanasia occur at the end of a palliative-care pathway.

The highest per capita assistance in conferences of the European Association of Palliative Care (EAPC) is from Belgium, followed by the Netherlands. In a 2007 EAPC survey, with the exception of the UK and Norway, the countries with the best palliative care tend to have legal assisted death. These and other data demonstrating mutual reinforcement of palliative care and legal euthanasia were published in the British Medical Journal (336: 864-867, 2008).