J.M. Cuperus-Bosma

Patient safety in Dutch hospitals.

In various studies outside the Netherlands, it has been shown that a substantial number of patients suffer from some kind of harm during their treatment in hospital. The incidence of these so-called adverse events varies between 2.9% and 16.6%; it is estimated that between over a quarter and a half of these are considered to be avoidable. Preventable adverse events can be considered to be a starting point for interventions to increase patient safety. In response to this, a study was initiated in Dutch hospitals investigating the nature and extent of adverse events and their causes. Lessons learnt will be discussed within the European Research Network on Quality in Health Care (ENQual), where researchers and policy makers come together to exchange knowledge and experiences. Two important goals of the Dutch study are to reach a consensus on basic concepts and to improve research methodology. An unintended event resulting in harm caused by healthcare is called an adverse event in international literature. Preventable adverse events are especially important for prevention, in these cases the harm can be attributed to unintended events in the care process, caused by insufficient action according to professional standards and failures within the care system. Most adverse events, caused as they may seem by human action or failing to act at first sight, are often partly caused by a care process that has not been properly organized. Uniform concepts are needed in order to facilitate European comparisons, which would allow, for example, the comparison of Dutch research results with those from other countries, and the identification of specific concepts. One of the six action areas of the WHO’s World Alliance for Patient Safety is the development of a ‘patient safety taxonomy’.

The Role of the Medical Examiner in the Euthanasia Notification Procedure in the Netherlands

The objective of the study was to provide an insight into the role of the medical examiner in the euthanasia notification procedure in The Netherlands. At the beginning of 1996 a representative group of 116 medical examiners was interviewed. The study found that there was a considerable variation in the way in which the medical examiners fulfilled their tasks. In all cases, after the physician-assisted death had taken place, the medical examiner investigated whether the attending physician had met the requirements for prudent practice, and in approximately 75% of the cases he reported his findings to the Public Prosecutor. In 78% of cases the attending physician was well known to the medical examiners, who were general practitioners, and in a third of the cases this influenced their assessment. Seventy-six per cent of the medical examiners, 61% of the members of the public prosecution and 47% of the physicians thought that it is the task of the medical examiner to review whether the requirements for prudent practice have been met by the attending physician. In conclusion, further specification of the task of the medical examiner would appear to be beneficial to increase uniformity in the procedure. In particular, it should be determined whether it is the medical examiners responsibility to review whether the requirements for prudent practice have been met. It should also be taken into consideration whether the position of the general practitioner medical examiner is sufficiently independent to make an objective report.

Mag een arts euthanasie weigeren vanwege de juridische nasleep

Ondanks de maatschappelijke en politieke discussies die de afgelopen jaren over euthanasie en hulp bij zelfdoding hebben plaatsgevonden, zijn deze handelingen nog steeds strafbaar. In het algemeen zal een arts echter niet worden vervolgd als deze handelt conform de in de rechtspraak geformuleerde zorgvuldigheidseisen en de meldingsprocedure euthanasie. Volgens deze meldingsprocedure, in gebruik sinds eind 1990, mag een arts die levensbeeindigend heeft gehandeld geen verklaring van natuurlijk overlijden afgeven, maar moet hij hiervan melding doen bij de gemeentelijk lijkschouwer, die op zijn beurt (sinds 1 november 1998) de regionale toetsingscommissie moet informeren.