Where Lord Joffe's Bill might lead from Letters to the BMJ 29 September 2005 If we want to know where Lord Joffe’s Bill might lead, we need only look across the North Sea. The Netherlands has a decades-long experience of euthanasia, and the results are such as to strike alarm into any reasonable observer. According to the second of three government-ordered studies, 900 patients were deliberately and actively killed without their request in 1995.[1]This figure does not include 1,537 cases where palliative drugs were given with the explicit, unrequested aim of hastening death.[2] If we include this group, more than a third of those actively killed were killed non-voluntarily. Even excluding this group of cases, one in five of those actively killed were killed without request – to say nothing of those deliberately killed by means of an omission. Unfortunately the 2001 data make it impossible to determine the exact level of non-voluntary active killing, since doctors who gave palliative drugs with the aim of hastening death were not asked if the patient had consented. What we do know is that, aside from this, 980 patients in 2001 were actively killed without their request.[3] It is all too clear where the concept of ‘lives unworthy of life’ has in practice led.[4] Van der Wal VG, van der Maas PJ. Euthanasie en andere medische beslissingen rond het levenseinde: De Praktijk en de Meldingsprocedure [Euthanasia and Other Medical Decisions Concerning the End of Life: The Practice and the Notification Procedure]. The Hague, 1996. This and the previous government-ordered study are analysed in Keown J. Euthanasia, Ethics and Public Policy. Cambridge: Cambridge University Press, 2002: 81-149. Van der Maas PJ et al. Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands. N Engl J Med 1996; 355: 1704. Van der Wal G, van der Maas PJ, Onwuteaka-Philipsen BD, van der Heide A. Medical decision-making at the end of life. The practice and the euthanasia notification procedure [in Dutch]. The Hague: Sdu Publishers, 2003: 67, Table 7.1. See also Fenigsen R. Dutch euthanasia: the new Government-ordered study. Issues in Law and Medicine 2004; 20: 73-79. See e.g. Gormally L. Euthanasia, Clinical Practice and the Law. London: Linacre Centre, 1994; Finnis J. Euthanasia, Morality, and the Law. Loyola University of Los Angeles Law Review 1998; 31: 1123-45; Linacre Centre for Healthcare Ethics. Submission to the House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill, available online at http://www.linacre.org/AssistedDyingBillSub.htm. Dr Helen Watt, Director   Published by ALERT 27 Walpole Street, London SW3 4QS. Telephone 020 7730 730 2800. Fax 020 7730 0181.