Sir.—Visser et al1 wrote an editorial to accompany our article2 on pediatric euthanasia. We would like to respond to the issues they raised.
We understand that an official procedure for reporting euthanasia now exists, as of November 1, 1990. Unfortunately this procedure was not published until 1991 to 1992, and we thank the authors for bringing our facts up to date. What the authors have not addressed is how often this official procedure is complied with. The Remmelink Commission estimated 2300 deaths from euthanasia in Holland in 1990,3 yet in 1989 only 340 cases were officially reported.4 A recent report by Dutch physicians stated that more than 25% of euthanasia deaths in the Netherlands do not have a certificate issued testifying to death due to unnatural causes.5 It appears that many cases of euthanasia in the Netherlands are not reported.
Any discussion of euthanasia