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Netherlands, first country But he adds: ‘‘One of the main reasons The proposed programme would to legalize euthanasia for requesting euthanasia is fear of the dying replace eight existing programmes, which Last month, the Netherlands became the first process. So if patients are confident that a each addresses a single public health topic, country to decriminalize voluntary euthana- doctor won’t refuse euthanasia at a future such as cancer, AIDS and other sexually sia. Under new legislation a doctor will not date this can be very reassuring and can give transmitted diseases, rare diseases, pollution- be prosecuted for terminating a person’s them the strength to continue.’’ related diseases, epidemiological surveil- life providing he or she is convinced that Belgium could be the next country to lance, health education, injuries and the patient’s request is voluntary and well change its laws on mercy killing, as a bill to accidents, as well as drug abuse. considered and that the patient is facing partially decriminalize euthanasia is currently The Commission’s public health pro- ‘‘unremitting and unbearable’’ suffering. before parliament. In Belgium, 72% of the posal, explains Member of Parliament An- The doctor must have advised the population is believed to support some sort tonios Trakatellis, ‘‘is the first integrated patient of his or her clinical condition and of death on demand. EU venture in this sector. To date, important have reached a firm conclusion with the The issue of euthanasia is likely to health topics have been dealt with in a patient that there is ‘‘no reasonable alter- remain high on the medicolegal or ethical piecemeal fashion, with different problems native’’. In addition, at least one other agendas of many countries in coming years. tackled mainly in isolation from each other’’. independent physician must have examined One reason, according to some experts, is The main goal of the new programme, the patient and reached the same conclusion. a growing insistence among patients in many Trakatellis says, would be to collect and The legislation reached its final hurdle countries on having the final say — in all evaluate medical and epidemiological data on 10 April when the Dutch senate voted senses of the word ‘‘final’’ — about their across the EU, bookmark health-determin- by 46 votes to 28 to approve the bill. The medical treatment. ing factors, including lifestyle, socioeco- vote was seen as a formality, after the lower Another reason is that people are living nomic or environmental factors, and house voted last autumn by 2:1 in favour longer and because of medical advances elaborate mechanisms by which one could of decriminalization. increasing numbers are surviving with debil- respond rapidly and efficiently to health There will be little change in practice, itating conditions, such as cancer and heart threats like, say, emerging infectious diseases. as Dutch doctors have offered euthanasia to disease. However, some experts in palliative The coordinating centre, the HCMC, terminally ill patients for at least two decades. care argue that advances in palliative medi- that Parliament is calling for would be a In 1994, a law was introduced which obliged cine mean that more patients should be clearing house for all types of public health doctors to report any cases of euthanasia able to live a pain-free life, thereby reducing data compiled from across the EU. It would to the authorities, who would then decide not the need for euthanasia. gather data through national health agencies, to prosecute if the doctor had followed Jonquierre believes it should not be monitor epidemiological trends and health certain guidelines. Euthanasia still remained an issue of palliative care vs euthanasia. ‘‘The inequalities, and come up with a catalogue a crime, however, carrying a maximum best possible care should be given before of best health care practices to be provided 12-year prison sentence. the issue of euthanasia arises. However, a to all EU citizens. ‘‘In order to collect and The Royal Dutch Medical Association discussion of euthanasia should be part of manage data, you need a functioning co- welcomed the move, saying it would resolve the palliative care package.’’ n ordination centre, which simply wasn’t there the ‘‘paradoxical legal situation’’ and ensure Jacqui Wise, London, UK [in the initial proposal],’’ Trakatellis says. that doctors acting in good faith and with due In their vote, members of Parliament care would not face criminal proceedings. also included a wish-list of urgent issues Although surveys show that the change Heated debate likely on plan for the new programme should focus on: they in law is supported by 90% of the Dutch EU-wide health coordination include cardiovascular diseases, mental dis- population, there were still angry protests In a vote on 4 April, the European Parliament orders, age-related neurodegenerative dis- outside the parliament building. In the weeks called for the creation of a European Health eases, cancer, respiratory diseases, and AIDS preceding the debate, the senate received Coordination and Monitoring Centre and other sexually transmitted diseases. over 60 000 letters urging legislators to vote (HCMC) — the cornerstone of a proposed The Parliament also called for safeguards against the bill. The mostly Christian new programme that would coordinate against exposure to electromagnetic fields protesters view the measure as an assault and streamline health policies across the and expressed the hope that research under on the sanctity of life. 15 member states of the European Union the current WHO programme on magnetic About 3000 cases of voluntary eutha- (EU). At the same session, the Parliament fields would be supported. nasia are carried out each year in the also called for an almost 30% increase in The Parliament’s revisions, says Traka- Netherlands. Mr Rob Jonquierre, managing funding — from E_ (euros) 300 million tellis, would help ensure that this is a sound director of the Dutch Voluntary Euthanasia (US$ 256 million) to E_ 380 million programme for the entire EU. ‘‘Ideally, it Society, believes that the new legislation will (US$ 336 million) — for the programme, would cover just about everything related not lead to a massive increase in the number which would run from 2001 to 2006. to public health. I consider it the beginning of cases. He told the Bulletin: ‘‘We may see Officially termed ‘‘programme of com- of a long journey toward the convergence more requests, as patients may find it easier munity action in the field of public health’’, of health policies and services among the to talk to a doctor about euthanasia knowing the new programme was first proposed last member states.’’ that the doctor will not now be committing May by the European Commission, the EU’s Dr Marc Danzon, the director of a crime.’’ executive body. The Parliament is currently the WHO Regional Office for Europe in calling for a number of revisions. Copenhagen, welcomes the EU proposal.

580 # World Health Organization 2001 Bulletin of the World Health Organization, 2001, 79 (6) News

The new programme, he says, would be of industrial and agricultural processes. p. 272, vol. 79, March 2001), have come to a signal that ‘‘the Commission is getting more WHO says prolonged exposure to arsenic much the same conclusion. An MMR-autism involved in the sector of public health — and in drinking-water causes cancer of the skin, link was first mooted in a study published that is good for the work of WHO’’. Once lungs, bladder, and kidneys. In particular, the in 1998 in The Lancet. Details from www. up and running, WHO is planning to agency notes in a soon-to-be-published fact iom.edu/IOM/IOMHome.nsf/Pages/ collaborate closely with the EU networks, sheet, lung and bladder cancers have been immunization+safety+review. n among other things in order to avoid any observed at levels below 50 ppb — the duplication of effort, Danzon says. ‘‘It’s international standard set by WHO in 1963. Petroleum funds to fuel malaria neither in their interest, nor in ours. But the In 1993, WHO set 10 ppb as a ‘‘provisional research risk really is minor. In the field of epide- guideline value’’ but notes that on health ExxonMobil announced in mid-April its miology and public health, there are far too grounds this value ‘‘would be less than support for three malaria initiatives — the few people and too much data. In fact, there 0.01 mg/l [or 10 ppb]’’. Harvard Malaria Initiative (HMI), the is work for 1000 organizations. The [Com- Countries where arsenic in drinking- Medicines for Malaria Venture (MMV) and mission’s] intention is good, the plans are water has been detected at concentrations the WHO-spearheaded Roll Back Malaria good; now let’s implement them together.’’ above 10 ppb include Argentina, Australia, (RBM) programme. The petroleum and But Trakatellis’s — and the Parliament’s Bangladesh, Chile, China, Hungary, India, petrochemical company is donating — vision has still a long way to go. The Mexico, Peru, Thailand, and the US. In at US$ 1 million to the HMI, a Harvard School Council of the EU, composed of the least four of these countries — Bangladesh, of Public Health initiative focusing on basic responsible ministers of the member China, India, and the US — adverse effects research for antimalarial drugs and vaccines, states, has its say on the proposal. Then on health have been documented, and US$ 300 000 to the MMV, a non-profit the Commission, the Parliament and the WHO says. n foundation that coordinates antimalarial drug Council have to settle on a compromise. Catherine Dold, Boulder, Colorado, USA development. A further, as yet unspecified, ‘‘The Commission is not ruling out amount will go to RBM to support its anything for the future but the first priority antimalarial activities in five African coun- right now is to get the new programme up tries — Angola, Cameroon, Chad, Equatorial and running — which, given its scope, is a In Brief Guinea and Nigeria — where ExxonMobil massive effort,’’ a Commission spokes- operates. For further information, visit these woman, who requested anonymity, told the Polio vaccine not HIV source, four Web sites: www.hsph.harvard.edu/malaria, Bulletin. Discussions are under way with other studies show www.malariamedicines.org, www.who.int/ n health agencies, including WHO, she added, Findings of four studies reported at the end rbm, and www.exxonmobil.com on a broad range of topics, including what has of April — three in the journal Nature, one to be done to make sure that there is in Science — strongly refute a much-publicised Malaria researchers note: parasite no duplication of effort when the new theory that the first cases of AIDS resulted genome now on Web programme goes into effect. from African trials of an oral polio vaccine PlasmoDB, an Internet-based database The Parliament’s April vote is thus likely supposedly contaminated with the chim- allowing genomic analysis of Plasmodium to mark the beginning of some heated panzee variety of HIV (SIVcpz). British falciparum, the cause of the most lethal debate. n writer Edward Hooper elaborated on the form of malaria, is now available at http:// Michael Hagmann, Zurich, Switzerland theory at length in his 1999 book, The River. plasmodb.org, two US research teams at the Three of the new studies found neither University of Pennsylvania announced in chimpanzee DNA nor genetic material from April. The database owes a lot to sequencing Arsenic in water — how much HIV or SIVcpz in samples of the vaccine work conducted at two US institutions, the used in the trials, as would be expected if is too much? Institute for Genomic Research and the the theory was correct. The fourth study Naval Medical Research Center at Stanford The United States is in the throes of a suggested that HIV was present in humans University, and to the UK’s Sanger Centre. n fractious debate about what the permissible long before the vaccine field trials. Put levels of arsenic in water should be. together, these new studies show that the oral The current US standard of 50 parts First guidelines out for tackling polio vaccine was not the source of AIDS. deadly lung disease per billion (ppb), in place since 1942, is For more information see pp. 1045, 1046 and criticized as dangerous by public health The US National Heart, Lung and Blood 1047 in Nature, 26 April, 2001 and p. 743 in Institute, together with WHO, issued in April watchdogs, who would like to see the level Science, 27 April 2001. n reduced to 10 ppb, a change proposed by the first international guidelines on diagnos- the Clinton administration in January. EPA ing, treating and preventing chronic ob- And MMR vaccine not a source structive pulmonary disease (COPD). The chief Ms Christine Todd Whitman has of autism, US panel says asked the US National Academy of Sciences guidelines were drawn up by the Global A 15-member immunization safety review initiative for chronic obstructive lung disease (NAS) to review more data and to consider ,or committee convened by the US Institute GOLD, a team of COPD experts from more standards ranging from 3 to 20 ppb and has of Medicine concluded in a report released than 100 countries. Although it is the fourth also asked an advisory council to study on 23 April that there is no causal relationship leading cause of death in the world, COPD the potential costs of lower standards. between the measles-mumps-rubella com- has failed to attract the attention it deserves Meanwhile, the current standard of 50 ppb bination vaccine and autism, and ‘‘no proven from the international health care commu- remains in place. biological mechanisms that would explain nity and from governments, says GOLD The arsenic found in drinking-water such a relationship’’. Other leading health chair Professor Romain Pauwels. For more is primarily from natural sources — it leaches groups, including the American Academy information and a copy of the guidelines into groundwater from rocks and soil. It can of Pediatrics, WHO and British health contact Dr Nikolai Khaltaev (khaltaevn also enter the environment as a by-product authorities (see News story in the Bulletin, @who.int). n

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