Humanist Perspectives: issue 152: Euthanasia in The Netherlands
the world around us
Euthanasia in The Netherlands
drawings in this article by Dushan Milic
During the previous decades, The Netherlands has been in the vanguard of implementing progressive public policies such as the legalization of prostitution, of the possession of marijuana for personal use, and most recently of euthanasia.
Although the words ‘euthanasia’ and ‘assisted suicide’ are often used interchangeably in the press and in public discussions, they are not the same. The distinction arises from the final act causing the intended death. Suppose that an intravenous needle has been inserted into a patient’s vein allowing a lethal drug dose to flow through upon the flip of a switch. If the patient activates the switch it will be assisted suicide. On the other hand if someone else activates the switch it will be euthanasia.
It was well known that doctors had practised euthanasia in hospitals for years. However, they did so under the imminent threat of criminal prosecution. The new law set strict guidelines and shifted to the Crown the burden of proving beyond a reasonable doubt that these guidelines had not been adhered to. The new law also resulted in more accurate reporting of euthanasia by medical doctors.
The new law was not without some opposition, particularly from religious quarters. However, the prevailing view was that the reasonably healthy among us hardly had any right to prevent others from ending their genuine suffering. After all we had no control whatsoever over our arrival into this world. At least we deserve the right to determine as much as possible the manner and time of our departure. This point was well made in the 1981 movie Whose Life is it Anyway? with Richard Dreyfuss.
Furthermore, evidence from studies in The Netherlands shows that knowledge of the legality and availability of euthanasia actually encourages suffering people to live longer. When the new law was enacted the Minister of Health was Else Borst, a medical doctor and university professor. In response to a reporter’s question during an interview, she said: “Why would you think that this is against God’s will? I think that you are too formalistic in interpreting what people may or may not do according to God. People are allowed to extend life endlessly and manufacture all kinds of medicine. In any case it is difficult to believe in a God who does say: ‘You may let a person die a week later,’ but not: ‘You may let him die a week sooner.’ I just cannot understand that.”
Following are the rules specified in the Dutch law:
- The request must be freely made, unchanging and carefully considered.
- The suffering must be hopeless and unbearable. (Note that the illness does not have to be terminal. Also Dutch courts have found that either emotional or physical pain can be used to meet the criteria of unbearable suffering.)
- Further medical treatment would clearly be pointless.
- A second physician must concur and must have communicated with the patient independently and directly.
- No alternatives are available.
- The euthanasia must be carried out in a medically responsible manner.
- It must be reported to the coroner.
In 1998 a physician assisted in the suicide of a former Dutch Senator, who suffered from incontinence, dizziness and immobility and who was ‘tired of life.’ Because the Crown did not consider this a case involving hopeless and unbearable suffering, the attending physician was prosecuted. The lower Court, however, found him not guilty and the judge concluded that there are no objective criteria to assess suffering. It is the subjective experience of the patient that should prevail.
However, this decision was overturned on appeal. The case then moved to the Supreme Court and in December 2002 the highest Court in The Netherlands ruled that the senator’s condition was not sufficiently critical to justify a mercy killing: “The question in this case was whether euthanasia is justified also in circumstances where a patient is tired of life.” They concluded that the euthanasia law had not been intended for situations like this one.
Nevertheless the physician was given an unconditional discharge.
It is noteworthy that doctors or other medical personnel are not obliged to participate in euthanasia if that is against their conscience. In that case they will refer the patient to another doctor.
In regard to minors requesting euthanasia, the law stipulates that those who are 16 or 17 years of age can make an independent decision although their parents have to be included in the decision-making process. Those between 12 and 16 require permission from parents or guardians.
Other countries such as Canada will no doubt closely follow further developments in The Netherlands. It is a positive sign that the recent Evelyn Martens case in British Columbia has stimulated a debate about this important issue that is truly one of life or death.
Theo Meijer is a retired educator, coordinator, freelance court interpreter/translator and a life-long modern Humanist. He was president of the BC Humanist Association from 1996 to 1999 and has since been involved with the Victoria Secular Humanist Association.