In Michigan, Dr. Jack Kevorkian continues to defy the law by helping people kill themselves. In the Netherlands, things are different. Here, doctors have government permission to assist patients who want to commit suicide–and to euthanize those who are unable to do it themselves.
By sanctioning and regulating such practices, the Dutch might be expected to avoid the sort of dangers represented by renegade doctors like Kevorkian. Instead, they have ingeniously managed to institutionalize abuses on a mass scale. Allowing patients to choose their own end may sound fine in principle, but it has been a ghastly mess in practice.
Proposals to allow “aid-in-dying,” as it is coyly referred to by its supporters, have already made headway among Americans. Last year, Oregon voters approved a measure to legalize physician-assisted suicide, and the issue has arisen in several other states. Before embracing the concept, we should ponder how it might actually work.
For that, there is no better place to look than the Netherlands, which maintains a formal ban on euthanasia but furnishes physicians with instructions on how to perform it so as to avoid prosecution. For all intents and purposes, it is legal here for doctors who follow these rules–and, for that matter, those who don’t.
The Dutch take pride in their realism and aversion to hypocrisy. By letting doctors accelerate the process of departing this world, they say, they are merely bringing out into the open a custom that elsewhere is practiced covertly. Doctors have to file a detailed report whenever they bring about someone’s demise, giving the public a check on misbehavior.
Even here, though, many of them prefer to operate in the dark. A confidential government survey of physicians done in 1991 found there were about 2,300 cases a year in which doctors euthanized patients at their request. But the number of cases reported to the authorities has never come close to that figure. Last year, only about 1,420 cases were reported. The government admits that hundreds of “mercy killings” take place each year outside the law.
The 1991 survey unearthed a yet more disturbing fact. A doctor is supposed to give a patient a lethal potion only if the patient requests it. But physicians admitted killing about 1,000 patients without their consent.
Did this revelation evoke condemnation and stricter regulation? Not at all. Jacob Visser, a spokesman on medical ethics at the Dutch health ministry, excuses the involuntary deaths. “It saves the patient that last bitter end,” he says. In most of the cases, he notes, the doctor consulted the family, and in most of those instances, the family consented.
But that’s not how it is supposed to work. The regulations forbid euthanasia unless the patient has made a “voluntary and durable” request based on “full information.” Doctors often ignore the most fundamental protection in the law–and the government approves.
Euthanasia continues to spread beyond rational patients who personally choose it to unconscious or incompetent people whose wishes are not known. This year, a doctor put to death a fatally handicapped infant at the request of her parents, and a Dutch court ruled he was justified in doing so.
The practice is also not limited to terminally ill patients who are suffering unbearable pain–two more conditions set down in the guidelines. In a survey of patients who asked for euthanasia, only 5 percent cited pain as the main reason they wanted to die.
Last year, a psychiatrist was acquitted after assisting in the suicide of a physically healthy 50-year-old woman who was distraught over the death of her two sons and the collapse of her marriage. He had not even had her see another doctor (much less another psychiatrist), as the guidelines mandate. But the Royal Dutch Medical Society refused to suspend his license.
It’s hard to see what good the regulations do. Despite widespread violations, few doctors have been prosecuted, fewer still have been convicted and none has ever gone to jail. The guidelines are clear, firm and wholly ineffectual.
Do we want a society in which comatose patients are killed without their consent, handicapped babies are given lethal injections and healthy but unhappy adults can get suicide potions from helpful physicians? If not, we should refuse to take the first step of legalizing assisted suicide. As the Dutch have shown, that is a step onto a slippery slope, leading into a deep abyss.
