Euthanasia and Assisted Suicide

The Netherlands has the most experience with physician-hastened death. Both euthanasia and assisted suicide remain crimes there but doctors who end their patients' lives will not be prosecuted if legal guidelines are followed. Among the guidelines are:

• • The request must be made entirely of the patient's own free will.
• • The patient must have a long-lasting desire for death.
• • The patient must be experiencing unbearable suffering.
• • There must be no reasonable alternatives to relieve suffering other than euthanasia.
• • The euthanasia or assisted suicide must be reported to the coroner.

These guidelines are similar to those proposed in legalization proposals in the United States, although the Oregon law requires a terminal illness, a limitation not included in the Dutch guidelines. On the other hand, the Oregon guidelines do not require that the patient be experiencing unbearable suffering or that there be no reasonable alternatives to relieve suffering other than assisted suicide.

There have been several professional studies conducted into Dutch euthanasia practice. Most have reported that approximately 2,700 deaths are caused each year in the Netherlands by either euthanasia or assisted suicide—approximately 3 percent of all Dutch deaths. Proponents claim this relatively low figure rebuts opponent's fears that euthanasia will become a relatively routine event. Opponents counter that this figure is horrifying: if the same percentage of Americans died with the direct assistance of doctors, it would amount to approximately sixty-eight thousand annual deaths, more than tripling the U.S. suicide rate.

Opponents also claim that the number of people actually killed by Dutch doctors is significantly understated in these studies. They note that the term "euthanasia" is very narrowly defined by the Dutch government, with the effect if not the design of undercounting the actual number of euthanasia deaths. If a doctor kills a patient with barbiturates and a curare-like poison at the patient's request, the Dutch classify the death as "euthanasia." However, if the patient is killed by an intentional overdose of morphine administered with the primary intention of ending the patient's life, it is not considered euthanasia because morphine is a palliative agent. Yet, intentional morphine overdoses may exceed "euthanasia" deaths. In 1990, according to a Dutch government report, 8,100 patients died through the intentional morphine-overdose method of mercy killing. A latter study found that about 1,500 die annually through the intentional morphine-overdose method of killing. Whatever the actual annual figure, if intentional morphine-overdose deaths are counted as euthanasia, the statistical mercy killing rate in the Netherlands significantly exceeds the published statistics.

Opponents point to the many documented cases of chronically ill people, as well as to terminally ill people, put to death by doctors at the patient's request as further proof of euthanasia's many dangers. A Dutch documentary showed a young woman in remission from anorexia requesting doctor-induced death because she was afraid of resuming food abuse. Her doctor assisted her suicide without legal consequence. Another documented case showed an asymptomatic, HIV-positive patient assisted in suicide because he feared future suffering.

Opponents point with alarm to the Dutch Supreme Court's decision approving euthanasia for cases of severe depression—even in the absence of physical illness (State v. Chabot, Supreme Court of the Netherlands, Criminal Chamber, 21 June 1994, nr. 96.972). This decision resulted from the case of a Dutch psychiatrist who assisted the suicide of a woman who wanted to end her life because her children had died. The court supported the psychiatrist's actions, ruling that for purposes of judging the propriety of euthanasia or assisted suicide, suffering is suffering and it does not matter whether the cause is physical or psychological.

Another disturbing statistic that is found consistently in studies into Dutch euthanasia practices demonstrates to opponents the ultimate danger of euthanasia: approximately one thousand Dutch patients are euthanized each year by their doctors "without request or consent," in other words, involuntary or nonvoluntary euthanasia. Since euthanasia is only supposed to be allowed for people who consistently ask to be killed, the fact of involuntary killing demonstrates the unworkability of guidelines. Proponents counter that the number, while too high, has been relatively constant over several years, thus belying fears of the slippery slope.

Pediatric euthanasia has also become a part of Dutch euthanasia practice. Opponents point with alarm to a 1997 study published in the British medical journal The Lancet indicating that about 8 percent of all infants who die in the Netherlands are euthanized—approximately 80 per year. Pediatric euthanasia, they claim, is a human rights abuse and a proof that guidelines do not protect vulnerable patients. Proponents counter this criticism with the defense that the infant-euthanasia deaths are only of the most severely impaired babies, most of whom would not live anyway, and note that the parents make the decision based on their judgment of what is best for their children.

Opponents also claim that Dutch euthanasia is "beyond significant control" since approximately 59 percent of euthanasia and assistedsuicide deaths are not reported to the coroner as required by the guidelines. Thus, they claim that the actual number of Dutch patients killed is probably far higher than the statistics seem to show. Proponents admit that unreported euthanasia deaths are a problem but counter that full legalization would remove fear of prosecution thereby increasing compliance with reporting requirements.

In 1999 the Dutch government announced its intention to formally legalize euthanasia. As with anything having to do with euthanasia, the announcement was extremely controversial: the proposed law would permit the euthanasia of children as young as twelve at the request of the child, even if the parents object.