In the United States, when the subject turns to euthanasia - known more commonly here as doctor-assisted suicide - ethicists and policymakers worry aloud about going down the "slippery slope." In the Netherlands, they've already slipped. And therein lies a cautionary tale for us.
The slippery-slope argument says that if we allow something relatively harmless today, we may nonetheless establish a trend that results in something currently unthinkable. Last November, opponents of the Oregon proposition allowing doctor-assisted suicide invoked the slippery-slope concept - and lost.
The Oregon law, the first such in the nation and as-yet held up by a federal court, clearly forbids anything other than ending the life of an already dying patient who requests it. Yet a very short time ago, so did Dutch law. In fact, it wasn't too long ago that physician-assisted suicide was completely illegal in the Netherlands.
That changed in 1973, when a doctor went on trial for killing her terminally ill mother with morphine. The court began a long process of slowly eating away at the law by convicting the woman, but giving her a mere suspended sentence of a week in jail, plus a year's probation. Probation violation would have been difficult, since presumably the woman had no mothers left to kill.
Soon courts were dispensing with convictions altogether and simply absolving any physician who killed a patient as long as doctors followed certain guidelines in terms of whom they killed and whom they consulted. Originally, it was understood, though not always explicitly stated by the courts, that the patient had to have been suffering from a terminal illness. Soon this was to fall by the wayside.
In 1985, Pieter Admiraal, a Delft anesthesiologist since retired, was tried for killing (an expression he uses) a young girl with multiple sclerosis who, while she was suffering, could be expected to live indefinitely. The charges were dismissed because the act fell within the criteria developed by the Dutch high court - namely, that the disability, although not fatal, was incurable. In one recent case, a physically healthy but severely depressed woman requested - and received - euthanasia from her doctor.
With the terminal-illness requirement gone, the other major prerequisite, that the patient had to make an explicit request, also was to disappear. Soon doctors were euthanizing infants born with disabling but nonfatal diseases such as Down's syndrome and spina bifida. Patients in persistent vegetative states, often incorrectly referred to as "comatose," also became fair game. After three Amsterdam nurses killed several such patients without any form of consent, they were found guilty not of any sort of unlawful killing but only of acting without the guidance of a doctor. Admiraal bluntly told me, "I think it's quite normal for society to ask for euthanasia of newborns and allowing the death of [people in] comas. …