As Assisted Suicide and Euthanasia Issues Simmer, Look at Holland

Article excerpt

As a race we have always worked harder at making life good than making death happy. Death unsettles us individually and communally. One manifestation of our nervousness is the expanding debate about assisted suicide and euthanasia

As the complex and emotional arguments ebb and flow in this country, we would do well to take a look at the Netherlands, "the only country where euthanasia is accepted practice," as Herbert Hendin writes in Seduced by Death: Doctors, Patients and the Dutch Cure (Norton, 256 pages, $27.50).

Hendin, a psychiatrist, has for much of his professional career studied and treated people who wanted to end their lives. In 1990 he became executive director of the American Suicide Foundation, which aims to prevent suicide, assisted suicide and euthanasia. He took over just in time for the currently burgeoning debate fueled by Dr. Jack Kevorkian and others.

While Seduced by Death contains scattered flights of theory, its power to persuade derives from the stark, lived experience in Holland. But also in America which brings the issues seriously close to home. Such as the story of Tim -- presumably not his real name -- a hard-driving young executive halted by leukemia, with a 25 percent chance of survival. Since Tim, the career track aside, wasn't having much of a life, his insistent pursuit of suicide was in its own way logical.

But if Tim should be allowed legal suicide, should everybody? And if allowing it is good, would insisting on it not be preferable? There is no context on earth in which the term "slippery slope" seems as appropriate as here.

Tim died eventually. But first he took the treatment previously rejected. This allowed him time for unfinished business. "Two days before he died," writes Hendin, "Tim talked about what he would have missed without the opportunity for a loving parting." But for every Tim there is a counter-story in which suicide might seem a good idea. "In the rush to legislate," suggests Hendin, "advocates have failed to understand the problem they are claiming to solve."

Search for answers

The author's own search for a solution took him to Holland in 1993. He learned that even in Holland the legalities are murky. The law still provides punishment for euthanasia and assisted suicide, but the same code stipulates exceptions to the law. By now these "special circumstances" have pretty much become the rule: "In a series of cases over the last 20 years, the Dutch courts have ruled that force majeure is such a special circumstance; euthanasia is thus permitted when a doctor faces an unresolvable conflict between the law, which makes euthanasia illegal, and his responsibility to help a patient whose irremediable suffering makes euthanasia necessary."

A cozy coexistence has evolved between the Dutch courts and the medical authorities who follow agreed guidelines for assisted suicide or euthanasia: (1) voluntariness -- the patient must freely, and repeatedly, ask for it; (2) unbearable suffering -- which cannot be relieved by other means; (3) consultation -- a second opinion.

These guidelines, it turns out, are ideal circumstances for the "slippery slope."

Slippery slope

It is hard to be sure how far down the slope the Dutch are, according to Hendin. The best guide is the celebrated Remmelink Report, published in 1991, the work of a government commission headed by Attorney General Jan Remmelink of the Dutch Supreme Court.

The report found assisted suicide uncommon: about 400 cases a year. There were, by contrast, about 2,300 cases of straightforward euthanasia, or about 2 percent of all Dutch deaths. Over 50 percent of Dutch physicians admitted to practicing euthanasia, mostly for cancer patients. Only 60 percent of doctors kept a written record of their cases.

More startling was how quickly physicians had slipped down the slope to involuntary euthanasia, unilaterally terminating the lives of competent patients, as distinct from those who were "out of it" Remmelink reported more than 1,000 cases of death caused or hastened without any request from the patient. …