At the Maastricht meeting our Dutch hosts opened a window on their society and invited us to take a look at euthanasia practices in the Netherlands. As Maurice de Wachter intimates in his article, the hosts were candid in their descriptions and the guests frank in their evaluations. All the Dutch participants wanted us to understand their brand of euthanasia better, and most of them defended it against what they perceived as outsiders' skepticism or even hostility. Nonetheless, some of the Dutch expressed doubts and misgivings, just us as the British, American, and Canadian visitors were not of one mind.
Not surprisingly, I was struck by the cultural specificity of the Dutch practices, which reminded me in turn of the cultural lenses I wore in viewing those practices. This does not mean, however, that the Dutch experience - or its thoughtful examination in Maastricht - is inapplicable to the United States as proposals to legalize "physician" aid-in-dying" are considered during the next few years. As long as we keep social, economic, and cultural differences in mind in drawing any specific lessons from one situation to the other, there is much to be learned. Moreover, as careful readers of Professor de Wachter's article doubtless perceive, behind the cultural specifics lie not only many similarities among the societies represented at the meeting but common (perhaps inevitable) ethical issues that inhere in any policy about the conditions and methods of dying in any society.
Clarity about the Subject
It is usual in discussions of the topic of active euthanasia to spend a great deal of time not merely defining one's terms but also lamenting the unwillingness or the apparent inability of others - particularly those with whom one does not agree - to make clear how they define the practices in question. I think it fair to say that the Dutch believe they have been much clearer on this subject than we in the United States have been.
In large measure, this criticism seems well taken. In particular, the use of the phrase "physician aid-in-dying" by proponents of active euthanasia seems at best an evasion when what it meant is legalizing physician's taking steps to kill patients directly, swiftly, and painlessly. There are so many things - including simple companionship and love - that one might do to "aid" a dying person, that the phrase "aid-in-dying" cannot help but disguise more than it reveals. In contrast, the Dutch do not mince words: whatever one thinks of its morality or legality, what is done by physicians in Holland is certainly active euthanasia and nothing is gained by euphemisms.
Yet the Dutch frankness turns out to be both adventitious and far from unclouded. The definition did not arise from a modern-day attempt to define acceptable medical practices but from a distinction drawn in the last century between ordinary murder and the less culpable situation in which the termination of a person's life (not necessarily - or even probably - by a physical occurred at his or her request. Thus, when the first case of physician-administered mercy killing arose recently, Dutch jurists, unlike their Anglo-American counterparts, began with a separate category of crime. When the Dutch courts (and medical association) turned that prohibition on its head by making it an acceptable rather than an unacceptable act, they perforce retained the characteristic that made it a separate category - namely, that the dead person had explicitly and seriously requested an end to life.
It happens that this requirement (self-determination) is one of the two factors (the other being relief of suffering) that virtually always arise as justifications for euthanasia. Self-determination is clearly coincident with the importance given to autonomy in contemporary bioethical analysis, besides fitting well with Dutch attitudes about life generally. But it is part of the definition of euthanasia for arbitrary not inherent reasons, akin to the Dutch requirement that a second doctor confirm the decision to perform euthanasia. …