Academic journal article Issues in Law & Medicine

The Dutch Experience

Academic journal article Issues in Law & Medicine

The Dutch Experience

Article excerpt

Abstract: Euthanasia has been legally sanctioned in the Netherlands by a series of court decisions going back to the 1970s. The author discusses the cultural and historical factors that may have contributed to this development. In the past decade, studies sactioned by the Dutch government reveal that guidelines established for the regulation of euthanasia--a voluntary, well-considered, persistent request, intolerable suffering that cannot be relieved, consultation with a colleague, and reporting of cases---are consistently violated. Of greatest concern is the number of patients who are put to death without their consent--there are more involuntary than voluntary cases. Euthanasia intended originally for the exceptional case has become an accepted way of dealing with the physical and mental distress of serious or terminal illness. In the process palliative care has become one of the casualties while hospice care lags behind that of other countries. Case examples are given.


In the fall of 2000 the Dutch Parliament passed a statute that formally legalized euthanasia and physician-assisted suicide in the Netherlands. Although the world media treated the passage as a major event, both practices had long been legally sanctioned as the result of a series of court decisions going back to the early 1970s that had made the Netherlands the only country where euthanasia and physician-assisted suicide were widely practiced.

Those in the Netherlands who seek an explanation for the Dutch embrace of assisted suicide and euthanasia usually emphasize the country's historical tradition of tolerance. The Dutch had fought to secure their religious freedom in the sixteenth and seventeenth centuries, and the Netherlands became a refuge for Jews, Catholics, and free thinkers like Spinoza and Descartes who fled there from religious oppression. Dutch secular society in the same period was marked by the Netherlands becoming a major maritime power whose merchants had to learn to accept different cultures, traditions, and practices. (1) In modern times the Dutch point to the presence of fifty different religions--most due to schisms in the Protestant church--and approximately twenty-five political parties. So much diversity in such a small country is seen as a sign of Dutch tolerance. (2)

Tolerance does not imply integration. Splitting up into so many autonomous groups has been seen as reflecting an inability to tolerate the conflict that differences bring. Derek Phillips, professor of sociology at the University of Amsterdam, sees the division into so many parties and religious denominations as coming from a difficulty in accepting the ambiguity and tension that result when people of different viewpoints are interacting in the same group. Dutch academic journals, for example, do not tend to reflect a diversity of viewpoints; more characteristically, different opinions find expression in separate journals. (3) Comparably, when the Royal Dutch Medical Society (KNMG) supported physician-assisted suicide and euthanasia, religious physicians formed a separate medical group opposed to euthanasia. The Dutch medical establishment believes that all opposition to euthanasia is fundamentally religious in nature but is far less tolerant of nonreligious physicians who oppose euthanasia on medical grounds and try to do so within the framework of organized medicine. (4) Compartmentalizing differences is seen as avoiding direct engagement and maintaining consensus within respective autonomous groups.

Most scholars point to Dutch Calvinism as an essential starting point in understanding the origins of contemporary Dutch attitudes toward euthanasia. Calvinism in the Netherlands had its own unique character with its self-righteous view of predestination, its extreme emphasis on simplicity, self-denial, and avoidance of worldly pleasures, its belief that the endurance of suffering was redemptive as well as admirable, and its dedication to one's work as a calling, attitudes that once diffused throughout society. …

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