Don't create gaps in the Dutch euthanasia system

Offering suicide assistance to everyone over 70 is like cutting a big gap in the dense hedge separating life and death. The Netherlands should stick with the careful euthanasia policy it now has, says Margo Trappenburg.

Foreign scientists frequent the Netherlands to study its euthanasia policy. Many of them have heard horror stories about it, and want to see for themselves. They usually visit ethicists, doctors, and social scientists who are familiar with the policy on medical end-of-life assistance. Being one of those Dutch euthanasia experts, I know such a conversation usually goes like this.

The foreign researcher says matters of life and death are of great importance and should be dealt with carefully. There have to be limits to what is allowed. Otherwise, we would end up on a slippery slope to who knows where.

The Dutch expert agrees completely and says medical professionals in the Netherlands look very carefully at euthanasia wishes. Clear criteria define what is and what is not permitted.

The visitor often can only imagine one strict condition for end-of-life assistance: the explicit request of the patient. People should only be helped to die if they themselves have asked for it. But in the Netherlands, the researcher has learnt, this criterion is not always followed. In this country, newborns with very serious disorders are euthanised and the same goes for terminally ill patients who are in a lot of pain but no longer able to ask for end-of-life assistance. Apparently, a personal wish is not a definite requirement in the Netherlands. What is the deal there?

Exceptional cases

This is where I explain how it works. The Euthanasia Act, which came into effect in 2002, lists two criteria. The first is the voluntary and persistent request of the patient, the second is his or her unbearable suffering without any prospect of improvement. Both criteria have to be met for a legitimate euthanasia procedure. Two doctors have to evaluate if the wish to die is sincere and diagnose whether the suffering is indeed hopeless and unbearable. This procedure has to be documented in order for a medical committee to review if sufficient care was excercised. Precisely because the law is based on two criteria, there are exceptional cases where one of those is not fully met. When it comes to babies, the request to terminate their life can come from the parents. In the case of dying patients, their suffering can be unbearable to even watch.

Not every foreign researcher is reassured by this explanation, but I myself am always impressed by the way we have arranged this in the Netherlands. We debated the issue of euthanasia for roughly 30 years before the law was finally instituted, but now we have a system we can be proud of. I believe it is extremely unwise to open a second way to death alongside the careful procedure we now have.

Last week, a citizens' initiative dubbed 'Out of Free Will' (Uit Vrije Wil) proposed an alternative route for elderly people "who feel tired of life" and want assistance in committing suicide. The group said this option should be open to everyone over 70. However there is no reason to limit this path to death to a certain age group.

The desire to die

Why should a woman of 50 who loses her only child in a car crash not be eligible? Does she have to live in hopeless despair for another 20 years before she can apply? What about a poorly educated woman of 45 who, after suffering ten miscarriages and two failed IVF treatments, has to face she will never have a child and that life has nothing more in store for her than a job behind a checkout counter? Does she have to hang in there for another 25 years?

I have read and understand the desire to die expressed by the people whose stories are on the initiative's website. I hear the carpenter who wants to die because he is physically no longer able to work with his hands, and the people over 80 who suffer from various ailments, who are just tired and have had enough. But I also feel the death wish of the women I just described. If I were related to them, I would not be angry if they killed themselves.

However, I agree with the foreign scientists who say a political community needs to set rules about life and death, with clear boundaries. The line between life and death is like a dense hedge. In the Netherlands, we have placed a neat fence in the hedge, constructed with broad support from society and with plausible rules. It would be weird to cut a big hole in the hedge for those who can't pass through the fence.