A License to Kill

Advocates of assisted suicide and euthanasia find a role model in Holland, the only country that permits both practices. They say its policy is a "remarkable triumph of common sense". Yet a closer look reveals the truth about the practice of euthanasia in Holland.

The Royal Dutch Medical Association officially endorsed euthanasia in 1984, and issued strict guidelines on how to perform it: The patient's condition must be one of unbearable suffering that cannot be relieved, and the patient must freely request to die. When a patient does ask, the doctor should not proceed without consulting an independent physician. Then each case must be reported as an "unnatural death" to local officials. Doctors who don't follow the guidelines can be imprisoned for up to 12 years.

Approved by parliament, the guidelines were meant to protect and empower terminally ill patients. But evidence suggests that they empower doctors instead.

Though patients are supposed to decide for themselves, they are sometimes influenced by doctors. If doctors judge someone's quality of life to be low, they ask, "Why should we add to the suffering?"

A survey commissioned by the Dutch government estimated that only 3,600 people died in 1995 as a result of assisted suicide or euthanasia. But this only included cases where the patient requested death. The survey did not count as euthanasia or physician-assisted suicide the 900 cases in which patients' lives were ended without their request and nearly 1,900 deaths in which doctors increased pain-killing drugs with the explicit intention of hastening death.

A 64-year-old woman, told in 1988 that she had advanced ovarian cancer, wished to die at home. When she awoke one morning covered in what looked like red pinpricks, her husband took her to the hospital. Returning to the hospital the next day to take his wife home, he took a short walk while he waited for the doctor to attend to his wife. When the husband returned to his wife's room, she was unresponsive. Three hours later she died—from lethal drugs the doctor had injected into her body.

The husband believes a doctor proposed the injection and his wife was swayed. "She always thought doctors knew best," the husband said. "It wasn't euthanasia—it was murder." But there was no investigation since he did not want the doctor prosecuted.

Because euthanasia is politically correct, prosecutors are often unwilling to press charges. Since 1981 only 20 doctors have faced the courts. Nine were convicted. Of those, six received suspended sentences, and three were given no punishment at all.

Doctors who have studied euthanasia in the Netherlands note that "what was intended as a solution for exceptional cases has become a routine way of dealing with terminal cases. The Netherlands has moved from euthanasia for the terminally ill to euthanasia for the chronically ill, from euthanasia for physical illness to euthanasia for psychological distress, and from voluntary to involuntary euthanasia.

Already, Holland's euthanasia guidelines offer scant protection to the mentally ill and newborn babies. Researchers from the University of Utrecht found that more than 40 percent of all mentally handicapped patients who died in 1995 did so after a doctor's decision to withdraw treatment, increase pain-killing drugs or give lethal injections. In that same year, doctors were charged with killing two handicapped newborns. The courts ruled' that the doctors had no option but to kill. The survey commissioned by the Dutch government reports that doctors now kill about 15 nonviable newborns a year.

In some cases, a patient's "right to die" has subtly become a "duty to die". Some people are pressured toward euthanasia by exhausted and impatient relatives. A story is told of a woman whose relatives gathered in Amsterdam for her planned euthanasia. One relative came from overseas. When the patient had last-minute doubts, the family said, "You can't have her come all this way for nothing." Instead of ensuring that the patient's true wishes were observed, the doctor carried out the euthanasia.

The key alternative to euthanasia—palliative care—is largely unavailable in Holland. Originated in England 30 years ago, this philosophy of total care for the terminally ill and their families offers spiritual comfort and the control of physical and mental pain without seeking to either hasten or postpone death. Today almost all communities in the United Kingdom and many in Europe and North America provide such care, often in facilities known as hospices.

Dr. Robert Twycross, a leading British authority on palliative care, recalls a cancer patient who drank excessively to escape the pain and mental distress caused by his illness and finally demanded to be put to death. After pain treatment, the patient changed his mind, saying, "It wasn't me speaking. It was the alcohol."

"Depression often overlaps and complicates terminal illness," Twycross says. "As the patient comes out of depression, the demand for euthanasia evaporates."

A 65-year-old widow learned in October 1996 that neither surgery nor chemotherapy was likely to cure her cancer of the throat and stomach. But the two options available—a hospital or a nursing home—did not appeal to her, because she feared that her wishes would not be respected in either place. "I'm not afraid of death," she said, "but I don't want someone else to decide how I should die." She seriously considered euthanasia.

Like most Dutch people, she knew little about options in palliative care. Then an acquaintance told her about a hospice in a nearby city.

Five weeks later, she was sitting in the sun lounge of the hospice. "When I came here, I could hardly walk or talk, and I hadn't eaten for a month," she recalled. "After ten days, I chat, walk and feel relaxed. I know I'm not leaving here alive, but I feel like a human being."

She died peacefully a few weeks later. She had been cared for by a doctor with a special sense of mission—Ben Zylicz.

Five years before, soon after his patient was euthanized by another doctor, Zylicz quit his hospital post to dedicate himself to an alternative. "As a doctor, I saw lives taken for reasons that had little to do with healing," he says, "Now lam able to help patients in a humane and caring way.

"I hope that others—both doctors and patients—will have that chance."