April 1, 2002

12:49 PM

Dutch Legalize Euthanasia"The Netherlands has become the first country in the world to legalise mercy killing after a controversial law on euthanasia came into force on Monday." While tolerated for nearly two decades, opponents are comparing the practice to Nazi Geramny. Is this a step forward for those living with severe pain and no hope in sight?
posted by futureproof (32 comments total)

Dunno. I've got mixed feelings about this:

Doctor to rich person: "Well, your situation is pretty severe, but with lots of expensive treatments, which I'm sure you can afford, you've got a chance"

Doctor to poor person: "Well, your situation is pretty severe. Have you considered euthanasia"

Of course, a proper national health care system might take care of this discrepancy...
posted by laz-e-boy at 1:18 PM on April 1, 2002

Opponents will compare just about anything to Nazi Germany. It's clear that the Dutch are aware of the ethical complications involved in this procedure and have taken measures to ensure that the law is used, so far as anyone can tell, strictly to allow people to choose a quick, peaceful death over a drawn-out painful one.

They've been doing this for years already and society has not collapsed. It's not going to fall apart now simply because the whole thing has been brought into the open.

-Mars
posted by Mars Saxman at 1:23 PM on April 1, 2002

I am curious if anyone out there knows how the agreement between doctor and patient are brought out? If the doctor could fake the person's agreement (ie, if it only had to be verbal, or even written where someone that sick might sign anything w/o thinking), then what would keep him from (in reference ot laz-e-boy's post), just saying (or forging) that the poor person agreed to the euthanasia (nevermind the fact that I don't agree w/ Euthanasia in the first place, but thats alos been a dead horse)
posted by jmd82 at 1:27 PM on April 1, 2002

Just to be clear, does this allow doctors to terminate patients without their consent, say if they're comatose or such?
posted by Mach3avelli at 1:28 PM on April 1, 2002

Only reference to comatose patients:
"In one case, a group of doctors is campaigning in support of a colleague who is appealing against a murder conviction for helping a comatose patient to die without a request for euthanasia."
Of course, this still doesn't say what the law says.
posted by jmd82 at 1:46 PM on April 1, 2002

What the Nazis did was KILL people without their consent. Euthanasia is done only when the patient requests it consistantly and from a sound state of mind. (Or if the patient is without conciousness and there is no hope of attaining conciousness, the family may make the decision.)
posted by fieldswn at 1:59 PM on April 1, 2002

At least the Dutch have universal health care, so the pressure on the poor to kill themselves (both from family and from insurers) might be slightly less than it would be in this country. It also appears that they don't have managed care, at least not American-style managed care.

Unfortunately, the right-to-die debate has overshadowed a far more important end-of-life issue that effects far more people--access to quality hospice and palliative care services.
posted by boltman at 4:40 PM on April 1, 2002

In Oregon, where we also had euthanasia laws (until Ashcroft recently killed it), two patient-signed forms were required: one sixth months in advance and another before death. Witnesses to the signing were also necessary. And the medication, in most cases, had to be taken by the patient; i.e., no injection from the doctor. The patient had to commit suicide for themself.

This may not be exactly correct, but that's the gist of it. I don't know the Dutch law, but one would assume it's something similar.
posted by Yelling At Nothing at 5:27 PM on April 1, 2002

I wonder if this euthanasia involves heroin.

boys keep swinging.
posted by Settle at 6:45 PM on April 1, 2002

It's hard for me to understand who beside me would have any business to decide if I'd want to live with suffering or die. Although it's also hard for me to understand why anyone would need permission to carry through a decision to die. There are so many ways.
posted by semmi at 10:57 PM on April 1, 2002

My father is currently dying from cancer which spread from his lungs to his brain and liver.

I got the call on Thursday night to drop everything and get home to be with him.

In the last four days I have listened to him cry out in anguish and beg to die. I've held his hand as he told me he had had enough, and wanted to go, and beg for help to get there.

Do I want him to die? Of course I don't.

Do I want to suffer like he's been suffering? Hell no.

He wants to die. He has told us he's had enough. He is unable to get himself there. We cannot assist. For the last 24 hours he has been slipping further into a coma, assisted by morphine on a pump driver to sedate him so he is no longer so distressed. Effectively, he's gone from us already. We are no longer sure whether he is aware of our presence. He lies in his bed, every breath laboured. The doctor tells us this could go on for another two or three days.

Do I wish that there was some way to ease his suffering and let him finally be at peace? Of course I do.

But there isn't. We just have to wait, and watch him die, inch by inch. Hoping that it will be sooner rather than later.

Yes, there is enormous potential for euthanasia to be misused, but there is just as much potential to allow those who are terminally ill to die peacefully, with dignity and without the heartbreaking mental anguish I've witnessed over the last few days.

When it comes right down to it, I don't think any of us would wish to live with suffering, particularly not where death is inevitable and the only variable is time.

No-one wants their loved ones to die, but when it's inevitable, and a long, drawn-out, painful affair, I think it'd be hard for anyone to stand and take the moral high ground.

My mother drew up a living will a few years ago, stating she did not wish to be treated or kept alive if she was beyond a certain probability of recovery. I will be drawing up a similar document in the coming weeks. In it I will set out my wish that if a euthanasia law were to be passed in the UK, and I am terminally ill and unable to request euthanasia, I would want my family to make that request for me.

For years I've sat on the fence on this issue, but the events of the last few days have set me firmly down on the side of intensely regulated euthanasia.
posted by pixeldiva at 1:40 AM on April 2, 2002

Euthanasia is about MONEY. It is evil. Sick and dying people do not have to live in severe pain with todays pain killers and opiates. Doctors are prevented from giving patients enough for pain because of the so called War on Drugs. I know a patient on oxycotin who almost had it taken away and they can barely function without it but with it, do fine.

I dont think a profit-driven business should be determining who lives or dies. Also doctors should protect life not take it. I am far more ill then some people who signed up to die with Jack Kevorkian. As a disabled person with serious chronic illness I see this as a pure evil and a start of Nazi like programs to get rid of non-productive members of society. They tout personal choice but that is just a smoke-screen. Instead of giving a person enough drugs to keep them out of pain or good hospice treatment the message now is to take yourself out. Economics now will determine what life will be worth perserving. It devalues life. Committing suicide is a sin. Society has fallen far and down.
This is a sign and a sympton of a culture that has removed itself from God.
posted by Budge at 4:45 AM on April 2, 2002

People are devaluing life more. I have had friends tell me on the phone: "if I had a retarded kid, I wouldnt keep it or I had an abortion before hand if I knew it. I have been told people who are in wheelchairs and who cant do nothing for themselves should just be allowed to die". Some of these people forget I am disabled during the course of these lovely conversations usually on the phone. I remind them gently of this fact and they tell me things like "well your mind still works" and "You can still walk nominally"... Well Thanks.....but no thanks.

Ive read about Nazi Germany. They would have taken me right out because I am too sick to work. There too it was promoted as a choice thing in the beginning for parents of disabled children not to be "burdened" with them. Everything was done underneath the radar. Wake up people! Sick people with cancer CAN be made comfortable today. This is a profit driven enterprise.
posted by Budge at 4:53 AM on April 2, 2002

With respect, budge, I don't think that the introduction of the new laws here in the Netherlands are profit-driven. In this country everyone is insured, whether privately or through the ziekenfonds, a government program. If you are sick, you receive the same care, tests etc. from your doctor whether you have the ziekenfonds insurance or the private particulier insurance. The ziekenfonds has to insure you, regardless of your medical history - there are no health-based application forms to fill out.

The Netherlands also has very good care for those who can't work due to illness or disability - to put it very generally, you get 70% of your normal income if you are too sick to work. Social benefits are very high here, which comes from our high taxes. (I should add that I'm not Dutch - I just think the system works pretty well).

semmi: Briton Diane Pretty is an example of someone who wants to end her life but is not physically able to do so without assistance. Mrs Pretty won the right to die, but many others believe she should not have this right. Some arguments against the right to die are put forward here.

Another Briton, Charles Anderson, suffers from Motor Neurone disease and has this audio diary, broadcast on the BBC. It's great. He is so chatty, so positive, and comes across as quite a character. He makes mention in his diaries of having been asked for comment on Diane Pretty's 'case', but simply says that 'life is for living'.

How one deals with a terminal illness is, I believe, like so many other things, dependent on the personality of the individual. As they say, "Don't ever say what you wouldn't do, because you'll do all that, plus things you never dreamed of doing".
posted by different at 7:11 AM on April 2, 2002

piveldiva, thanks for sharing your experience. As with a lot of these hot-button social issues it is always important to remember that utimately the debates are about real people in incredible difficult situations.

That being said, the flip side of your experience is the person who has been declared terminally ill, who the doctors expect to die within a short time frame, that defies the doctors expectations and goes on to live a long life. Stephen Hawking comes to mind as a famous example, but there are probably tens of thousands of similar cases, many of them involving supposedly terminal cancer.

Another problem that comes up is where to draw the line about who should be allowed to decide to kill themselves. What about Alzhemer's patients that live an average of 10 to 12 years after diagnosis, but would not be compentent to make a decision about whether to kill themselves long after diagnosis. What about people that don't have a terminal illness but one that seriously diminishes their quality of life. What about people with severe mental illness that may rationally believe that they would be better of dead?

Once the door is opened, we will have to have all these discussions and we can't just assume that "oh, that will never happen." The additional groups that want the right to die will argue "why can't we have it if terminally ill patients have it? As the practice becomes more socially acceptable, those groups will gain more political support.

The phrase "culture of death" gets thrown around a lot as a kind of ideological club, but I don't think the concept is as crazy as many seem to think. Law does, in the long run, change cultural norms, and, in my view, the taboo against suicide is just not a taboo that we want to be changing.
posted by boltman at 8:04 AM on April 2, 2002

Budge: "Euthanasia is about MONEY. It is evil. Sick and dying people do not have to live in severe pain with todays pain killers and opiates."

My grandmother is 87 years old. She suffers from advanced Alzheimer's. Extreme dementia. She hates her life. Not that she's in physical pain, mind you: just that she wanders lost and terrified through the hallways of the home, crying and crying to herself, occassionally biting other seniors, and every once in a while breaking through her dementia and realizing, for a few brief moments, that she's still alive when she shouldn't be.

Every time she breaks through her dementia, she expresses her wish to die. Every time she breaks through her dementia, she's upset and wonders why she's being punished so.

So what's a self-righteous twat like you got to tell her? Please, I'll pass on your comforting message next time she's lucid. Tell me what to tell her to make her realize that being a crazy, terrified, out-to-lunch, demented old lady is A Good Thing.
posted by five fresh fish at 9:35 AM on April 2, 2002

boltman: "What about people that don't have a terminal illness but one that seriously diminishes their quality of life. What about people with severe mental illness that may rationally believe that they would be better of dead?"

What about them? Why should someone who's quality of life is so poor that death seems preferable be forced to continue living for your peace of mind? Why should someone who rationally believes they would be better off dead be forced to continue to live?

The debate about euthanasia is never about the people who wish to be dead: it's always about the discomfort of the living who might have to face up to their mortality.
posted by five fresh fish at 9:40 AM on April 2, 2002

Budge: I'll agree with you about one thing; a big part of the problem is the War On Drugs. If those in palliative care/chronic pain were allowed to receive appropriate opiates (cocaine and heroin, not just morphine and codeine) in appropriate dosages (since opiates have different effects on different people a fatal dose for one person can be an appropriate pain-relief dose for another), then it's distinctly possible that those with terminal illnesses could find their lives tolerable.

That being said, as long as appropriate controls are in place (more than one consent given, with witnesses, counseling, etc.), I see no reason why someone's opinion of the morality of euthanasia should have any bearing on another's. I agree with FFF in this case for sure.
posted by biscotti at 9:58 AM on April 2, 2002

fff: I just saw a poster on my walk home that said rape victims are 13 times more likely then average to commit suicide. I'd imagine that many of these women commit suicide because they have a low quality of life and can see little hope of improvement. I take it that you don't see any reason for the society to try and convince them otherwise?

The law against suicide is based on the presumption that the choice to kill oneself is usually going to be irrational. there may well be cases where one could make a rational choice to kill oneself, but these cases are the exception rather than the norm. in other words, most people that commit suicide wouldn't if they could see things clearly.

the law against suicide won't actually stop someone determined to kill herself, but it does reinforce a social taboo against suicide that probably prevents a lot of people from even considering suicide when they otherwise might. If we change the law to legitimize suicide legally, moral legitimation naturally follows. Suicide rates will eventually go up as the taboo loses force and less people are deterred from comitting suicide.

I'd prefer to live in a society tries to help people to live fulfilling lives, not one that encourages people to off themselves. If that's selfish, so be it.
posted by boltman at 2:07 PM on April 2, 2002

Strawman argument, Boltman: I never indicated that society should just abandon the suicidal to their fate.

But perhaps I spoke too complexly. Let me put it in simple terms:

I do not believe that you should force me to continue living. If you wish to supply resources that I can choose to make use of to rid myself of a suicidal wish, then by all means supply them -- but you do not have the right to force me to use those resources.
posted by five fresh fish at 5:48 PM on April 2, 2002

Oh, and please, Boltman, describe how you are going to compassionately force my Grandmother to continue living. Remember: her body is strong, so there are no plugs to pull. But her mind is gone, save the few minutes every week or so that she manages to break through the dementia and cry out how she never wanted to be a senile old woman, how she never wanted to live so long, how she wishes her body would let her go.

Please, please: how can I compassionately insist that she keep on living?
posted by five fresh fish at 5:55 PM on April 2, 2002

First as I said, people that really want to kill themselves are going to find a way to do it, regardless of what the law says.

Suicide's illegality does two things:
1) it protects the societal norm against suicide. For example, I knew a person once that would have liked to commit suicide but didn't because she felt that it was morally wrong to do so. As much as we would like to deny it, in any culture law and morality are linked. Legalize something and you start morally legimating it it as well.

2) it requires the legal system (i.e. government) to take suicide attempts seriously and respond by connecting the victim with services that can help them. It's not like people who attempt suicide go to jail.

As to your second post, I am very sorry about your grandmother, Alzhemer's is a terrible illness to be sure. However, I don't think she would be eligible for PAS even in Oregon because a) Alzhemer's is not immediately terminal and b) there would be serious questions about an Alzhemer patient's competence to make a decision like that.

I suppose in the end it is a utilitarian calculation: is the preservation of a moral norm against suicide (and the resulting lives saved) plus the assurance of knowing that sick people are not being coerced into suicide by family, medical bills, insurance companies, etc. worth the cost of preventing some very sick people from dying on their own terms? I think that it is.
posted by boltman at 7:52 PM on April 2, 2002

if you think that knowing it's "morally wrong" is going to keep a cancer patient who is incurring horrible agony in this world, you are very sadly mistaken.

knowing it's "morally wrong" doesn't even stop people with mental illness from killing themselves. wrong? maybe. but then again, maybe you've never been in a place that's so bad that any annihilation after death seems like paradise compared to what you're facing now.

in any case, people with severe mental illness aren't legally competent and wouldn't be allowed to legally euthanize themselves, thereby solving your problem and ensuring that only people suffering real pain get to choose when enough is enough.
posted by Nyx at 8:31 PM on April 2, 2002

Cool, I can now legally smoke some hash, visit a brothel and then kill myself. Can't wait for my next trip to Amsterdam!
posted by scottfree at 8:55 PM on April 2, 2002

Nyx: I was using "morally wrong" in the context of a specific person that happened to feel that way. (Although there are many people, often peple of faith, that endure cancer and other terrible illnesses precisely because they feel that to do otherwise would be morally wrong. Are we going to say that their choice to do so is foolish?)

But leaving that aside, when I talk about "societal norms", I'm not talking about rational moral choices so much as social taboos. Reason may not stop many people from killing themselves, but you can bet that social taboos prevent many people from even considering it in the first place. There is a reason why suicide is far more common in some cultures than in others.

Finally, I would just reiterate my original point, that proper palliative and hospice care can allow terminally ill people to die peacefully and with dignity. The real debate should be over how to ensure that everyone has meaningful access to these services.
posted by boltman at 9:18 PM on April 2, 2002

So, Boltman, you basically have no answer for me. My grandmother, who is sound in body but basically absent of mind, who has consistently expressed a wish to die every time she becomes temporarily lucid, must continue to live in abject terror and misery, because you are uncomfortable with death.

Thanks, pal.

Next up, please explain why your discomfort with death should override other's wishes to die. What makes you the one to judge what is best for them?
posted by five fresh fish at 8:45 AM on April 3, 2002

I haven't recontributed to this thread before now, because a few hours after I made that post, my father died.

Sitting with him those last few hours were nothing short of hell on earth, and before I bow out of this conversation, I just have a few points I'd like to make.

Budge: I understand your fear of a "nazi" style society. I myself am disabled, with a chronic but non-fatal condition, which will only deteriorate with time. This is a genetic condition, with an autosomal dominant inheritance pattern, giving a 50% likelihood of passing it on. In such a society I wouldn't have been allowed to be born. While there have been times I've wished I hadn't been born, overall, I'm glad I'm here. I do worry about what will happen if I were to contract a serious illness such as cancer, as I am allergic to morphine and derivatives. I can't really imagine what manner of palliative care would be available to me. Lack of money for prescribing drugs isn't my main worry in that situation.

On the moral issue, I would defy anyone to look into the eyes of a loved one as they beg to die, and not for a second wonder if there would be a way of helping them without legal consequences. No, I did not kill my father. I doubt I could have done, but that didn't stop me wishing I could find some way to release him from that suffering.

Lastly, we could debate this subject from now until the ends of the earth, but I really don't think that there will ever be consensus. It's just one of those issues, you're either on one side or the other.

When it comes down to it though, I wonder how many people would continue to be against it, should they find themselves in a situation where it would be a seriously considered option.
posted by pixeldiva at 4:07 PM on April 3, 2002

Condolences and hugs, pixeldiva.

I think you're right: people might be opposed... until they're actually confronted with the situation. Then they understand that forced living can be inhumane, and should take second seat to acting compassionately.
posted by five fresh fish at 10:17 PM on April 3, 2002

fff: and you have completely failed to respond to any of my arguments. so i guess we're even.
posted by boltman at 5:56 AM on April 4, 2002

You've asked no questions that I have not answered, and have made only strawman attempts to frame me as someone who wants to kill the ill against their will. And you're the one that wants to restrict people's freedoms, not me. Burden of proof is on you.
posted by five fresh fish at 7:10 AM on April 4, 2002

you're the one that wants to change the law. I would say that puts the burden of proof on you.

do you deny that if we legalize suicide, then the number of people who kill themselves for irrational reasons will increase?

we haven't even gotten into the ethical problems that euthenasia poses for the medical profession. families and patients would start looking to doctors for moral advice on euthenasia, just like people look to vets to tell them when it is a good time to put down the family dog. How is a doctor supposed to deal with that? Not to mention that doctor-assisted suicide is a blatant violation of the hypocratic oath.

finally, with re: to your grandmother, I think its a little bit tacky to be using your grandmother's situation as a rhetorical bludgeon to support your own libertarian ideology. but i will say this: saying "I wish my body would let me go" is not the same thing as saying "I wish I could kill myself." Perhaps your grandmother, like many others with terminal illness, believes that it would be wrong to kill herself, even though she would like to die. Of course, even if your grandmother wanted to kill herself, I do not believe that the law should legitmate that choice. Why? because a legal system that affirms people who chose to live is preferable to one that encourages them to die.

You can make all the arguments that you want about freedom and liberty, but you simply cannot escape the cultural dimension of law. Legalizing suicide sends a cultural messege that suicide is OK. Even if it might be for an exteremly small number of people, that's not the message that the law ought to be sending to the public at large.
posted by boltman at 8:19 AM on April 4, 2002

Boltman, I hope you never find yourself in the situation where a loved one wishes to die, but is prevented from it. It would change your perceptions, but at a cost of suffering that's far too high.
posted by five fresh fish at 9:31 AM on April 4, 2002