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Court guidelines for the 1973 euthanasia law in the Netherlands have progressively loosened to allow physicians to kill patients without their consent. Doctors were responsible for 9% of all deaths in the Netherlands in 1990.
In the United States, when the subject turns to euthanasia - known more commonly here as doctor-assisted suicide - ethicists and policymakers worry aloud about going down the "slippery slope." In the Netherlands, they’ve already slipped. And therein lies a cautionary tale for us.
The slippery-slope argument says that if we allow something relatively harmless today, we may nonetheless establish a trend that results in something currently unthinkable. Last November, opponents of the Oregon proposition allowing doctor-assisted suicide invoked the slippery-slope concept - and lost.
The Oregon law, the first such in the nation and as-yet held up by a federal court, clearly forbids anything other than ending the life of an already dying patient who requests it. Yet a very short time ago, so did Dutch law. In fact, it wasn’t too long ago that physician-assisted suicide was completely illegal in the Netherlands.
That changed in 1973, when a doctor went on trial for killing her terminally ill mother with morphine. The court began a long process of slowly eating away at the law by convicting the woman, but giving her a mere suspended sentence of a week in jail, plus a year’s probation. Probation violation would have been difficult, since presumably the woman had no mothers left to kill.
Soon courts were dispensing with convictions altogether and simply absolving any physician who killed a patient as long as doctors followed certain guidelines in terms of whom they killed and whom they consulted. Originally, it was understood, though not always explicitly stated by the courts, that the patient had to have been suffering from a terminal illness. Soon this was to fall by the wayside.
In 1985, Pieter Admiraal, a Delft anesthesiologist since retired, was tried for killing (an expression he uses) a young girl with multiple sclerosis who, while she was suffering, could be expected to live indefinitely. The charges were dismissed because the act fell within the criteria developed by the Dutch high court - namely, that the disability, although not fatal, was incurable. In one recent case, a physically healthy but severely depressed woman requested - and received - euthanasia from her doctor.
With the terminal-illness requirement gone, the other major prerequisite, that the patient had to make an explicit request, also was to disappear. Soon doctors were euthanizing infants born with disabling but nonfatal diseases such as Down’s syndrome and spina bifida. Patients in persistent vegetative states, often incorrectly referred to as "comatose," also became fair game. After three Amsterdam nurses killed several such patients without any form of consent, they were found guilty not of any sort of unlawful killing but only of acting without the guidance of a doctor. Admiraal bluntly told me, "I think it’s quite normal for society to ask for euthanasia of newborns and allowing the death of [people in] comas."
By 1990, about 11,800 deaths, or 9 percent of all deaths in the Netherlands, were at the hands of doctors. Chillingly, about half of these were labeled "active involuntary euthanasia" or cases "in which morphine was given in excessive doses with the intent to terminate life ... without the patient’s consent." No matter how loosely the courts set the guidelines, later courts always managed to loosen them further. Indeed, only one Dutch doctor has ever actually served jail time for killing patients - and his conviction later was overturned.
Polls consistently show the Dutch favoring their liberal euthanasia laws, although it seems to depend on one’s circumstances. One poll of the elderly found that while half of those living independently favored euthanasia, almost all of those in nursing homes opposed it. More than half the institutionalized persons said they personally feared being killed without their permission. A group of people with severe disabilities from Amersfoort stated in a letter to the government, "We feel our lives threatened.... We realize that we cost the community a lot.... Many people think we are useless.... Often we notice that we are being talked into desiring death.... We will find it extremely dangerous and frightening if the new medical legislation includes euthanasia."
Just this year, the Parliament passed such legislation, finally codifying what the courts had been doing all along. All this, ironically, is taking place in a country whose doctors risked their lives refusing the demands of German occupiers to euthanize the sick and crippled.
One euthanasia opponent with whom I spoke, retired Amsterdam dermatologist Isaac Van der Sluis, doesn’t pretend to know exactly why his country has taken the lead in this macabre business. But, he says, "Here, as in the U.S., people are idealists. They want to be able to trust the government and doctors to do the right thing." Several critics with whom I spoke said a socialized health care system also lends itself to such cold-blooded rationing as killing off the sick.
As to the future of Netherlands euthanasia, even some of its strongest proponents harbor fears. Admiraal told one American newspaper that as the population continues to age, "We realize there will be demented patients by the tens of thousands. So I’m a little bit afraid. I really think that we may accept that, for purely economic reasons, they can stop life after a period of three years of complete dementia, for instance. I can imagine that. I don’t know if you can stop it. I don’t believe we can prevent it."
Whatever you do, don’t say it can’t happen here. After all, that’s what they said in the Netherlands.