Blurred boundaries in the Netherlands' Right-to-Die Laws

By Alex Schadenberg

Executive Director - Euthanasia Prevention Coalition

Barbara Kay

Barbara Kay, a National Post columnist, has published two articles outlining the indepth analysis by the Dutch journalist, Gerbert van Loenen, who is publishing an english translation of his book that is titled: Do You Call This a Life? Blurred Boundaries in the Netherlands’ Right-to-Die Laws.

In the past, van Loenen supported the Netherlands euthanasia law, but after his significant relationship became disabled, his experience caused him to question.

Kay outlines new information from van Loenen's book that was gathered from Dutch sources and articles. Much of the information has not been reported by the english media and almost none of the information has been presented through the lens of a Dutch journalist who has personally experienced the social change that resulted from the legalisation of euthanasia.

In her first article (National Post - January 28), Kay focused on the meaning of the Dutch euthanasia law. Most people view euthanasia as a form of "self-determination," but van Loenen explains why that is not the reason that the Netherlands legalized euthanasia. Kay wrote:

But the Netherlands’ euthanasia law does not recognize any such right. In 1984, the country’s Supreme Court accepted euthanasia, but rejected self-determination as the driver. The law in fact focuses on the right of the physician to exercise his compassion in what is deemed a “situation of necessity.” Citizens “may request,” but cannot demand, euthanasia. So in fact the law endorses a species of medical “paternalism.” Van Loenen claims this compassion-based perspective “is the opposite of self-determination,” which he continues to support.

Kay then uncovers the underbelly of the Netherlands euthanasia law.

One of van Loenen’s settled convictions is that what begins in compassion invariably creeps over to the dark side. Up to 1,000 Dutch citizens are killed every year without express consent, according to van Loenen, either because they are incompetent (dementia) or in comas, or too young. In 14% of the without-consent cases, people are actually competent, but not consulted. Typical reasons given for euthanasia by doctors in such cases are “consultation would have done more harm than good,” or “this course of action was clearly the best one for this patient,” or it was “the request or wish of family” — a far cry from the self-determination principle debate began with. 

These doctors have acted outside the law, but are rarely convicted, as judges are reluctant to call “termination of life without request”… murder. Indeed, van Loenen says, cultural acceptance of euthanasia has progressed to the point that it is no longer the physician who ends someone’s life without request who must justify his actions; rather it is the physician who decides to prolong a life perceived as meaningless who feels societal pressure.

In her second article, (National Post - February 4) Kay focuses on the difficulty that the Dutch have had limiting the euthanasia law. Kay wrote:

Once you accept the logic that suffering justifies killing, it is not easy to set boundaries. The Netherlands’ experience shows that euthanasia spreads to individuals that other people — physicians or family members — consider better off dead, and that judges’ rulings tend to bend the law to satisfy the zeitgeist. Regular physician surveys offering guaranteed anonymity since 1991 concerning all end-of-life medical decisions indicate euthanasias without request are performed 300-1,000 times a year. In cases that arrive in court, judges almost invariably exonerate physicians on a “situation of necessity” principle. (According to van Loenen, there is no similar research in other countries, which makes the Netherlands “a unique laboratory that all the world can come and visit.”)

Kay completes her article by quoting van Loenen's story about a doctor who did euthanasia.

In a 2001 interview Dutch physician Joke Groen-Evers noted that, when talking with a terminal patient, she would feel bound to bring up the subject of euthanasia: “And nine times out of 10 the patient would return with a request for euthanasia.” Finding herself more comfortable suggesting palliative care, she stopped using the “E-word.” “And what do you know: almost no one asks for it anymore! … If you mention euthanasia, they will ask for it. If you mention palliative care, then that is what they will choose.”

van Loenen's book will be published soon.