Depending on your viewpoint, Holland is either famous or infamous, enlighteningly progressive or morally deviant, in its approach to social issues like legalizing soft drugs and sanctioning gay marriage.
In the first of a series of articles, we examine the pragmatic Dutch approach to some complex and controversial social issues.
Being the first country to decriminalize euthanasia, the Netherlands shocked the world. Opponents worldwide feared ‘death tourism’: patients flying to Amsterdam on one-way tickets. Although this hasn’t happened, acceptance of the Dutch approach to euthanasia is by no means a fait compli. “But provided some important preconditions are met, euthanasia can be a morally good thing, if it’s done out of respect for the choice of a patient in a hopeless situation,” says Sabine Roeser, TU Delft assistant professor of ethics.
Still, when it comes to legalizing euthanasia, the Dutch have some explaining to do. For many foreigners, Holland’s ‘Termination of Life on Request Act’ seems horrifying. What complicates the discussion is that for the Dutch the meaning of the term ‘euthanasia’ is restricted to cases in which patients request their lives to be ended, whereas abroad the term is often used as a synonym for doctors killing their patients without their consent . in the United States, for instance, Dr. Jack Kevorkian, a proponent of euthanasia, was dubbed ‘Dr. Death’ in the media.
Opponents of euthanasia worry that by legalizing euthanasia, the Dutch put a new and potentially dangerous responsibility into the hands of medical professionals: determining whether a person’s life is still worth living or not. This law will have gruesome consequences, critics argue. Yet, they forget that in Holland euthanasia is bound to strict and comprehensive rules of due care. If a physician performs euthanasia on a patient without his or her written or oral consent, and without consulting with a colleague physician for a second opinion, the acting physician is guilty of a crime and can be prosecuted for murder.
“Another requirement is that people who request euthanasia should face unbearable suffering,” Roeser explains. Although this notion is liable to subjectivity, a physician can make an estimate of the pain on the basis of a patient’s medical condition. Furthermore, before agreeing to perform euthanasia a doctor must be convinced that there is no prospect of improvement.
According to Dorothea Touwen, a medical ethics lecturer at the Leiden University Medical Center, the act itself is a complex and difficult one for the medical staff as well as for the patient: “No one thinks lightly about euthanasia in the Netherlands. For our physician’s it’s a burden, too. Euthanasia will always remain a last resort.”
Delirium
Roeser offers a pragmatic argument in favor of legislating euthanasia: “It happens anyway, even in countries where euthanasia is strictly forbidden. By legislating it, it’s possible to have tight controls, checks and balances and transparent procedures.” Since the new Dutch euthanasia law was introduced, the percentage of people dying from euthanasia has not changed significantly. Some 140,000 people die every year in the Netherlands. Of these, 3,600 are from euthanasia, with the majority suffering from cancer or AIDS. Official figures state that two thirds of all euthanasia requests are refused by doctors.
Touwen is convinced that doctors working in countries where euthanasia is illegal struggle with the boundaries of medical possibilities. All around the world physicians are trying to find ways to relieve suffering and hasten death. Touwen: “The only difference is that most of them have to do it in secret.” And sometimes without taking proper care criteria into consideration. Terminally ill patients are often given high doses of morphine to end their lives. “Yet morphine isn’t a reliable medium to hasten death,” Touwen says. “It can also produce an undesirable side-effect such as delirium.”
Despite all the figures and the general practice of euthanasia in the Netherlands, Roeser is not a strong advocate for the introduction of a worldwide system of euthanasia. She fears the system could be easily abused in countries where health care is not available to everyone, regardless of whether they are rich or poor.
“Might doctors, because of severe budget cuts at their hospital, are tempted to talk their patients into signing a euthanasia request?” Roeser wonders. “And is every patient made aware of the alternatives to euthanasia? Or are they pressured into it because they simply can’t pay the hospital expenses and medical bills?”
For this reason, Roeser is convinced that in a country like the United States euthanasia should never be legalized. “Millions of Americans do not even have health insurance!”
Roeser, who used to defend the Dutch euthanasia policy abroad, has however recently grown more skeptical: “For the past few years the Dutch also have to deal with long waiting lists for life-saving operations and other treatments. Market forces have been introduced into the Dutch health care system.”
This means, Roeser explains, that “some lesser educated people with little money have less autonomy and choice than the wealthier ones with a higher education.” She believes that the Dutch government has a huge responsibility in providing good preconditions for everyone in a healthy healthcare system. In such a system the Dutch euthanasia law is a good thing. But it the government fails, she worries, “the fears of foreign critics might come true after all.”
Being the first country to decriminalize euthanasia, the Netherlands shocked the world. Opponents worldwide feared ‘death tourism’: patients flying to Amsterdam on one-way tickets. Although this hasn’t happened, acceptance of the Dutch approach to euthanasia is by no means a fait compli. “But provided some important preconditions are met, euthanasia can be a morally good thing, if it’s done out of respect for the choice of a patient in a hopeless situation,” says Sabine Roeser, TU Delft assistant professor of ethics.
Still, when it comes to legalizing euthanasia, the Dutch have some explaining to do. For many foreigners, Holland’s ‘Termination of Life on Request Act’ seems horrifying. What complicates the discussion is that for the Dutch the meaning of the term ‘euthanasia’ is restricted to cases in which patients request their lives to be ended, whereas abroad the term is often used as a synonym for doctors killing their patients without their consent . in the United States, for instance, Dr. Jack Kevorkian, a proponent of euthanasia, was dubbed ‘Dr. Death’ in the media.
Opponents of euthanasia worry that by legalizing euthanasia, the Dutch put a new and potentially dangerous responsibility into the hands of medical professionals: determining whether a person’s life is still worth living or not. This law will have gruesome consequences, critics argue. Yet, they forget that in Holland euthanasia is bound to strict and comprehensive rules of due care. If a physician performs euthanasia on a patient without his or her written or oral consent, and without consulting with a colleague physician for a second opinion, the acting physician is guilty of a crime and can be prosecuted for murder.
“Another requirement is that people who request euthanasia should face unbearable suffering,” Roeser explains. Although this notion is liable to subjectivity, a physician can make an estimate of the pain on the basis of a patient’s medical condition. Furthermore, before agreeing to perform euthanasia a doctor must be convinced that there is no prospect of improvement.
According to Dorothea Touwen, a medical ethics lecturer at the Leiden University Medical Center, the act itself is a complex and difficult one for the medical staff as well as for the patient: “No one thinks lightly about euthanasia in the Netherlands. For our physician’s it’s a burden, too. Euthanasia will always remain a last resort.”
Delirium
Roeser offers a pragmatic argument in favor of legislating euthanasia: “It happens anyway, even in countries where euthanasia is strictly forbidden. By legislating it, it’s possible to have tight controls, checks and balances and transparent procedures.” Since the new Dutch euthanasia law was introduced, the percentage of people dying from euthanasia has not changed significantly. Some 140,000 people die every year in the Netherlands. Of these, 3,600 are from euthanasia, with the majority suffering from cancer or AIDS. Official figures state that two thirds of all euthanasia requests are refused by doctors.
Touwen is convinced that doctors working in countries where euthanasia is illegal struggle with the boundaries of medical possibilities. All around the world physicians are trying to find ways to relieve suffering and hasten death. Touwen: “The only difference is that most of them have to do it in secret.” And sometimes without taking proper care criteria into consideration. Terminally ill patients are often given high doses of morphine to end their lives. “Yet morphine isn’t a reliable medium to hasten death,” Touwen says. “It can also produce an undesirable side-effect such as delirium.”
Despite all the figures and the general practice of euthanasia in the Netherlands, Roeser is not a strong advocate for the introduction of a worldwide system of euthanasia. She fears the system could be easily abused in countries where health care is not available to everyone, regardless of whether they are rich or poor.
“Might doctors, because of severe budget cuts at their hospital, are tempted to talk their patients into signing a euthanasia request?” Roeser wonders. “And is every patient made aware of the alternatives to euthanasia? Or are they pressured into it because they simply can’t pay the hospital expenses and medical bills?”
For this reason, Roeser is convinced that in a country like the United States euthanasia should never be legalized. “Millions of Americans do not even have health insurance!”
Roeser, who used to defend the Dutch euthanasia policy abroad, has however recently grown more skeptical: “For the past few years the Dutch also have to deal with long waiting lists for life-saving operations and other treatments. Market forces have been introduced into the Dutch health care system.”
This means, Roeser explains, that “some lesser educated people with little money have less autonomy and choice than the wealthier ones with a higher education.” She believes that the Dutch government has a huge responsibility in providing good preconditions for everyone in a healthy healthcare system. In such a system the Dutch euthanasia law is a good thing. But it the government fails, she worries, “the fears of foreign critics might come true after all.”
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