Netherlands struggling with right-to-die law

In the first nation to legalize euthanasia, some applaud death with dignity

others are dubious

January 18, 2004|By Keith B. Richburg, The Washington Post.

AMSTERDAM — For Nelleke Jorissen-Dumee, the Netherlands' right-to-die law means death with dignity. She recalls her mother Maria's fight with cancer, and how five years ago the sick woman chose the day to end her life.

The family brought 20 red roses and played Maria's favorite songs, including Fats Domino's "Blueberry Hill." They lighted 64 candles, one for each year of her life. Then, after a final glass of wine, she lay in her daughter's arms while a doctor administered a lethal injection.

"For us, it was quite a beautiful experience," Jorissen-Dumee said.

Nearly two years after the Netherlands became the first country to legalize euthanasia and doctor-assisted suicide, an estimated 2,000 to 3,000 lives end that way there each year. The law appears to enjoy support among much of the Dutch public and among doctors, many of whom carried out such procedures in secret.

But it doesn't seem right to others. Christian groups condemn euthanasia as counter to their faith.

Activist opponents are urging American counterparts to block passage of a similar U.S. law. They see little hope of undoing it in their own country, where privileges granted by law rarely are rolled back.

Opponents argue that, moral objections aside, euthanasia in practice often is not a black-and-white decision: The patient may be of unsound mind; relatives may disagree on how to proceed, and morphine given to relieve pain also may hasten death, without anyone having made a clear decision to end the patient's life.

For euthanasia to be legal, a doctor must determine the patient's suffering is what the law describes as "unbearable" and "lasting," with no prospect of improvement. The doctor must give all "due care" beforehand, and determine, in consultation with the patient, that "there is no reasonable alternative."

Children ages 12 to 16 need their parents' consent; youths ages 16 to 18 must involve their parents in the decision but do not need parental approval. There is no requirement that the patient's condition be terminal, nor that the suffering be physical.

"I'm very pleased that it is in the law, because now you know what you can do and you know what you can't do," said Nico Mensing van Charante, who has been a family doctor for 27 years. When he began practicing medicine, most doctors had a "criminal period," he recalled. "There was no law, but we did euthanasia."

Mensing van Charante said he was asked to perform euthanasia about every two years.

`You should never aim to kill'

Opponents argue that the law encourages people to end their lives when confronted with suffering, and that it creates an atmosphere in which doctors feel free to make decisions for death that in many cases go unreported, though failure to report remains illegal.

"You should never aim to kill a person--that's the bottom line," said Bert Dorenbos, chairman of the Dutch anti-euthanasia group Cry For Life.

Dorenbos said he has followed the case of Terri Schiavo, a Florida woman who has been in a persistent vegetative state for 13 years. Schiavo's husband won a court order to have her feeding tube removed, only to have it overturned by Gov. Jeb Bush and the state Legislature.

Dorenbos e-mailed leaders of U.S. groups opposed to the tube's removal, warning them that if Schiavo is allowed to die, her case will quickly open the door to legal euthanasia. He cited the 1990 case of a Dutch woman in a coma, Ineke Stinissen, who was allowed to die at her husband's request, with food and fluids withheld. Dorenbos said that case "shifted the debate" and led to legalization in the Netherlands.

Rob Jonquiere, a physician who runs a pro-euthanasia group--The Right to Die, Netherlands--said the lesson to be learned from the Schiavo case is that, if she had filled out a right-to-die request form like the type freely available in the Netherlands, her wishes would be known.

"It's still a difficult decision," he said. "But if she had a piece of paper saying, `I don't want to be in a vegetative state,' then her husband would have a stronger case."

There is some dispute about the number of mercy killings performed in the Netherlands, but both sides agree there has been no surge in reported cases since the law took effect in April 2002.

According to Cry For Life, 1,882 euthanasia cases were reported in 2002, compared with 2,054 in 2001 and 2,123 in 2000. The group uses figures first published by the Health Ministry and supplied by regional euthanasia committees.

On the opposite side of the debate, The Right To Die, Netherlands, lists 3,800 reported cases of euthanasia for 2001, a figure it said was virtually unchanged from the 3,600 in 1995. It has no figures after 2001 but says that anecdotal evidence suggests the numbers generally have held steady.

Legalizing euthanasia was supposed to encourage doctors to be more honest in reporting it, but even supporters concede it hasn't.