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Dying the Dutch way

by Jeffrey P. Kahn, Ph.D., M.P.H.
Director, Center for Bioethics
University of Minnesota

The Dutch senate voted this week on euthanasia, passing into law a bill that had been approved by the lower house of parliament last fall. With the vote, the Netherlands becomes the first country in the world to legalize voluntary euthanasia. Though the law outlines strict criteria that must be followed before the request for euthanasia is granted, many critics voiced their concern about allowing one person to kill another, the role of physicians, and how the policy might be abused. Passage of the law brings into the public arena a practice that has been going on for many years in the Netherlands, although until now has not been formally endorsed by the government. It rekindles the debate about how far individuals should be allowed to control their life and death, and who if anyone should be allowed to help them. Should the Dutch be proud or ashamed of their historic first, and what will it mean for the rest of Europe and the world?

Making policy for euthanasia

Debates about helping people die are not new, and neither is euthanasia in the Netherlands. In 1993 the Dutch parliament adopted guidelines under which doctors engaging in voluntary euthanasia would not be prosecuted -- this week's vote turned those guidelines into law. Among the rules that must be satisfied for legal voluntary euthanasia:

  • the patient's request for euthanasia must be voluntary and persist over time

  • the patient's suffering must be unbearable and untreatable

  • the patient must be adequately informed of his or her condition, prognosis and medical options

  • the decision must be reached in an ongoing relationship between the doctor and patient

  • there must be consultation with at least one other physician

  • the death must be carried out in a medically appropriate fashion

    Enabling choice or devaluing life?

    Does such a policy empower people to choose how best to die or does it devalue life by making death too easy? The Dutch policy permits patients to request that euthanasia be performed if they become physically unable to make their wishes known when the time comes. This is intended to make sure patients have their wishes honored, but also turns over to the physician discretion about when to perform death. Requiring at least two physicians to decide offers some safeguard, but removing the final decision from patients opens the door for potential missteps, especially since legalization of euthanasia may lead to an expectation that patients will use it.

    Should doctors prescribe death?

    Perhaps the most troubling aspect of legalized euthanasia is the confusion of roles it may create for physicians. Should doctors be healers as well as killers? Some critics claim that doctors acting as agents of death and health at the same time can only undermine trust in the medical profession. But that trust is between doctors and their patients, and many patients hope they can rely on their doctor to help them whatever their condition requires -- treatments to cure or prevent disease as well as treatments to relieve pain and suffering, which may include hastening the end of life. The question is not whether any of us must choose death but whether we may, and whether we can enlist our physician in the process.

    Whatever any of us thinks about the choice of euthanasia, the Netherlands has opened the next stage of debate over assisted death, by becoming the first country to legalize it. How far should we be permitted to go in controlling the time and manner of our death, and what is the role of the state in preventing or aiding our decision? The Dutch now know the answer to these questions -- the rest of us must wait and wonder.

    Visit the
    "Ethics Matters" Archive
    where you'll find other columns from Jeffrey Kahn
    on a wide range of bioethics topics.

    "Ethics Matters" is a biweekly feature from the
    Center for Bioethics and CNN Interactive.


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