Although clinical and research experience confirm that the overwhelming
majority of suicidal patients including the terminally ill suffer
from a depression that can be treated, when a patient finds a
doctor who shares the view that life is only worth living if certain
conditions are met, the patient's rigidity is reinforced (Hendin
1995).
Many of us have known situations in which a doctor would have
acted humanely by helping a terminally ill person die in the final
weeks of illness. My observations in the Netherlands persuade
me that legalization of assisted suicide and euthanasia are not
the answer to the problems of the seriously or terminally ill.
The Netherlands has moved from assisted suicide to euthanasia,
from euthanasia for the terminally ill to euthanasia for the chronically
ill, from euthanasia for physical illness to euthanasia for psychological
distress and from voluntary euthanasia to involuntary euthanasia
(called "termination of the patient without explicit request").
The rationale for such extensions has been that to deny the right
to die with assistance to the chronically ill who will have longer
to suffer than the terminally ill or those who experience psychological
pain not associated with physical disease is a form of discrimination.
Euthanasia is preferred by patients and doctors as a safer and
more certain way of assuring death so that assisted suicide is
now used relatively infrequently.
Ending patients' lives without their request has been justified
as necessitated by the need to make decisions for patients not
competent to choose for themselves. The Dutch Government's own
commissioned research has documented abuses of the system. In
more than 1,000 cases a year, doctors actively caused or hastened
death without the patient's request. In more than 5,000 cases
doctors made decisions that might have ended or were intended
to end the lives of competent patients without discussing the
decisions with them (van der Maas, van Delders and Pijnenborg
1992).
Some euthanasia advocates defend the need for doctors to make
decisions to end the lives of competent patients without discussion
with them. One Dutch euthanasia advocate gave me as an example
a case where a doctor had terminated the life of a nun a few days
before she would have died because she was in excruciating pain,
but her religious convictions did not permit her to ask for death.
He did not argue, however, when asked why she should not have
been permitted to die in the way she wanted.
Other advocates admit that a system in which doctors become used
to playing a predominant role in making decisions about ending
life encourages some to feel entitled to make decisions without
consulting patients. Many of the professionals who are advocates
of euthanasia conceded that abuses were common. In their published
articles, however, they do not admit this since they see the issue
of euthanasia as political.
Neither legalization of euthanasia nor opposition to it addresses
the larger problem of how to care for the terminally ill. The
call for legalization is a symptom of our failure to respond to
the needs of the terminally ill and their understandable fear
of artificial prolongation of the process of dying.
Yet the dangers threatened by legalization of assisted suicide
are being avoided elsewhere in Western Europe where there is no
great demand for legalizing assisted suicide or euthanasia. Care
for the terminally ill is better in the Scandinavian
countries than in the United States and in the Netherlands. Scandinavian
doctors do not accept excessive measures for prolonging life in
people who are virtually dead, but neither do they encourage people
to choose death prematurely.
