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.
