In the United States as in the Netherlands doctors are not sufficiently trained in the relief of pain and other symptoms in the terminally ill. Hospice care is in its infancy in both countries. We have not yet educated the public as to the choices they have in refusing or terminating treatment that prolongs a painful process of dying. And we have not devoted enough time in our medical schools to educating future physicians about coming to terms with the painful truth that there will be patients they will not be able to save but whose needs they must learn to address.
Psychiatrists and psychologists in the Netherlands played a relatively passive role in the growing normalization of suicide and euthanasia even though this has meant that patients who are basically suicidal, whether physically ill or not, are being assisted in death like those who seek relief in the last days of a terminal illness. We should learn from that experience to be more involved, educating the public that legalization may become a license to abuse and exploit the fears of the ill and depressed. Legalization constitutes acceptance of the view of those who are engulfed in suicidal despair that death is the preferred solution to the problems of illness, age and depression. It encourages the worst tendencies of depressed patients, most of whom can be helped to overcome their condition. "Normalizing" suicide as a medical option inevitably lays the groundwork for a culture that will not only turn euthanasia into a "cure" for depression but may prove to exert a coercion to die on patients when they are most vulnerable.