DUTCH EUTHANASIA:
THE DREAM AND THE NIGHTMARE

By Wesley J. Smith

Tuesdays with Morrie, which recounts conversations between author Mitch Albom and Morrie, his former professor who was dying of Lou Gehrig's disease (amyotrophic lateral sclerosis-- ALS), has been on the New York Times Bestseller List for years. There is a reason. In a time in which dying people are too often devalued and isolated--malignly turned into a "them," almost as if having a terminal illness is something about which to be ashamed - - Albom presented Morrie as a man who remained to the end fully alive and engaged - - always and ever "us" in the truest sense of the word.

How disheartening, then, that the author would use his notoriety as a writer and thinker about death and dying to promote and extol in almost breathless terms the legalization of euthanasia in the Netherlands. (Detroit Free Press, "Terminally Ill People Know What Is Best for Them," December 3, 2000.)

Euthanasia, by definition, devalues those whom it is supposed to serve by expressly proclaiming that there are some among us whose lives are so degraded and undignified that their lives are no longer worth protecting. Albom does a profound disservice to terminally ill, disabled, and despairing people everywhere in supporting euthanasia as a general concept, and in accepting whole cloth the utter nonsense that in actual practice Dutch " protective guidelines" prevent abuse against the vulnerable.

Lest you think I overstate the case, consider this. Assume that your sister asks her psychiatrist to kill her because her two children have died, one from disease and one from suicide. She has become obsessed about being buried between them.

Toward that end, she has purchased a cemetery plot and buried her children there, one on each side of her own awaiting grave. Rather than treat her and attempt to overcome her suicidal ideation, the psychiatrist interviews your sister four times over five weeks and then does the dark deed as requested because, in Albom's words, he believes that suffering people "know what is best for them." Not only would you consider the psychiatrist to have profoundly abandoned and betrayed your sister but you would probably sue him for malpractice!

That would not sit well with the Dutch Supreme Court. You see, these were the exact facts in the killing of a grieving mother named Hilly Boscher, euthanized in 1991 by her Dutch psychiatrist. Rather than punish the psychiatrist for facilitating the death instead of trying to save the life of his suicidal patient, the Dutch Supreme Court essentially applauded his actions, ruling that there is no difference between physical and emotional suffering when justifying euthanasia.

This case is not an anomaly. The "merciful" Dutch euthanasia system is rife with such documented stories of people discarded rather than compassionately being cared for during their darkest hour. For example, there was the young woman in remission from anorexia nervosa depicted in a Dutch pro-euthanasia documentary shown in the United States on PBS. She was so worried about returning to food abuse that she asked her doctor to kill her. On screen, she tells the doctor, "I've thought about dying day and night, and I know that if relief [death] does not come, I will return to the old pattern of self punishment, hurting myself. I know it. I feel it and therefore I hope the release will come soon and I die."

It did. She did. The Dutch authorities yawned that her death was at the hands of her own doctor.

The same documentary also depicted Henk Dykema, a young man diagnosed with being HIV+. He had no symptoms but wanted to die as soon as possible. His doctor assisted his suicide without referring him to a psychiatrist and without informing his distraught patient of the many palliative measures that could be taken to keep him comfortable should his disease progress to active AIDS.

In contrast, according to a letter published a few years ago in the New England Journal of Medicine, doctors at the St. Christopher's Hospice in England have treated more than 1,800 AIDS patients during their final months of life, with rarely a request for assisted suicide. The reason is as simple as it is profound: these patients knew that their suffering would be effectively palliated and they would never be abandoned. That allowed them to live with AIDS until their last breath was taken rather than resort to the despairing embrace of hastened death.

Which approach is the more compassionate, hospice or hemlock? Which values the inherent human worth of patients with AIDS? Which embraces the patient with unconditional love and acceptance? Ironically, due in part to the ease in which doctors may perform euthanasia, the Dutch have no widespread system of hospice care. Where's the compassion in that?

Here is the heart of the problem: transforming killing from a terrible wrong into a legal right opens wide the gate to an ever- expanding culture of death. Indeed, the Dutch experience proves that once killing is defined as an acceptable solution for one cause of suffering, it is soon viewed as the answer to 100 more. Thus, since 1973, when euthanasia was decriminalized in the Nether-lands (doctors would not be prosecuted so long as they followed the "guidelines"), Dutch physicians took their country right down the slippery slope from killing terminally ill people who ask for it, to killing chronically ill people who ask for it, to killing disabled people who ask for it, to killing depressed people (as illustrated by the cases recited above) who ask for it.

It gets worse. Each year Dutch doctors kill babies born with birth anomalies - - acts that the American bioethicist Joseph Fletcher once approvingly labeled "post birth abortion." Nor is infanticide a rare occurrence in the Netherlands.

According to a 1997 study published in The Lancet, a British medical journal, approximately 8% of all infants who die in the Netherlands are killed by doctors - - about 80 per year. According to the study, 45% of neonatologists and 31% of pediatricians who answered the authors' survey questionnaires have killed infants.
Apologists for Dutch infanticide claim that parental consent is sufficient to justify these acts of premeditated killing. But unless babies are mere chattel, parents have no more right to consent to the murder of their children than doctors have to do the deed on their own initiative.

Nor is involuntary euthanasia in the Netherlands limited to infants. Study after study of the Dutch medical killing regimen report that Dutch doctors kill more than 1,000 patients each year who have not asked to be killed. Such involuntary euthanasia deaths aren't even labeled "euthanasia" by Dutch medical statisticians. Rather, they are known as "termination without request or consent."

These involuntary killings are almost never prosecuted, much less punished, and are blithely justified because the patients were near death or incompetent. And now, with euthanasia about to become formally legal, the last remaining vestige of restraint - - the often-ignored requirement that doctors report their euthanasia cases to the coroner's office - - will be gone.

For some reason, commentators who support Dutch euthanasia and assisted suicide never get around to mentioning these inconvenient facts about that country's system of medicalized killing. Instead, they resort to the hokum of the romanticized and idealized mercy killing performed only as a last resort when nothing can be done to alleviate the suffering of people, in Albom's words, who are "wailing and crying from sunrise to sunset."

What bunk! In their enlightened compassion, pro-euthanasia advocates never contemplate how painful their zeal for creating categories of killable people wounds many of those whom they claim to be compassionately serving. Along this line, a few years ago I had the honor of being a hospice volunteer for a man in his 40s named Robert Salamanca, who, like Morrie, died from ALS.

Like Albom, I visited Bob once a week - - usually on Mondays instead of Tuesdays. I too relish memories of my Mondays with Bob, the hours I spent listening to him as he spun the stories of his life and commented upon the human condition.

Bob had strong opinions about euthanasia that bear repeating. He was outraged that the poster patients for the entire movement were people with ALS - - people like him. Indeed, he felt so strongly about the issue that he wrote an opinion column - - not easy to do when you can barely move your fingers - - for the February 19, 1997, San Francisco Chronicle, entitled, "I Don't Want a Choice to Die."

Euthanasia advocates believe they are doing people like me a favor. They are not. The negative emotions toward the terminally ill and disabled generated by their advocacy is actually at the expense of the "dying" and their family and friends, who often feel disheartened and without self assurance because of a false picture of what it is like to die created by these enthusiasts who prey on the misinformed.
What we, the terminally ill, need is exactly the opposite--to realize how important our lives are. And our loved ones, friends, and indeed, society need to help us feel that we are loved and appreciated unconditionally. Instead, reporting in the media too often makes us feel like token presences; burdens who are better off dead.

We are not people just waiting for someone to help us end our misery, but to the contrary, we are people reaching out to love-- to be loved--wanting to feel life at its best. In my view, the pro-euthanasia followers' posture is a great threat to the foundation on which all life is based', and that is hope. I exhort everyone: Life is worth living, and life is worth receiving. I know. I live it every day.

Morrie could not have said it better.

Oakland, California, attorney Wesley J. Smith is the author of the recently released Culture of Death: The Assault on Medical Ethics in America, as well as Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder.