Euthanasia in the Netherlands

Abstract

In 1973 a lady doctor who had killed her sick mother was sentenced by the court in Leeuwaarden to a one-week suspended prison sentence. The judge declared that the court never doubted the defendant's integrity. The trial initiated the present open practice of euthanasia in the Netherlands. Many people expressed support for the accused doctor, and in the wake of this campaign two associations were founded: the Dutch Society (Vereniging) for Voluntary Euthanasia, and the Foundation (Stichting) for Voluntary Euthanasia. The public had been prepared for these events, first and foremost by the publication of Dr. Jan Hendrik van den Berg's book Medical Power and Medical Ethics in 1969.(1) In this work Van den Berg, a professor of neurology, declared that the ethics of unconditional respect for human life belonged to the past, to the time when medicine had been powerless. The new era of medical power required a new ethic allowing doctors to terminate human life.(2) Why it should be so was not clear, since Van den Berg failed to validate this assertion. However, his vivid pictures of human suffering (supposedly created by doctors exercising their power), the serene descriptions of euthanasia, and the daring reversal of many habits of thinking immediately captured the public imagination. The book went through ten printings in the first year and twenty-five in all. Since this work has strongly influenced Dutch public opinion on the issue of euthanasia, it is important to know the ideas it promoted. Van den Berg insisted that defective children must not be allowed to live.(3) In his view doctors are not only authorized(4) but have the duty to terminate meaningless lives.(5) In his book Van den Berg did not mention voluntary active euthanasia, but advocated involuntary active euthanasia. In all model case histories he cited, the decisions to actively terminate the patients' lives were taken by the doctors and the patients' families without the patients' knowledge. Van den Berg condemned the families who failed to request euthanasia and showed an attachment to hopelessly ill patients, this being a dishonor and an adherence to the old dismissed ethics.(6) Neither the patient's nor the family's consent was necessary to carry out euthanasia: in case of the family's refusal a committee of doctors and laymen should impose the decision.(7) Thus, Van den Berg went further than the demand to release the destruction of lives unworthy of being lived: he planned the enforcement of such policy and made provisions for the suppression of possible resistance. The book was an enormous publishing success and evoked virtually no protests. On the contrary, many concurring declarations followed, issued by Protestant ministers,(8) Protestant church authorities,(9) Catholic intellectuals,(10) ethical bodies,(11) and even by leaders of the movement in favor of voluntary euthanasia.(12) Apparently, Van den Berg expressed the views held by a large part of the public. This was later confirmed by opinion polls,(13) which showed that 77% of the public supported involuntary euthanasia. The Present Open Practice of Euthanasia During the Leeuwaarden trial it was revealed that some practice of euthanasia had already existed: in support of the defendant, eighteen doctors declared that they, too, had actively terminated the lives of their patients. It is certain, however, that after the Leeuwaarden trial the practice of euthanasia increased. How many people at present die by active euthanasia is not known because so long as Article 293 of the Dutch Penal Code, which makes euthanasia a punishable crime, remains formally valid, many doctors who perform euthanasia do not state it in the death certificates. All published figures are estimates, often based on questionnaires. The most often cited figure is ten thousand cases of active euthanasia a year.(14) However, a recent study done by VARA TV Corporation and interview polling firm has indicated that the number of cases of active euthanasia may be as high as 18,400 a year, and that in another 21,600 cases medical treatment is withdrawn with intention to cause death. …