From the Department of Philosphy, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama. Requests for reprints should be addressed to Dr. Gregory E. Pence, Department of Philosophy, School of Medicine, University of Alabama at Birmingham, HB 420, Birmingham, Alabama 35294. Manuscript submitted September 10, 1987, and accepted November 11, 1987. The Dutch are known for practicality, fierce independence, moral integrity, free-thought, and defense of civil liberties. Under Nazi occupation, Dutch physicians successfully resisted Hitler’s programs [I]. Holland is nominally Catholic but 27 percent of Dutch citizens claim no religious affiliation, and Dutch Catholicism is very democratic and aggressively anti-Vatican. Moreover, the Dutch seem to distrust elaborate technology and wish to die at home more than Americans, 80 percent of whom die in hospitals [2]. Seventy-five percent of Dutch citizens now endorse mercy killing by physicians after requests by terminal patients [3]. These attitudes have changed Dutch medical practices. It is estimated that Dutch physicians have now killed between 5,000 and 8,000 terminal patients. This new development in the history of medicine needs to be carefully studied. The Dutch national movement for decriminalization began in 1971 when a female physician accepted her mother’s repeated requests for death. Geertruida Postma’s mother had had a cerebral hemorrage that left her partially paralyzed, deaf, and mute. After the stroke, Postma’s mother lived in a nursing home, where she was tied to a chair for support. Dr. Postma said, “When I watched my mother, a human wreck, hanging in that chair, I couldn’t stand it anymore” [4]. So she injected her mother with morphine and killed her. Postma then told the director of the nursing home, who called police. Postma was found guilty of murder, but was given only a symbolic sentence. Postma’s lawyer argued that “rational suicide” assisted by a physician should be a legal defense. The judge rejected this defense but nevertheless specified some guidelines. The 1973 case of physician Piet Schoonheim also concerned mercy killing, but of patients who were not immediately terminal [5]. Schoonheim was eventually cleared. Two Dutch euthanasia societies grew after such cases. One group sought legislative reform, like the American Society for the Right to Die, and the other helped terminal patients to die, like the American Hemlock Society. In 1973, the Dutch Medical Association softened its condemnation of mercy killing by physicians. While stating that euthanasia by request should still be a crime, it urged that courts should decide whether physicians could be justified in particular cases. Public support for euthanasia dramatically increased over the next decade, and in 1984 the Dutch Medical Association advocated new guidelines stating that: (1) only a physician may implement requests for euthanasia, (2) requests must be made by competent patients, (3) patients’ decisions must be free of doubt, well documented, and repeated, (4) the physician must consult