The debate on the issue of euthanasia is now going on in many countries including the United States, but active euthanasia, injecting sick people with drugs that cause death, is widely and openly practiced only in Holland. What does it mean for the people involved, and for all people? Has the practice of euthanasia changed the medical profession, the society in which it is practiced?
At present Holland is the only place you can look for answers to these questions. The truth about Dutch euthanasia has been the subject of controversy.
Defenders of euthanasia, particularly in the United States, say that Holland is a democratic nation of decent, reasonable people. They have allowed active euthanasia for some twenty years with no bad consequences whatsoever. Though not formally legalized, official guidelines strictly regulate the practice of euthanasia and provide good safeguards against abuse. The rights of people have been expanded; they include now the choice of death, and the dying patients who are in intractable pain can now be put out of their misery.
Critics of Dutch euthanasia always asserted that it is practiced on a very large scale, not only in terminal cases, but also on people with various chronic ailments, with psychological disorders; that many doctors arbitrarily terminate patients' lives without the patients' request, consent or knowledge; and that irregularities and misdemeanors are rather the rule than the exception. Critics further have alleged that euthanasia frightens whole groups of people; it corrupts the legal system, the family ties, and the whole fabric of society. Which picture is true?
In 1990 a government-appointed committee ordered a nationwide survey of the practice of euthanasia. Very reliable methods of study were adopted. The result was the Remmelink Report, issued in September 1991. This factual report showed that the situation is worse than the opponents of euthanasia ever suspected.
Professor Joseph Fletcher, who was a prominent advocate of euthanasia, proposed a descriptive definition that I present here in my own wording. Euthanasia means deliberately causing the death of a person either by action or omission with or without the request of the person involved, and with the professed aim of sparing that person the suffering of illness or an imperfect life.
When we apply Fletcher's definition to the data supplied in the Dutch report, we see that the number of people who died by euthanasia in the Netherlands is more than 25,000 a year. Every fifth person in the country dies of euthanasia. This does not include handicapped newborns, sick children, psychiatric patients, and patients with AIDS, as, according to the report, termination of life is practiced in these cases as well, but no quantitative estimates have been obtained. Euthanasia Without Consent
According to the data published in the report, 14,691 people died in 1990 by involuntary euthanasia, which means that these lives were cut short by the doctors without the request, consent or knowledge of the patients. Fourteen hundred persons who underwent active, involuntary euthanasia were fully competent. In 8% of cases, the doctors proceeded to perform active involuntary euthanasia while they believed that other courses of action were still possible. "Low quality of life," "no prospect of improvement," and "the family could not take it any more" were among the most frequently cited reasons to terminate the patients' lives without their consent.
In Holland, when a person is admitted to a hospital one is supposed to trust, a doctor will evaluate the quality of his life, will make up his mind, and without asking the patient whether he wishes this or not, will give him an injection which stops the breathing and the heartbeat. One Dutchman out of 22 dies in this way.
The report is the first official acknowledgment that involuntary euthanasia is practiced in Holland as part of regular medical practice. The report also showed that the rules of so-called careful conduct officially accepted as guidelines for euthanasia are widely disregarded by the physicians.
In cases of voluntary euthanasia, 19% of the general practitioners disregard the rule to consult another physician, and 54% omit recording the proceedings in writing, which is one of the rules. Sixty percent of the general practitioners do not consult another physician before carrying out involuntary euthanasia. In the death certificate, 72% of doctors conceal the fact that the patient died by voluntary euthanasia. In cases of active involuntary euthanasia, the doctors, with a single exception, never stated the truth on the death certificates.
Perhaps the most striking finding published in the report is the total number of cases in which death is deliberately hastened by action or omission. In 1990, of the 86,700 non-sudden deaths, in about 49,000 cases (which is 56.6%!), the physicians took decisions that possibly or actually shortened the patients' lives. This figure exceeds all previous estimates.
What is happening to the society which has embraced euthanasia? The message that society sends to its members is changed now. Instead of the message humane society sends to its members, "everybody has the right to be around, we want to keep you with us, every one of you," the society that has accepted euthanasia tells people, "we wouldn't mind getting rid of you." And this message reaches not only the elderly and the sick, but all the weak and dependent. The Dutch Patients' Association stated in 1985, "The fear of euthanasia among people has considerably increased." A group of severely handicapped adults wrote to the Parliamentary Committee for Health Care and Justice, "We feel our lives threatened.... We realize that we cost the community a lot.... Many people think we are useless...often we notice that we are being talked into desiring death.... We will find it extremely dangerous and frightening if the new medical legislation includes euthanasia."
There were several reports that out of fear of euthanasia, elderly people refused to be placed in old- age and nursing homes, refused to be admitted to hospitals, or to see doctors, or to take medicines. A study of the elderly done by Segers showed that 47% of those living in their own homes and as much as 93% of those living in the homes for senior citizens oppose euthanasia "because later on when they won't be in command of the situation any more, their lives, against their will, will be put to an end by others."
Pathetic attempts are made to protect oneself from imposed medical death. There are so-called Declarations of the Will to Live cards which one can carry on his person stating that the signer does not wish euthanasia performed on him.
Since euthanasia has become an option, it is now up to every disabled and dependent person to justify his staying alive. It is now he who owes an explanation to his attendants, to the community, to his own family.
A study conducted among patients showed that many fear their own families because these are people who decide upon euthanasia or pressure the patient to request it.
Hearing the news from Holland, people ask with apprehension whether euthanasia will come to the United States. But it has already come: by courts' orders unconscious persons are starved and dehydrated to death.
We should realize that the Law and Medicine are governed by different principles and defend different values. We should try to prevent the one from overwhelming and destroying the other.
Unconscious persons are now directly threatened with euthanasia and meanwhile the pro-euthanasia shift in public opinion is promoted.
Test cases of "mercy killing" are boldly publicized. Terrible examples that strike at the imagination are cited to convince the public of the necessity of euthanasia. We know that it is improper to use uncommon cases to promote change that would affect millions of people and the society as a whole, but this kind of argumentation helps to mold the public opinion.
A violent attack is directed against people who do their best to assist fellow humans in distress. Not death and disease, but doctors and their machines are accused of being the enemies of mankind. The "right to die" is forcefully emphasized, as if it were indeed a right and not a sad necessity.
The theme of dignity is widely exploited. We are also told that one way to die in dignity is to let oneself be killed by a professional! A special soothing language is used to make it easier for the public to accept euthanasia: documents intended to hasten death are given the name of "living wills," and killing the patients with injections is called "aid in dying."
The acceptation of euthanasia involves a new and different role for medicine, and a new and different vision of the world. The striving of libertarians for expanded rights and unlimited freedom of the individual is producing the opposite: compulsion to die, denial of the right to live, and replacement of the human community we know, by a new Killing Society. Every effort should be applied to prevent this from happening.
Dr. Richard Fenigsen, a Dutch citizen, is a retired cardiologist who has lectured and published widely. His publications include numerous articles on euthanasia.
This article is a condensation of his address at a euthanasia conference at Biola University, La Mirada, Calif., in March 1991.