Assisted Death — An Individual Liberty Or A Right of the State

YOWUSA.COM, 01-August-01
Jacco van der Worp

For as long as memory serves us, life has been a battle of power, of control over ourselves and over others. Control by man over another man, by State over man, by higher powers over man. The fundamental question is who is in control over your life, you or something or someone else. The question is one of fundamental power. People are slowly taking back that power and it first happened in the Netherlands. 

In the Netherlands, April 11th 2001 was a special day, because a law passed by the Dutch First Chamber of Parliament that day. This law is meant to provide a framework within which people can be assisted in taking their own life.  

Is this a radical new concept? How many times have we seen war movies showing the brave soldier who rolls over on a live grenade to save his friends, or a mortally wounded pilot who chooses to end his life by diving his airplane into an enemy position?  In these cases, the choice of how to die is patriotic and glorified.  But what about those who face death from natural causes or an accident during a relative period of calm?  There are no grenades for them to roll upon, and no enemy targets to dive upon with their aircraft. 

Has the Netherlands really lead us into a new direction of thought about the value of life, or will the powers-that-be quickly maneuver the development back into their grasp again? If they do, will their grasp again give them firm control over all of our lives, putting us at their "disposal"?  

At this moment in time, the citizens of the Netherlands are beyond this grasp, because the terminally ill are free to decide, with the assistance of qualified physicians when  to end to their own lives. This is not a right for the healthy, it is solely reserved for the terminally ill once it has been determined that prolonging their lives will only serve to prolong their needless suffering.   

Therefore, the key point in this discussion is not the act of assisted suicide itself, but rather, who has the power to decide.  Should this power go to the individual, the nation state, or special interests seeking to benefit themselves or to impose their ideologies upon terminally ill patients who do not share their vision?  

This article is not advising anyone to request assisted suicide. Simply put, it is not telling anyone what to do.  Rather, it examines the right of patients to choose one of many options. This is not a new subject, but simply a variant of one that is very much a part of our lives.

Assisted Death Today, and
In A Possible Dark Future

At the present, the world is enjoying a relative level of prosperity and peace. Therefore, the issue is more academic for now.  However, should this status change in a catastrophic direction, the issue will no longer be academic -- it will be fundamental.

To illustrate the differences between the abstract and fundamental views of assisted death, this article will take a look at where this new law passed in the Netherlands might lead us. First, it will show a time of relative peace and quiet, then scenarios of more troublesome times.

• Part 1, this article will attempt to demonstrate the possible benefits of euthanasia in peacetime. It discusses such peacetime scenarios as assisted suicide for the terminally ill or those so critically injured that they have virtually no chance at recovery. Then, it faces scenarios in which abortion might be most humane. It goes on to discuss the possible dangers of euthanasia and abortion, to include incomplete or poorly conducted procedures that can cause the patient further agony.
• Part 2 emphasizes the possible dramatic increase of need for euthanasia in wartime or during an epidemic. In this section, graphic illustrations are given of such extreme conditions as a pandemic outbreak of diseases previously considered to be extremely rare or nonexistant. Several drastic solutions to check the spread of the disease are considered here, including poison aerosols, nuclear assaults and death camps.

Both parts clearly point out that euthanasia is to be used for humanitarian purposes only.

Part 1: A Time of Relative Peace

Fundamental Rights or Crime

It is a revolution of thought, to give the control over life or death to the individual instead of to the State alone. On April 11th 2001, the Netherlands became the first Western democracy to legalize assisted suicide.

The Netherlands is a progressive country and has long ago broken other social taboos such as the legalization of marijuana. Has the Netherlands now pushed the envelope of propriety, or has it shown a more enlightened way of coping with hopeless pain and suffering?   

It is all about power. The state says that killing is illegal, so most of us don't do it. Those of us who do and are convicted are severely punished by sentences up to and including the death sentence. In many cases, the people of a state voted for these laws without thoroughly considering the consequences. However, not everyone gladly puts his or her life in the hands of the state.

Furthermore, the state decides when one is allowed to die! A person may not take his or her own life because it is, again, illegal. If enforcement of the law is taken to extreme, it could lead to the conviction, sentencing and "capital punishment" (on paper, anyway) of the suicide victim! There is the sting. Although the state can't kill the victim any more, because he or she is dead already, the state has the power to choose to make an example of your case. The example shows where the true power lies in this issue -- with the state, not the individual.  

The driving force behind the new euthanasia law in the Netherlands lies here. The law seems to be an attempt to give back to the individual the right to die with dignity when the end becomes inevitable. The question is, shouldn't that have been the case all along? 

The Facts and Fiction of The New Law

Of course, the legislators approached the development of the new law with much extremely careful planning, because the implications less thoughtful planning could be disastrous. Some light will be shed on that process here as well. First, this article will attempt to clarify a few points within the newly passed law.  

The law, which has only two core regulations, was published immediately after it passed the Parliament.

Dutch Justice Department
December 2000

Summary of the Bill

Special provision on exemption from punishment
A physician who helps a patient to die must comply with two conditions to remain exempt from punishment: 

1. He must practice due care as set forth in a separate law, the Termination of life on request and assisted suicide (Review) Act.
2. He must report the cause of death to the municipal coroner in accordance with the relevant provisions of the Burial and Cremation Act.

The incorporation of a special provision on exemption from punishment in Criminal Code (Article 293, paragraph two, and in Article 294, paragraph two, sentence two), does not decriminalize other forms of euthanasia and assisted suicide. Therefore, to say that euthanasia and assisted suicide are no longer punishable is not a correct presentation of the tenor of this bill. 

The following is a list of conditions that need to be met to fulfill the ‘due care' needed in such a decision. That list has been put together as carefully as could be done in an attempt to cover all possible eventualities. 

Due care requirements

Under current legislation termination of life on request is punishable but will not be prosecuted if due care requirements have been complied with. The due care requirements stipulate, among other things, that the patient's request to die must be voluntary and well-considered, that his condition is hopeless and his pain unbearable, that a second doctor must be consulted and that the euthanasia or assisted suicide is performed with due medical care. Furthermore, the physician is obliged to report that the cause of death is euthanasia or assisted suicide. The physician's action is then examined by a regional review committee to determine whether it was performed with due care. The judgment of the review committee is then sent to the Public Prosecution Service, which uses it as a major argument to decide whether or not to institute proceedings against the physician in question.

The new legal regulations do not essentially change anything in the grounds permitting termination of life on request and assisted suicide. However, the due care requirements have been formulated somewhat more extensively. The due care requirements mentioned in Criminal Code Article 293, paragraph two, stipulate that the physician:

• must be convinced that the patient has made a voluntary and well-considered request to die;

• must be convinced that the patient's is facing interminable and unendurable suffering;

• has informed the patient about his situation and his prospects;

• together with the patient, must be convinced that there is no other reasonable solution;

• has consulted at least one other independent doctor of the patient;

• has seen and given his written assessment of the due care requirements as referred to in points a to d;

• has helped the patient to die with due medical care.

As one can see, each individual request for assisted suicide must be considered with extreme care, including multiple medical opinions.  

The line separating murder and euthanasia is extremely fine, as described on the web site of the Dutch Ministry of Health, Welfare and Sport:

Dutch policy on voluntary euthanasia

On April 10, 2001, the Upper House of the Dutch Parliament passed the Termination of Life on Request and Assistance with Suicide (Review Procedures) Act. As Els Borst, Minister of Health, Welfare and Sport put it, the Netherlands "wants to bring the matter out into the open". The main aim of Dutch policy on euthanasia is to guarantee that every step towards the termination of life is taken openly, reviewed in a consistent manner, and surrounded by meticulous care. It is expected that the Act will come into force later this year.

No longer a criminal offense

The idea that the new Act means that euthanasia is no longer an offense in the Netherlands is a misunderstanding. What the Act does is to incorporate grounds for immunity from prosecution into the Criminal Code. In other words, doctors are not criminally liable if they fulfill two conditions when terminating a patient's life on request. Firstly they must satisfy the following due care criteria:

• the doctor must be satisfied that the patient had made a voluntary and well-considered request;

• the doctor must be satisfied that the patient's suffering was unbearable and that there was no prospect of improvement;

• the patient and the doctor must have come to the conclusion that there was no reasonable alternative in the patient's situation;

• the doctor must have consulted at least one other physician with no connection to the case;

• the patient's life must have been terminated with due medical care and attention.

There is yet another statement on the driving force behind creating this law and how carefully it shall be applied:

Care and clarity

Due care, clarity and the right to self-determination are the keys to the new Act. The government emphasizes that all requests for euthanasia are extremely difficult for doctors to deal with, and that no doctor will take the decision lightly. The government hopes that this legislation will help to make the procedures surrounding euthanasia clear and transparent.

Only a third of requests for euthanasia in the Netherlands are complied with. The work of the review committees will be evaluated in 2001 and 2002. At the same time, a study will be conducted of medical decisions relating to the ending of life, along the same lines as the studies of 1991/1992 and 1995/1996. With the publication of these studies, the Netherlands is the only country to have statistics on euthanasia in the public domain.