Ingeborg van Teeseling outlines the benefits and framework of legalised Euthanasia, explaining why we should be following the Dutch example.
Last night, Andrew Denton used ABC’s Q&A as a platform to advocate a law that allows voluntary assisted death in Australia. One of the countries Denton has visited to investigate the practice of, was Holland, where this law has existed since 2001/2002.
Because I think the debate in Australia suffers from a lack of knowledge, it would be good to explain how “active euthanasia,” as we call it in my country, actually works.
My grandfather was a village GP, and this, in the 1930s to 1960s, made him God. When patients were sick, he decided everything: What to tell them, how to treat them and how and when they died. Patients accepted this, because they did not have a lot of education, and the doctor was considered the expert. As a GP, my grandfather performed many acts of euthanasia, either by withdrawing medication or by upping people’s doses of morphine or another opiate. This was accepted, as everyone trusted the doctor would do “the right thing.”
But this changed (at least a little) in Holland in 1951, when a GP killed his brother, who was suffering from terminal cancer and had frequently asked for his life to end. The case went to court and the doctor was sent to jail for a year. In his verdict, the judge said that he realised that the act had been one of compassion, but that he was bound by the law that said that ending somebody’s life was murder.
This was the start of a decades’ long discussion, which eventually ended with the 2001/2002 Euthanasia Law. By this time, three-quarters of the Dutch population supported voluntary euthanasia, about the same percentage that is in favour of it in Australia now.
The law as it was agreed, was a compromise, as most things are in Holland. It did not legalise euthanasia per se, but it said it was legal if a number of very stringent guidelines were followed.
First of all, the doctor needed to make sure that the patient had come to his or her request voluntarily, that it was well thought-out and deliberate. He or she also needed to be convinced that the patient’s suffering was unbearable and that the illness had no known cure. Beyond that, it needed to be determined that there was no other reasonable alternative and that the patient understood his or her prospects.
After this had all been verified and the patient had put their wishes on paper, the doctor had to ask for at least one second opinion. This physician also had to meet the patient, to again discuss matters and sign off on the request. Then, and only then, was the doctor able to administer the life-ending medication, which in Holland is usually Propofol, combined with something like lidocaine and a sedative. After this, the doctor was required to tell the authorities what he or she had done, so they could look at the death to make sure all the guidelines had been followed to the letter.
There have been a few cases lately of very old people, who were healthy, but just, in their opinion “done with life.”
This is still the way euthanasia is done in Holland. And despite what we might think, it doesn’t happen that often. Every year 135,000 people die in my country, the Dutch equivalent of the ABS has calculated; out of those, roughly 3,600 from euthanasia. Usually, those are people with terminal cancer, but even there the numbers are small: 44,000 people die each year from cancer, so the cases of euthanasia do not even equate to ten percent.
Euthanasia is “legal” for people who are 16 years and older. For patients who are 16 and 17 years old, parents have to be involved in the discussion, but they don’t have the last word. Children between the ages of 12 and 16 can only get euthanasia with the permission of their parents or guardians. Between 2002 and 2012, only five children under the age of 18 were assisted with dying, and only one was younger than 16.
One of the issues that seems to stop euthanasia from becoming legal in Australia, is the attitude of doctors.
Dr Christopher Middleton, the chairman of the Tasmanian branch of the Australian Medical Association (AMA), uses extremely inflammatory language to describe the reservations doctors have. He thinks euthanasia compromises the doctor’s role as healer and says they don’t want to be viewed as “agents of death.”
From the Dutch perspective, a few remarks might be important here. First of all, no medical professional is obligated to participate in euthanasia. They have the right to decide if they want to participate or not. Most Dutch people write their euthanasia declaration when they are still healthy and discuss the case with their GP, to see what his or her view is. If their doctor tells them they don’t want to be involved, patients simply find another doctor.
Another valuable point to make is that the Dutch Euthanasia Law also says something about the role of doctors in general. It states that a doctor should respect their patient’s wishes, even if those involve the refusal of medicine. And, more importantly, that not using medical intervention is part of normal and accepted practice.
This, of course, is a bitter pill to swallow for a lot of doctors.
They are, as Middleton said, healers, and will usually keep trying to heal even if healing is not possible anymore. What is interesting though, is that research by Stanford University recently found that most doctors would not choose the aggressive treatment they give to their patients when it is their time to die.
A good death would take away a lot of angst, undignified pain and uncertainty.
A lot can be said about the Dutch Euthanasia Law. There has been a discussion about actually broadening the law. Many people think that the law still gives too much power to doctors. They also consider it unfair that only unbearable physical suffering is recognised and not mental misery as well. There have been a few cases lately of very old people, who were healthy, but just, in their opinion “done with life.”
As the law stands now, they are also excluded. The critics are of the opinion that euthanasia is a human right.
We all die, they say, and a good death would take away a lot of angst, undignified pain and uncertainty. So maybe the Dutch Euthanasia Law is not “best practice” yet and can be improved upon.
But what we can take from it, is a framework, a start. And that is better than the nothing we’ve got at the moment.