Monday, January 10, 2005

Docs in the Netherlands Push for More Euthanasia

Two weeks ago I reported on a bill being considered by the House of Lords that would permit physician-assisted suicide in the UK for those who are terminally ill. Now doctors in the Netherlands, where physician-assisted suicide has been legal since 2001, desire an expansion of their own physician-assisted suicide laws.

A report commissioned by the Royal Dutch Medical Association argues that doctors should be allowed to assist with the suicides of people who may not be ill, but consider themselves as "suffering through living."

The conclusion has reopened a fierce debate over what constitutes grounds for requesting euthanasia, as it contradicts a landmark Supreme Court decision that a patient must have a "classifiable physical or mental condition." The 2002 ruling upheld a guilty verdict on a GP for helping his 86 year old patient die, even though he was not technically ill but obsessed with his physical decline and hopeless existence

The Dutch euthanasia law does not specifically state that a patient must have a physical or mental condition, only that a patient must be "suffering hopelessly and unbearably."

The new report does not rule on how doctors should respond if a patient without a classifiable condition should approach them for help but says that doctors believe that some cases of "suffering through living" could be judged "unbearable and hopeless" and therefore fall within the boundaries of the existing euthanasia law.

The report argues that the Supreme Court criteria are unhelpful in defining the limits of medical practice in varied and complex cases. It is "an illusion," it argues, to suggest that a patient’s suffering can be "unambiguously measured according to his illness."

What is it with the Netherlands and their enthusiasm for euthanasia? First there's the proposed Groningen Protocol, which would allow physicians to euthanize terminally ill people, including children up to twelve years of age, the mentally retarded and those considered to be in an irreversible coma -- and would put these life-ending decisions in the hands of an advisory board. And now there's this push for physician-assisted suicide for those who may not even be physically ill.

Jos Dijkhuis, the emeritus professor of clinical psychology who led the inquiry, said that it was "evident to us that Dutch doctors would not consider euthanasia from a patient who is simply ‘tired of, or through with, life,’" (terms used in the original court case). Instead his committee chose the term "suffering through living," where a patient may present a variety of physical and mental complaints.

He said there was "enormous protest" from doctors to the Supreme Court’s ruling. "In more than half of cases we considered, doctors were not confronted with a classifiable disease. In practice the medical domain of doctors is far broader . . . We see a doctor’s task is to reduce suffering, therefore we can’t exclude these cases in advance. We must now look further to see if we can draw a line and if so where."

His report recommends caution, saying that doctors currently lack sufficient expertise and that their roles remain unclear. It recommends drawing up protocols by which to judge "suffering through living" cases and collecting and analysing further data.

And we slide further down the slippery slope to oblivion.

If doctors in the UK adopt the bill to allow physician-assisted suicide for the terminally ill, how long before they, like the docs in the Netherlands, want it expanded to include those who are merely depressed?

When someone feels his life is not worth living, it falls to us -- fellow members of the human race -- to show him that his life has value. It is abhorrent and repulsive that anyone -- but especially doctors -- would inform someone in despair that, no, his life is not worth living and he ought to just kill himself.


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