Bottom of the slope - euthanasia in the Netherlands

On April 28, 1995 it was reported that the Dutch experiment with euthanasia had reached its nadir. Two years earlier, an infant in the Netherlands, born, with the defect of the spinal column called spina bifida and in terrible pain, had been injected with a drug that paralyzed her muscles and stopped her breathing. By means of a surrogate's consent--that of her parents--the little girl's life had been terminated by her physician, Henk Prins. Although Prins was prosecuted for premeditated murder by the Dutch Ministry of Justice two years after the little girl's death, the government hinted that the real reason for the charge was to produce new guidelines permitting newborn euthanasia in extraordinary cases. Justice Minister Winnie Sorgdragger insisted on a trial in order to set a legal precedent in cases where euthanasia candidates are unable to request death. Prins was charged with murder, the court said the charge was proven, yet the doctor was not convicted. What is most extraordinary here, however, is that prescribed regulations requiring a patient's consent for euthanasia have been dismantled in favor of the wishes of a proxy. Karel Gunning, a retired doctor and secretary of a medical anti-euthanasia group in Holland, had earlier predicted that Prins would go free and that his act would lead to "the euthanasia of the useless."

Proponents of active euthanasia and assisted suicide generally downplay the significance of the "slippery slope" argument, citing checks and regulations built into their propositions which prohibit the drift toward involuntary euthanasia. For example, Measure 16, passed last November in Oregon and now held up under a court injunction, endeavors to ensure that assisted suicide can be legalized without inevitably resulting in "the euthanasia of the useless." This is purportedly ensured because a terminal diagnosis of the patient, concurrence by a second physician, testing for depression, repeated requests at specified intervals, self-administration of the dosage, and family notification are all required. The Dutch experiment demonstrates, however, that such safeguards are weak.

On February 9, 1993, the Netherlands' lower parliamentary house approved guidelines which are to be followed in cases of euthanasia. In voting to allow euthanasia under certain conditions, the Dutch parliament was officially recognizing a practice that had been common for at least twenty years. Though still technically illegal, active euthanasia in the Netherlands is now regularly tolerated where the patient repeatedly asks for his life to be ended; where the patient's consent is free, conscious, and explicit; where patient and physician agree that the suffering being experienced is intolerable; where all other measures for relief have been exhausted; where a second physician has concurred; and where these facts have been duly reported to and recorded by the state prosecutor. If these conditions are not met, it is possible for a doctor administering a lethal injection to a patient to be prosecuted.

It has been demonstrated, however, that the regulations imposed upon the Dutch practice of euthanasia are too often ignored (see, Carlos Gomez, Commonweal, August 9, 1991). In addition to the 2,300 reported cases of euthanasia in 1990, a further 1,040 had their deaths hastened without making formal requests for intervention. The Economist (September 17, 1994), in typical British understatement, noted, "There is a worrying drift in the Dutch experience."

The additional safeguards required by Dutch law and provided by a second physician's concurrence, the exhausting of all other measures, and the intolerability of pain were essentially rendered moot by the case of Hilly Bosscher in 1991. Having endured twenty-five years of spousal abuse by her alcoholic husband, and having suffered the suicide of one son and the death from lung cancer of another, the fifty-year-old former social worker from the Dutch town of Ruinen went to see psychiatrist Boudewijn Chabot for but one reason--she wanted him to help her die. Over the next four months, Chabot tried to relieve Bosscher's depression and urge to commit suicide, but to no avail. Chabot consulted with seven colleagues, all of whom concurred that Bosscher's prognosis was dismal. On September 28, 1991, Chabot gave Bosscher twenty sleeping pills and a toxic liquid mixture, which she administered to herself and died.

Even in the Netherlands, with the most liberal euthanasia policy in the world, there had never been a reported case of a physician helping someone not terminally ill to die. Bosscher's was the first reported case of physician-assisted suicide for the mentally ill. Chabot was subsequently charged with violating the country's implicitly held guidelines on euthanasia. But in June 1994, the Netherlands' highest court ruled that although Chabot neglected to have another physician personally examine Bosscher, the psychiatrist would not be punished. Chabot's lawyer, Eugene Sutorius, concluded, "The ruling recognizes the right of patients experiencing severe psychic pain to choose to die with dignity." Concurring physicians' opinions, the exhaustion of all other measures, and the intolerability of the patient's suffering were thus rendered impracticable in favor of the patient's repeated request and conscious, free, and explicit consent to die. George Annas, health-law professor at Boston University, cautioned, "If you're worried about the slippery slope, this case is as far down as you can get."

The bottom of the slippery slope had not yet been reached, however. After the Bosscher case, there still remained one key condition for active euthanasia to occur in the Netherlands. There was still the safeguard of the free, explicit, persistent, and conscious consent of the patient. With the most recent Netherands' case, however, this last and most important condition has now been removed. A surrogate's decision may now be sufficient to terminate a human being who is not terminally ill. Henk Prins, the doctor who administered the lethal injection to the deformed baby, defends the altruistic motives of her parents: "They did not make their decision out of selfishness or egocentricity. They loved the baby. They were not concerned about having a handicapped baby. What bothered them most was the pain the baby was in. They couldn't bear to see that, and we couldn't stop the pain."

Succinctly put, because they couldn't stop the pain, the parents terminated their baby's life. This is the bottom of the slippery slope. All that awaits now is the broader application of the decision. Oh, there is still the remaining condition regarding repeated requests, but those need no longer be made by the patient. Repeated requests may now be made by a proxy. With this Dutch case, involuntary euthanasia has finally been governmentally sanctioned, with all its horrifying ramifications for the elderly, handicapped, and retarded. Proponents of Oregon's Measure 16 and advocates of similar legislation in a half-dozen other states, beware; like the Dutch, you too will go slip sliding away.

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