In the last week of November, the lower house of the Dutch Parliament passed a bill that made the Netherlands the first country in the world to legalize euthanasia and physician-assisted suicide (PAS). U.S. newspapers printed brief wire stories about the event, but our nation's editorialists and opinion writers were distracted by the Florida election.
In the first week of December, The New England Journal of Medicine published a report by four medical researchers, showing that 75 percent of those who had died at the hands of Jack Kevorkian, Michigan's grandstanding advocate of pas, were not actually terminally ill. Again the nation's newspapers printed only well-buried wire stories.
Unfortunately, the media focus on Florida, as important as it was, failed to keep us informed on developments with serious moral consequences; and it missed an opportunity to stimulate public debate on a vital public concern.
Here is some of what American readers missed:
1. The lower house of the Dutch Parliament passed a more restrictive bill than euthanasia and PAS advocates had been pushing for. Originally, the bill would have extended the age for euthanasia without parental consent as low as 12 years. Fortunately, this proposal of the radical D66 party was unable to garner a majority. But the new law still accords this level of autonomy to 16-year-olds.
2. The parliamentary vote was lopsided. The bill passed 104-40, reflecting the attitudes of the Dutch population, which some reports pegged at 90 percent in favor. Only the Christian Democrats and three small Calvinist parties voted against the bill. The upper house's approval of the bill this spring is expected to be a mere formality.
3. In Canada and the United Kingdom, PAS activists quickly used the event as a platform for renewed advocacy, but the German reaction was swift and negative. According to a UPI report, a spokesman for the Marburger Bund, a powerful association of hospital physicians, said, "Killing does not belong to the duties of a doctor." And Hartmut Steeb, secretary-general of Germany's Evangelical Alliance, said, "This law shows that the lessons from the human rights catastrophe in the Third Reich have not been learned."
In Germany, the moral memory of Aktion T4, Hitler's euthanasia law, is still alive. But the Dutch seem to have forgotten that Hitler's regime first sharpened its execution skills and tested its gas chambers on sick children and disabled adults from 1939 to 1941 before it applied its new technical expertise to Jews at Auschwitz and Treblinka.
4. The Dutch law still considers euthanasia and assisted suicide as crimes—unless it is performed by a doctor and under certain clearly spelled-out conditions. Advocates claim those conditions will help prevent abuse.
But for more than two decades, euthanasia and pas have been tolerated by the Dutch courts within certain guidelines—and those guidelines have been regularly flouted. According to a 1999 study cited by Canada's National Post, of all the Dutch cases of euthanasia and PAS in 1995, 20 percent of the deaths took place without the patient's express consent, 56 percent were not motivated by "unbearable suffering" but by "loss of dignity," and nearly two-thirds were not reported to authorities as required.
Advocates of the new law, such as D66 leader Thom DeGraaf, say the new measures are "for people who are in great pain and have no prospect for recovery." But the widespread practice of ignoring the existing guidelines suggests, as Bert Dorenbos of Cry for Life has said, that such laws only amount to issuing the medical profession a license to kill.
5. Terminal illness is only a minor factor among those who seek pas or euthanasia. Historian Kevin Yuill reported in The Spectator that in Holland "only 2 or 3 percent of all patients with terminal illnesses choose voluntary euthanasia." In the study of Kevorkian's "patients," only 25 percent appeared to be terminally ill, according to autopsy findings. The number of those who had experienced recent decline in health status, and who therefore may have been seriously discouraged, was 72 percent. And a large percentage were experiencing some sort of social isolation. The divorced, widowed, and never-married were disproportionately represented at 69 percent. In addition, a Detroit Free Press study of three "patients" who had "no medical problems" found that all "took mood-altering drugs and painkillers, and had histories of psychiatric problems or diseases that were difficult to diagnose."
The role of discouragement, depression, and social isolation in death decisions must be studied very carefully, for the experience of isolation can mesh with the cultural values of individualism in dangerous ways.
One Canadian pundit wrote that "if the Netherlands didn't exist, high school debating clubs would have to invent it" and called the country "a one-stop shop for libertarian ideas." Those libertarian ideas—which include a broad tolerance of drugs, sex-for-sale, and gay marriage—are descended from a noble Dutch tradition of individual freedom. After the Reformation, English pilgrims and Swiss Anabaptists found a haven from religious persecution in Holland before eventually migrating to American shores. Today's Dutch libertarianism is a perversion of that fine tradition.
The libertarian arguments offered by euthanasia and pas advocates appeal to highly individualized notions of autonomy, rationality, and dignity. But the best biblical and secular thinkers have recognized that we are inescapably social creatures, and that we are most free when we are enmeshed in supportive, intimate relationships. Living or dying, it is not good for man to be alone. Divorced from emotional and physical support systems, an individual can easily rationalize the urge to end life. However, in the context of mutual support, enormous suffering can be borne and transcended for the sake of love.
6. The argument is becoming increasingly centered on belief in God. Yes, much liberal Christian rhetoric appeals to so-called compassion. And the Hemlock Society is not ignoring the supernatural dimension. (It even has "chaplains" who help candidates weigh their choices in the light of the suspect literature on Near Death Experiences.)
But arguments against euthanasia or PAS fail to persuade when they are divorced from belief in God. Writing in Canada's National Post, an advocate of PAS who is unconvinced by mushy religious arguments called for clarity:
Arguing about the risk of abuse in the context of euthanasia is a lot like weighing the evidence of crime deterrence in the context of capital punishment: It is merely a rhetorical sideshow in which pundits who have already decided the issue along ideological and spiritual lines trot out empirical studies that happen to support their side. The Vatican denounces the new Dutch bill as an affront to "human dignity." [Bioethicist Margaret] Somerville tells us euthanasia does violence to "the human spirit" and our "sense of the sacred." At their root, both arguments represent variations on the same mystical idea: that it is somehow degrading and morally wrong if the time and manner of a human death is not left to a higher power. Only by invoking God … can opponents of euthanasia overcome the utilitarian presumption that it is correct and good to answer a person's plea for death.
That quote is an ideological and "rhetorical sideshow" in its own right. Nevertheless, it inadvertently makes the same point that the Canadian newspaper Christian Week made less colorfully: Secular ethics has hit a dead end. Shun utilitarian thinking. Only revealed ethics can address this issue safely.
What are we to make of this challenge? We are not are own. We belong to each other and to God, both by creation and redemption. We are bought with a price, to use St. Paul's words. Life is thus for us a matter of stewardship rather than ownership. And the lives entrusted to us are to be loved and nurtured until the Master takes them from us.
7. The battle continues in the United States. In Oregon, where PAS has been legalized, a fundraising letter for the Compassion in Dying Federation declares, "We have expanded our mission to include not only terminally ill individuals, but also persons with incurable illnesses which will eventually lead to a terminal diagnosis." That definition, the National Post editorial page points out, "covers myriad conditions, including early-stage cancer and heart disease." The federation's director of legal affairs even claims that Oregon's 15-day waiting period is "overly restrictive" and "unduly burdensome."
In the Senate, Majority Whip Don Nickles (R-Okla.) has sponsored the Pain Relief Promotion Act. This bill, which was backed by the American Medical Association, would protect and promote the appropriate use of pain medication, but it would also bar physicians from using federally controlled substances to aid a suicide. In effect, it would encourage physicians to prescribe generously for pain, while it would also void Oregon's maverick pas law. In an unforeseen upset, liberal senators won a public-relations campaign and defeated Nickles's efforts to attach his provisions to the final spending bill of 2000.
Ron Wyden (D-Oreg.) said he expects President Bush to instruct his new attorney general to reinterpret the Controlled Substances Act to invalidate the Oregon law. For his part, Bush has said he would sign a version of the Nickles bill. Let us hope he does both. But ultimately, it is up to all who see themselves as stewards of a divine gift to model their belief in compassionate care for the dying and the discouraged.
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Books and Culture took on the euphemisms that surround euthanasia in "The Subjunctive that Killed Hugh Finn | Our language about what a patient 'would' want turns sympathy into empathy, pity into murder."
Previous Christianity Today coverage of euthanasia includes:
Severe Mercy in Oregon | How two dying patients dealt with a new right: When to die. (June 14, 1999)
Hospice Care Hijacked? | A bottom-line, cost-efficient mentality obscures the movement's original Christian vision. (March 2, 1998)
What Really Died in Oregon | The state's voter-approved suicide law represents more than an extreme belief in personal autonomy. (January 12, 1998)
'Right to Die' Debate Returns to States | (August 11, 1997)
Deadly Compassion | Some support physician-assisted suicide out of fear of a lonely, pain-filled death. Here are four professionals who are making the dying a part of the church's ministry. (June 16, 1997)
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