The expansion of euthanasia in the Netherlands

Dr. Steve Phillips

Ever since advocates for euthanasia began making arguments that euthanasia was morally permissible and should be legal, their arguments have begun by picturing a person who is near death from a disease that is causing severe pain. Then they argue that out of respect for the autonomy of and compassion for that person we should conclude that it is permissible for her or him to request and receive euthanasia as a means of ending suffering. Those who take the opposing position frequently counter with arguments about the value of human life in the midst of suffering, the importance of never saying that a human life is not worth living, and an understanding that compassion means coming alongside a person to help them live the life that they have the best that they can rather than destroying that life.

In addition to those arguments related to ethical principles, some raise concerns about what will happen if we make the decision that euthanasia is permissible and should be legal. One of those concerns is that euthanasia will spread to a much wider range of situations if it is accepted in an initially limited way. When we examine the arguments favoring the permissibility of euthanasia, the argument from respect for autonomy is actually arguing for euthanasia in any situation in which a person would choose to request it. The argument from compassion actually argues for euthanasia even in situations in which the person is not able to request it. Can euthanasia remain limited or will acceptance lead to much broader use?

Frequently people look to the Netherlands because of its long history with euthanasia to answer that question. A recent detailed report on the Netherlands’ experience with euthanasia by Christopher de Bellaigue in The Guardian adds some insight to this question. He looks at how the situations addressed by euthanasia in the Netherlands have expanded. He focuses on cases in which the person is not in the process of dying and cases in which an advance decision results in euthanasia of a person who is not requesting it at the time it is done. These have been areas of concern that have caused some who supported euthanasia in the past in the Netherlands to have second thoughts.

Bellaigue reports that the indications for euthanasia have expanded to include those with psychiatric illness who have no life-threatening condition and the elderly who are not dying but have become tired of living. He shares the story of a physician who once performed euthanasia but has stopped because patients were expecting him to provide euthanasia in situations in which he saw no need for it. They simply wanted him to do it because they requested it. He also reports on the problems that have arisen when a person with progressive dementia makes an advance directive requesting euthanasia when a certain level of intellectual and functional decline has occurred. The problem is that many times when the conditions stipulated to trigger the use of euthanasia occur the person who has requested it in the past no longer has a desire for euthanasia and may actively resist it, but no longer has the capacity to refuse it.

The experience in the Netherlands makes it clear that moral and legal acceptance of limited euthanasia leads to expansion of the indications for euthanasia beyond those who are terminally ill and beyond voluntary to at least nonvoluntary euthanasia.

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