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.

Worldview Matters at the End of Life

Writing this reflection on Easter Sunday, I’m reminded of the powerful influence one’s worldview exerts on end-of-life decision-making. In my considered judgment, voluntary active euthanasia (VAE) and physician-assisted suicide (PAS) are out of sync with the Christian worldview that maintains that God made human beings in his image; that believes that God the Father was co-sufferer with Christ the Son on the cross, and even now is present with us in our suffering; that trusts that God is sufficiently sovereign, merciful, and creative to transform even the darkest night into glorious day; that affirms there is meaning in suffering in this life and in the life beyond; and that reminds disciples to live with an end-time horizon in view.

For those committed to live and die for Christ, according to his sovereign will for their lives, VAE and PAS make no sense. Even Derek Humphry—though he does not embrace the Christian worldview and is an ardent supporter of euthanasia—observes that worldview makes all the difference in one’s attitude toward VAE and PAS. In Final Exit, sort of a “how-to” book on euthanasia, he cautions readers: “If you consider the God whom you worship to be the absolute master of your fate, then read no more. Seek the best pain management available and arrange for hospice care.” (Final Exit, 3rd ed., New York: Random House, 2002, p. 3) Regarding one’s understanding of suffering and death, he asks: “Does suffering ennoble? Is suffering a part of life and a preparation of death? Our response here is that if that is your firm belief you are not a candidate for voluntary euthanasia.” (“Euthanasia is Ethical.” In Euthanasia: Opposing Viewpoints, ed. David Bender and Bruno Leone, San Diego: Greenhaven Press, 1995, p. 19) Humphry may reject the Christian worldview, but he perceives that it precludes consideration of euthanasia.

The worldview of Humphry, Peter Singer, Jack Kevorkian, and a host of other euthanasia proponents is a material one devoid of the presence and influence of a personal God who created human beings in his image and who entered into the suffering of humanity in the Incarnation. In a materialistic worldview, the dignity of human beings is diminished, the notion of redemptive suffering is nonsensical, and the possibility that the glory of eternity might bring perspective to here-and-now suffering is neutralized. Brought low in such a worldview, humanity seeks to move upward through the exercise of unbridled self-determination. Disdaining true dignity that derives from being created in the image of God, human beings conceive “dignity” merely as the exercise of absolute autonomy at the end of their lives. A shadowy “dignity” indeed!