The euthanasia debate in the Netherlands is entering new and ever more complex waters.

An influential commission recently ruled that the Dutch euthanasia law allows, under strict conditions, doctors to help in the ending of a patient's life even though that patient may not be suffering from a life threatening physical illness.
 

Being 'tired of life', or 'suffering from life,' is reason enough for a doctor to answer a patient's request to end his or her life according to the advice of the commission.

"Unbearable suffering, with no end in sight" has always been the benchmark test for doctors to apply before considering a request for euthanasia.

Under the commission's advice that "unbearable suffering" does not necessarily have to be linked to terminal illness.

Radio Netherlands Worldwide's discussion programme Amsterdam Forum focused on the issue this week asking if euthanasia really should be made available to those "tired of life".

Listen to the discussion:

Dr Rob Jonquiere, director of the Dutch Voluntary Euthanasia Society, and Dr Henk Jochemsen, director of the Christian centre for medical ethics, the Lindeboom Institute, joined host Andy Clark for the discussion.

"I think for doctors it [carrying out requests for euthanasia] is one of the most difficult questions they get and, of course, a doctor as a doctor will be more prepared to positively think about it if it is a real disease - something you can see from the outside, something you can feel and easily believe in and be empathetic with," says Dr Jonquiere.

Andy Clark: "So in cases where a patient is just tired of life this is going to be even more difficult?"

A commission was set up to examine the 'tired of life' euthanasia issue after a Dutch doctor was prosecuted for answering a request for euthanasia from an ageing politician, Edward Brongersma, who, although ill, was not facing imminent death.

The senator was tired of living and didn't want to go on.

The commission, under the chairmanship of emeritus professor of clinical psychology and psychotherapy Jos Dijkhuis, has now decided that the rules do indeed, under strict conditions, allow for a doctor to help in such cases.

Now the Dutch doctors organisation, the KNMG, will consider the commission's position and decide what advice doctors should be given in such cases.

Research has shown that 30 percent of Dutch doctors have received a request for euthanasia from people who were tired of living.

"It certainly would be. But it would be good to mention that these sorts of requests do not come out of the blue. You grow together with your patient in this sort of situation and the request comes up in a sort of process."

"And certainly with the 'suffering from life' situation it would take a lot of time to talk with your patient," adds Dr Jonquiere.

Dr Henk Jochemsen opposes euthanasia on principle and he says extending the boundaries sends the wrong signal:

"I think it is a sign that as a society we think those people are correct in wishing to be dead. Whereas I think this is not the sign we as a society should give to people who are in a very vulnerable and difficult situation."

"The very fact that a regulation would exist that would allow this is a wrong sign, even if it would only happen a few times a year."

To Dr Jochemsen, this idea is something outside of the medical domain. But for Dr Jonquiere the question of unbearable suffering is key:

"We are not just talking about people who are tired of life; we are talking about people who are really suffering. It is not a classifiable disease, it's not cancer, but it is an existential problem."

"It is very difficult but any doctor who gets a patient who is really suffering because of their life they will be able to tell that immediately."

"The law recognises at this moment that the real reason for euthanasia is not that you have cancer, or a serious disease, but that you have to be unbearably suffering."

"For me the position that it is possible for people who are really suffering from their life, that they can make their choice, that they can ask a doctor to give help instead of having to make choices for a more inhumane way to end their life, I think that is a good thing."

Dr Jochemsen responded: "I think it is very important in all countries to discuss this issue of terminal care and to make clear what are the limits of the competencies of physicians, but we should stay away from legalisation of the intentional ending of people's lives. That makes it much more difficult for physicians and for society as a whole."

So what will the rest of the world make of this latest twist in the Dutch euthanasia debate? Dr Jonquiere:

"I'm afraid that the world will see in this development a kind of slippery slope and I think that that message is the wrong message. I certainly would fight against that - it is not a slippery slope down.

"It is not extending the domain but it is making it possible to discuss new issues, new problems which we have not tackled before."

Our panellists:

The director of Dutch Voluntary Euthanasia Society, the NVVE, Rob Jonquiere.

"The observations that the NVVE has always had in respect to the question of 'suffering from life' have been confirmed by the committee Dijkhuis. One of the legal criteria involved with euthanasia and assisted suicide is that there must be evidence of unbearable and hopeless suffering. Just as suffering with cancer can be unbearable and hopeless so can suffering linked to 'suffering from life.' That doen't mean to say that all people who are tired of life are necessarily suffering unbearably."

Henk Jochemsen, director of the Lindeboom Institute, a Christian centre for medical ethics. Mr Jochemsen is also special professor for medical ethics at the Free University of Amsterdam and adviser both nationally and internationally on medical ethics to governmental and non-governmental groups.

He says: "Acceptance of euthanasia for people who are tired of life will further social pressure, to those who feel themselves to be a burden to others, to ask for euthanasia."