A citizens action group wants to legalise assisted suicide for all people over 70.
By Folkert Jensma for NRC International.
All Dutch people over 70 who feel tired of life should have the right to professional help in ending it, demands a citizens' initiative in the Netherlands called Out of Free Will. It will start collecting signatures on Tuesday in support of this proposed change in Dutch legislation, hoping to place the matter firmly on the parliamentarian agenda. A number of prominent Dutch citizens have come out in support of the initiative, including former ministers and artists, legal scholars and physicians.
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Under current Dutch law, euthanasia is only legal in cases of “hopeless and unbearable” suffering, which in practice means it is limited to those suffering from serious medical conditions and in considerable pain. Only doctors are allowed to assist in euthanasia. Helping somebody commit suicide who does not meet the qualifications stipulated in the current euthanasia law is illegal. The Netherlands legalised euthanasia in 2001 and is one of the few countries in the world to have done so.
A new medical trade
Out of Free Will does not only want to decriminalise these acts, it wants to found a new profession to assist those weary of life in ending it. The group has suggested this task be carried out by specially trained and certified nurses, psychologists or spiritual professionals who could verify the request for assisted suicide in a series of conversations with the patient. Only after a second healthcare professional has confirmed the patient’s death wish, would they be provided with lethal drugs. The same caretaker would finally supervise the patient as he takes them.
The group paints the following scenario: the specialists should ensure that the patient is of sound mind and that their request is explicit, logical and consistent. The assistants must make sure the death wish is more than a rash impulse, the product of depression or the symptom of another illness, and that the patient has considered the consequences of his actions for those who will survive him. Once the patient has taken his own life, the suicide assistant writes a report that can be reviewed by the municipal coroner. The case is then assessed by the regional euthanasia approval commission, which has already been instituted to oversee the application of the current Dutch euthanasia law.
Out of Free Will proposes that healthcare professionals looking to assist in suicides will need to complete a special “Completed Life” training programme and join a professional association responsible for maintaining standards of professional, transparent and safe conduct. The group argues suicide assistance should only be provided to Dutch citizens. Currently, an estimated 400 elderly people take their own lives every year, sometimes by violent means.
Enjoy old life – up to a point
In an interview in the office of Dick Swaab (65), a leading member of the group and the managing director of the Netherlands Institute for Neuroscience in Amsterdam, three of the initiative’s prominent supporters explained why they felt suicide assistance should be made legal. Former minister and self-described feminist Hédy d’Ancona (72) said arguing for the right to choose one’s time of death was a natural extension of her lifelong battle for emancipation.
Legal scholar Eugène Sutorius (63) said he considered the right a cultural matter, and that he was looking for freedom to face death “in a stoic manner”, without fear of a legal system that branded assisted suicide as criminal.
For neurologist Swaab, death is straightforward. “Throughout the animal kingdom, individuals are simply replaced, rather than patched up endlessly,” he explained. Aging constitutes nothing more than “cells wearing through use,” Swaab said. His argument: when you feel you have no more life left in you, you should be able to say so, and act on it.
All three expressed enthusiasm about ageing. Everything becomes easier to put into perspective as time passes, they said. Sutorius called it an “immense pleasure”. D’Ancona referred to it as “a great phase of life.” But they also expressed fear of what is still to come. D’Ancona said the knowledge she would be unable to end her life when she wanted to left her with a “nagging feeling”. She said it took some of the enjoyment out of what was otherwise a pleasurable phase of her life. Sutorius too feared a moment would soon come when he would come to experience the drawbacks of ageing. “I do not want to outlive myself,” he said.
Completed life – time to end it?
The citizens action group refers to that moment as the time “life is completed”. The lack of purpose that befalls elderly people when their family, friends and acquaintances have all passed away. When they feel left behind, unable to escape an empty existence. Dutch Legal scholar Huib Drion proposed providing the old with an “acceptable means to end their lives at a moment they see fit” as early as 1991. Based on opinion polls, Out of Free Will believes broad popular support exists to pass this option into law. The issues that would arise from such a move are surmountable, the group feels.
The risk of abuse, for instance. The elderly may find themselves being pushed into taking their own lives by an unsupportive social circle. Wouldn’t legalising suicide assistance be taking things a step too far? Sutorius denied this, calling the group’s proposal “a step in the right direction”. Taking the responsibilty of assisting suicides away from doctors would help these keepers of life steer clear of situations where they would be required to take it.
According to Sutorius, criminal law has little bearing on assisted suicide for people over 70. Responsible, transparent, assisted suicide, carried out in a proper manner, is far removed from the capital offences listed in the criminal code, he said. “No one stands to win or gain personally from it, and there is no disproportional violence harming other peoples’ interests involved.”
Still, criminal law knows a plethora of cases involving so-called “angels of death”: nurses or doctors who carried out mercy killings. According to Sutorius, “illegitimate coercion” can never be ruled out completely. The law can only do its best to fight it. Sutorius recalled that the introduction of legal euthanasia in the Netherlands was once seen as a corruption of medicine too. “It was thought to be the first step onto a slippery slope that would lead the medical profession to lose its integrity. But I have seen nothing of the kind happen.”
Only for 70 and over
The group wants to draw a line at age 70. Helping young people commit suicide “cannot be justified,” Sutorius said. When a younger person kills himself, it is always “a disaster”, he claimed. “An older person can understand more, has more perspective."
The group admits the age of 70 was a somewhat arbitrary cut-off point. “Whether it should be 65 or 90 is a good question. We think that once someone has reached old age, he has proved his ability to live. He can then chose to leave this life in a procedural, medically-supervised manner,” Sutorius said.
The three think the proposed role of a suicide assistant would be akin to “taking a walk with death”. A job advertisement would read something like this: “Wanted: nurse or spiritual caretaker in possession of a Completed Life Certificate.” Who would respond to such an ad? “I would not hesitate to do so myself,” Sutorius said. "You would be guiding someone to death at his express request, in the most humane way possible,” D’Ancona added.
Still, since suicide itself is not illegal under current law, why would anyone want to burden someone else with the taking of his own life? Because, Swaab explained, “you need to know how much of what you need take”. Usually, the required drugs are not hard to come by and under current law, relatives are usually the ones procuring the lethal drugs, sometimes with help from a physician who has been tricked into providing them under false pretences.
Also, a do-it-yourself suicide leaves ample room for error. “Current practice is in no-one's interest,” Sutorius said. “Also, people might act on a whim. Or because they are depressed or otherwise ill and unable to oversee their own situation.” Suicide assistance might therefore also help to prevent people from taking their own life, Swaab added.