Today it is ten years since the Netherlands passed a law legalising euthanasia. This made the Netherlands the first country in the world to establish legal guidelines for ending a human life. But why has almost no other country followed the Dutch example?

The Netherlands likes to see itself as an ethical guide that other countries should follow. In 2001, the Mayor of Amsterdam presided over the first same-sex marriage while the world looked on. Since then, over ten countries have legalised same-sex unions.

One year earlier, the Netherlands became the first country to adopt a law on euthanasia. This was another Dutch breakthrough that attracted the attention of the world, but it did not inspire widespread admiration. Only two other countries have ventured to follow in the Netherlands’ footsteps: Belgium in 2002 and Luxembourg in 2009.

Discussion
“Euthanasia centres on fundamental medical-ethical issues, so other countries cannot simply transplant the Dutch legislation to their own context,” explains Walburg de Jong of the Voluntary Euthanasia Association.

“The Dutch Euthanasia Act was preceded by 30 years of debate in the Netherlands. That discussion was initiated by the general public and filtered through to the world of politics. Interestingly, the process in Belgium two years later was the other way around. There it was the government that wanted to regulate the issue and so the euthanasia law was imposed from the top down.”

Beyond the Benelux countries, legal arrangements for euthanasia exist in Switzerland and in the US states of Oregon, Washington and Montana. There is a difference, however: in those places a doctor is only allowed to provide the medicines that enable someone to end their life. But taking action to end someone’s life, for example by administering and excessive dose of morphine, is still very much illegal.

Cultural shift
Regulating euthanasia by law requires a huge cultural shift. After all, it is the responsibility of the state to protect its citizens, a role that appears to be at odds with helping them end their own life.

From an international perspective, there are only two situations imaginable in which the state gives its assent for the taking of a human life on professional grounds, says Evert van Leeuwen, Professor of Medical Ethics in Nijmegen. “An executioner is allowed to do so when implementing a death sentence and it is permitted during wartime.” This is why doctors in other countries are not permitted to take a life.

“Here in the Netherlands, we tend to take a different view,” Prof Van Leeuwen says. “Here, a doctor gets to choose between his oath and his patient’s wishes. If his patient wants to die, he is allowed to assist them”. Many countries do allow palliative sedation, in which a doctor administers heavy sedatives and stops treatment.

Open and pragmatic
The easygoing Dutch attitude toward a doctor playing an active role in ending a patient’s life appears to be mainly due to well-known Dutch values such as tolerance, transparency and an almost compulsory urge to regulate. Ethicist Van Leeuwen:

“Deeply engrained tolerance means that the wishes of others are taken seriously. Our openness makes it much easier to talk about someone’s wish to die”.

And the Dutch are also pragmatic; they want to structure and regulate anything they can. On top of which, the church - a fierce opponent of euthanasia - in the Netherlands has little say in people’s private lives.

‘Nazi laws’
Instead of emulation, Dutch euthanasia policies have over the past ten years mainly met with criticism:

“After euthanasia and infanticide, the next step in the Netherlands will most likely be a suicide pill for people who are tired of life, even though it will probably take a few years before it’s legal.” (Correspondent Greg Burke, Fox News)

“The Nazi laws and Hitler’s ideas have made a comeback in Dutch euthanasia laws and the debate about how sick children are killed.” (Italian minister Carlo Giovanardi)

These spectres are not borne out by the facts: the number of cases of active euthanasia has been steady at 2,500 for years, slightly lower than before the introduction of current euthanasia laws. The criticisms regarding the killing of children refer to a medical protocol drawn up by neonatologists for the termination of life for newborn babies who are suffering unbearable pain without a prospect of improvement. Professor Van Leeuwen says: “You could ask yourself if it was even necessary”.