"Euthanasia in all the other countries is practised … Whether you legalise it or decriminalise it or not, euthanasia was there, and is going to be there," Dr John Bos.

Euthanasia became legal in the Netherlands five years ago - but why is the rest of the world unwilling to follow the Dutch example?

Besides the Netherlands, the only country where a doctor is allowed to take the life of a patient - and only ever at the patient's request - is Belgium.
 

Listen to the discussion programme:

Physician-assisted suicide is allowed in Switzerland and in the state of Oregon in the US. There doctors do not perform euthanasia, but they can provide patients with the means to take their own life.

In all other parts of the globe, euthanasia remains illegal. By comparison, laws legalising abortion - a practice which raises similar concerns - have now been passed in a wide variety of countries around the world.

Definition

So why has the Dutch example not been taken up in the rest of the world? Has the experience of the Netherlands since 2002 encouraged those who support the law - or has it confirmed the fears of those who oppose it?

These questions and more were scrutinised in this week's edition of Radio Netherlands' topical discussion programme, Amsterdam Forum.

Panellists:

Dr John Bos - a retired oncologist from the Netherlands who has experience of carrying out euthanasia under the law.

Professor Ian Dowbiggin - an historian from the University of Prince Edward Island in Canada, author of A Concise History of Euthanasia.

Professor James Kennedy - a specialist in contemporary Dutch history, based in Amsterdam, author of A Well-Considered Death, a study of euthanasia in the Netherlands.

Extracts from the debate:

James Kennedy on the Dutch definition of euthanasia:

"The Dutch in their definition of euthanasia always mean active and voluntary."

James Kennedy on the conditions that must be met to allow euthanasia to be performed in the Netherlands:

"Some of the most important criteria include, for example, that a patient really has to persistently request this - and that it's not just a whim, but it has to be something that is stated over a period of time, and unambiguously. Another criteria is that there are really no other alternatives for ending this suffering, and that the suffering itself must be without any reasonable prognosis of improvement."

Ian Dowbiggin on how others view the Dutch situation:

"The anti-euthanasia forces tend to publicise the Dutch law and tend to publicise all aspects of the Dutch experience. The right-to-die movement itself tends to be quite reticent about what's going on in the Netherlands."

John Bos on euthanasia in other countries outside the Netherlands:

"Euthanasia in all the other countries is practised … Whether you legalise it or decriminalise it or not, euthanasia was there, and is going to be there."

James Kennedy on the difference in the doctor-patient relationship:

"The Dutch trust their doctors to do this, and I think certainly in the Anglo-American world, that's a kind of a big no-no. [People think], how can you give so much room to doctors, who have so much power, to do this?"

John Bos on the closeness of the doctor-patient relationship:

"I wouldn't dream of doing euthanasia on a patient I don't know … You build a relationship with the patient, and that's something special I think - otherwise, I don't know how you could do it."

Ian Dowbiggin on the kind of political culture that permits euthanasia:

"The doctor-patient relationship is really a relationship that's embedded in a wider political culture… In Oregon, what you have is a political culture which is very similar to the Netherlands, in the sense that they take a very tolerant - or as the critics would say, a very permissive attitude - to a wide range of social issues ranging from abortion to pornography and gay marriage, and this political culture creates a kind of situation which makes it possible for euthanasia to be legalised."

Ian Dowbiggin on why the euthanasia debate is more fierce in wealthier countries:

"People are simply living longer lives … and of course this means that a significant segment of the population in western industrialised nations become increasingly worried about how they're going to die and under what conditions they're going to die … The movement in favour of legalising forms of euthanasia is part and parcel of rising levels of affluence in western industrialised countries."

John Bos on palliative sedation:

"In euthanasia you cause the death of the patient, and in palliative sedation, you let the disease kill the patient."

James Kennedy on the trend towards palliative sedation rather than euthanasia:

"One of the leading figures in the Dutch Voluntary Euthanasia Society said to me, 'In 10 or 20 years I don't expect there to be euthanasia in the Netherlands because my members want palliative sedation.' I think that's hyperbole, I don't think that's going to be the case, but…"

John Bos on talking with a patient about euthanasia:

"If you talk with the patient about euthanasia, and they say they don't want to suffer, can they get euthanasia when things come to the worst - if you say yes, and the patient sees and understands that you mean that, that you will do something if they want it at that time, that usually takes away the necessity for euthanasia. Not all people who ask for euthanasia get euthanasia, and that's not the intention."

James Kennedy on how people in the Netherlands understand their laws on euthanasia:

"When I was researching my book on euthanasia in 1999/2000, I don't think I met a single layperson who could give me a definition of euthanasia - of how Dutch policy defined it. They didn't know what it was … I don't think I've seen either in my experience of writing that book or just following the Dutch debate in recent years that this is something a lot of Dutch really get impassioned about."

A selection of listeners emails:

Alhaji, UK
"Euthanasia or accelerated death by a qualified medical professional may take a much more legal debate in the United Kingdom. The mental status of the individual may be a contributing factor to this."

Anthony, Canada
"I think it is very wrong to refer to euthanasia as suicide. It does introduce a bias. Also it makes the task of any one feel like an accomplice to an act that is decidedly amoral."

Frank, Lagos, Nigeria
"Euthanasia is a very delicate  issue. It is a moral issue that will take a lot of discussions and debates before countries can be convinced. I think the reason most countries are yet to support euthanasia is because of the moral implications. Just like cloning, people have not accepted it. Personally I support it."

Jon, Chicago, USA
"Euthanasia is murder, pure and simple. It can never be condoned."

John, Florida, USA
"It's the quantity of life, not quantity of life that matters. Unfortunately, there are too many busy-bodies who involve themselves in the personal lives of other people, and who always claim to know how the person REALLY feels rather than minding their own business and letting the person decide what happens to him when he becomes terminally ill and often in pain."

"In the USA it seems the Bible Thumpers meddle in everyone's life and feel it's their duty to interfere, and no one seem to have the nerve to tell them to butt out. The case of the girl who was proven to be brain dead for over 20 years is an example, the busy-bodies are still claiming that she could have become well again, even though an autopsy of her remains proved that most of her brain had long been dead with no hope of recovery."

Charles, New York, USA
"Once the mind or body is gone, euthanasia should be a legal option. As the world population ages and grows in number, as its resources disappear - euthanasia will become more commonplace and widely accepted. It must always be voluntary and within the law. Advanced directives are necessary before dementia sets in. The law is slow but eventually it will catch up with society's realities and needs."

Jennifer, Canada
"Religions play a major role now to ban euthanasia but I believe the financial burden could be the major issue for tomorrow."

Cheryl, Surrey, Canada
"I quote Dr Karl Gunning, Dutch physician: 'Once you accept killing as a solution for a single problem, you will find tomorrow hundreds of problems for which killing can be seen as a solution.' Currently one can be simply 'bored of life' to qualify for euthanasia. Depression can be classified as hopeless and incurable."

"As a Canadian anti-euthanasia activist for over 15 years, I hope our country will never allow for PAS or euthanasia, and I will do my part to continue to fight passionately against it becoming so."

Henry, Colorado, USA
"[I] fear that euthanasia would become not a choice, but something demanded by the society/government. While, on the face of it, this seems far fetched - after seven years of living in the USA under GW Bush and the ultra conservative Christians (who know what is right and who is evil and should be punished) it no longer seems just a possible threat of the distant future."

"If you lived here and were aware of the creeping details of their choking of the constitution, the Department of Justice, and the media, fears of euthanasia being used as the Nazis used it would not seem very far fetched at all, I am sad to say."

Victor, Moldova
"I think that no one wants to be like the Netherlands, because it destroys all of the principles of LIFE itself and all the NORMS of it. They have TOO MUCH and are TOO RICH and are still not satisfied. People in a third world country don't think about how to die, but rather how to survive. You legalised abortion, drugs, prostitution, pornography, euthanasia, homosexuality and even considered legalisation of paedophiles - how much further do you want to go? Stop being immoral."

Mustafa, Kroonstad, South Africa
"The reverse should actually happen. The Dutch should scrap this absurd right to play God rather than the world following it. Man (and woman) should reach a stage where he is sane enough at the stage he/she has run out of ideas to allow God to continue showing his power, might, mercy and indefinite wisdom."

"Euthanasia is one of the many dark stains that continue to show that man would very much like to play God notwithstanding the many instances he has realised that in the final analysis the decision is only God's and His alone."

Jasmin, India
"It is very easy to pass such laws for the public but very hard on your own conscience when someone close to you is terminally sick. I have been through this twice and lots of tender emotions are involved and you also have to take care of the sentiments of the other relatives. Though palliative care is better than before, still the patient suffers a lot but even then the patient has his/her close bonds which he doesn't want to snap forever. Nobody wants to die and the patient and the attendant always have a flicker of hope of a miracle waiting to happen. It is a tough situation where you helplessly watch your family member slipping steadily into the Unknown but don't have a heart to snuff life out of him."

"I wonder if studies have been conducted in the Netherlands on the mental health of the persons who have assisted in giving euthanasia to their dear ones. It is very hard on their conscience in my opinion and affects their peace of mind. They need help too."

Jude, Vancouver, Canada
"I fear the answer to why fewer countries choose to follow the courageous Dutch example in providing a legal framework for euthanasia is very simple. Too many people in government fail to understand that merely outlawing an activity and refusing to address it is every bit as much a decision full of consequences as if it were legalised. To do nothing also means taking responsibility, even if people do not realize."