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Why nobody else wants euthanasia.

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.

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.

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 medical world said to me, ‘In 10 or 20 years I don’t expect there to be euthanasia in the Netherlands because everybody wants 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.”

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