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A licence to kill - the slippery slope of 'assisted dying'

Euthanasia’s development in Holland and Belgium is a cautionary tale for those considering the idea here

29 August 2015

9:00 AM

29 August 2015

9:00 AM

A couple of years ago I contacted Holland’s top pro-euthanasia organisation. Our House of Lords looks likely to approve a bill legalising euthanasia here, I told them. ‘Very exciting!’ came the reply.

Next month Parliament will again be discussing ‘assisted dying’, and although the tone of the British debate is not yet quite like the Dutch one, a shift in tone has undoubtedly occurred. In the past few years euthanasia has been renamed ‘assisted dying’ and become part of the ‘progressive’ cause. As two assisted dying bills, including Lord Falconer’s, come back to Parliament, the onus seems to have moved away from supporters having to explain why people should be killed before nature takes its often-ugly course on to opponents of euthanasia explaining why they could conceivably wish to prolong anybody’s suffering. As Dignity in Dying puts it in one of their advertisements, this is about letting people safely control ‘the manner and timing of their death’.

This week the Labour leadership candidate Liz Kendall backed assisted dying, telling an interviewer, ‘I believe in giving people as much power and control over what happens to them as possible.’

The House of Lords has proved an especially good place to debate this. Many members have friends or spouses who have experienced the miracles of modern medicine and endured the prolonged indignities that can be a side-product of that blessing. Most lords belong to a lucky generation, having won the full panoply of rights. The right to education and welfare were followed by sexual liberation, which from the 1960s onwards came with the idea of having total rights over one’s own body, including the right to abort unwanted fetuses. It is partly in this language that Lord Falconer’s bill comes wrapped: the baby-boomers awarding themselves one last right — the ‘right to die’. Press commentators have taken up the cry: ‘Nobody can tell me what to do with my body.’

Of course there are religious objections to this. ‘I have set before you life and death,’ God says in Deuteronomy, ‘therefore choose life, that both thou and thy seed may live.’ For centuries that edict — ‘choose life’ — defined the ethics of our people. Along with ‘Thou shalt not kill.’ Many euthanasia enthusiasts see themselves as bringing the law into line with a post-religious society. But those who are not religious can still have many philosophical objections to euthanasia. If society comprises, as Edmund Burke said, a contract between the dead, the living and those not yet born, should it not disturb us to sever that contract at both ends? There is, after all, the greatest difference between deciding to take your own life and having the law help you do so. We do not live on islands of absolute solitude. What you choose to do with your body might very well have an effect on what someone else does with theirs.

The principal objection to euthanasia is a slippery-slope argument — and many people profess to disdain such arguments. Nevertheless, anyone doubting the slipperiness of this slope should consider the places where euthanasia is already legal.

As with today’s debate, the movement for reform of the abortion laws 50 years ago was driven by attempts to avoid heart-breaking personal tragedies. Yet, as Mary Wakefield once wrote here, the tone has so shifted that the aborting of unborn children is now generally presented — far from the infinitely sad and rare necessity that the 1967 Act accepted it to be — as a kind of triumph. Not to mention a matter of convenience. Today almost one in five conceptions in Britain end in an abortion.


Meanwhile, anyone who decides that aborting fetuses is slippery while killing off elderly people is not has clearly not studied those places where euthanasia has been legalised. The Falconer bill is based on legislation passed in the American state of Oregon 20 years ago, but its timing could hardly be worse. Just this week, one of Oregon’s most senior doctors, Professor William Toffler, declared the legislation a ‘disaster’ which has, among other things, led to ‘a profound shift in attitude toward medical care’ and fundamentally changed the relationship between doctors and patients. But perhaps Lord Falconer’s supporters are fond of citing Oregon because they know that the precedents geographically and culturally closer to home do not assist their argument.

Holland’s euthanasia debate really started in the 1980s, when members of the medical profession were bolstered by legal verdicts supporting the practice in very specific circumstances. Early advocates had a list of ambitions, including the ‘mercy killing’ of disabled people, though in time the arguments came packaged in more humanitarian language. But as one lifelong Dutch critic of euthanasia tells me, ‘They always have a next step.’

In retrospect, Holland’s next steps look inevitable. Doctors who helped kill their patients were tried, but even when found guilty often went unsentenced. Judges asked for guidance and the public prosecutor developed guidelines (no further treatment possible, must be voluntary) within which there would be no prosecution. By the 1990s, parliament began considering a bill to clarify the matter. But already, tied up with the dementia and cancer sufferers who constituted the majority of those wishing to die, there were harder cases. There was the case of a depressed woman in Haarlem who received the assistance of her psychiatrist in helping her to die. In 2001, the Dutch parliament signed euthanasia into law. On its passing, the former health minister, Els Borst, who had steered the bill through parliament, quoted Jesus’s last words: ‘Het is volbracht’ (‘It is finished’).

Dutch doctors could now legally assist the deaths of terminally ill patients (usually using an injection of barbiturate followed by poison). But demand continued to stretch the law. In 2002 the main pro–euthanasia group in Holland, the NVVE, ‘started operating’. With a network of professionals and volunteers across the country, this four–decade-old group (145,000 members ‘and growing’) now deals with around 4,000 cases a year where ‘the normal procedure via the doctor cannot be achieved’. This includes advice on which drugs to take.

The problem, an NVVE press officer told me, is that a doctor can say no. Those who are turned down by doctors can apply to other clinics. Does NVVE ever say no? Yes, if the criteria aren’t met or patients refuse to hand over medical files. And what cases mainly come through their doors? Terminal cancer, obviously. People with ME. Older people are most common. Their oldest patient was 100. Their youngest? ‘In his thirties.’

Though ‘a lot has been achieved’, there is ‘still work to do’. Like most euthanasia advocates, NVVE remains concerned with advancing the borderline cases. Dementia is a problem. People can be locked into an agreement if they sign a form which replaces the oral ‘OK’ when the patient is no longer able to speak. In 2011, 49 people with dementia were euthanised. But the timing is difficult. People might have decided they do not want to die after all, but be unable to speak. Yes, I was told, some people may have ‘died before they really wanted to’.

Then, of course, there is mental illness. Dutch law now blurs any difference between physical and mental illness. In 2011, 12 people with psychiatric problems were helped to die, being ‘firm in their wish to die, and lucky’. Why ‘lucky’? ‘Because they may be locked up in an asylum if they say they want to die.’ By 2013 the numbers had swollen; 42 people with psychiatric problems and 97 people with dementia were euthanised or assisted in their suicide. The line between being suicidal and wishing for euthanasia is ‘very hard to decide’.

And then there are the people with ‘tired of life’ syndrome. This is euthanasia for those who are ‘not necessarily ill, but they suffer from being old and having done everything they want to. And they see society is changing around them.’ A number of groups I spoke to in Holland are campaigning for a single pill to be made available for people with this condition. Some want it available for all ages. One tells me the age limit should be 18. Others won’t set an age. Next door in Belgium, the parliament last year passed a bill to extend euthanasia to children, with no age limit, if the child is terminally ill. Belgium passed its first euthanasia bill a year after Holland, and people who are ‘suicidal’ can also now apply for euthanasia there. Two years ago a female-to-male transsexual whose sex change operations left scarring was euthanised by the same Belgian health service that tried to make him a man.

Regarding possible pressure on old people, who may feel they have become a burden, NVVE tells me: ‘We don’t know how to make specific rules for this.’ Prevention of profit from a death is already written into law. A doctor told me that, because Britain does not have euthanasia, he notices his British colleagues can provide far better palliative care than the Dutch now do.

Having been told about the ‘tired of life’ pill, it began to interest me. Could I see one? What would happen if I did? Would I have that sensation you sometimes get on a balcony or cliff edge? Might I feel tempted to snatch it from the doctor’s palm and gobble it down? I hoped to find out at the coastal clinic of Dr Sutorius, a likeable and laid-back man. Did he register my disappointment that his waiting room and surgery were so like any other? We went back to his house, where the grouting is new, and I met his beautiful family. His wife brought drinks.

‘You just meet the problem,’ he tells me. ‘As a doctor it comes to you.’ When he began working in the 1980s, he felt that doctors were on their own. Opponents of euthanasia tell me doctors hate doing it because it so fundamentally alters their relationship with their patients: bringing death not life. Is this the case? Dr Sutorius is still upset by his own experience. In the 1990s, when the law was still fuzzy, he assisted a patient in a ‘tired of life’ case. ‘Suffering doesn’t mean you have a disease that is lethal,’ he says. The doctor was prosecuted, though his practice supported him through a legal battle that lasted nearly five years. He said he never had any sense of stepping over any line. Like other doctors he had considered earlier cases — like the depressed lady in Haarlem — as precedents. Nevertheless he was worn down by the trial: ‘Medicine is about trust, law is about distrust.’

‘All of the cases cause difficulty,’ he told me. Though many more patients want to talk about it than go through with it, it is an option. On those rare occasions — perhaps now no more than once a year — when he heads by arrangement to a patient’s house, ‘You feel like the loneliest person in the world.’ Nevertheless, he said, ‘I like my job. I like to help people ease their suffering. And I always hope the patient dies naturally.’ Are families a problem? He finds that children often object when told of their parents’ decision. He prefers the family to know in advance. Since the law changed, he feels there is better support for the profession. And the practice may yet be booming. ‘Now we have all the 1960s people coming towards us.’ It is in tune with their philosophy, he said: ‘The right to live your life as you like it.’

I think continually about this. Perhaps this will become the dominant vision of life in Britain, as it has in Holland and Belgium. But I cannot wish for it. There’s the slippery slope, the uncertain old who may feel pressured, the pathetic cases of depressed teenagers choosing death, and the shift in meaning it brings to life as well as death. Also, a line keeps recurring to me: the penultimate scene of Lear, at the darkest midnight of the play. Blinded and already having failed to kill himself once, Gloucester insists he can go no further. It falls to Edgar to urge his father on:

‘Men must endure
Their going hence even as their coming hither.
Ripeness is all.’

Gloucester lives for only a few more minutes. But the moments he has left, after he is persuaded to get up, turn out to include the moment in which he discovers everything.

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