On March 30 of this year, a team of doctors euthanized a Belgian couple, at their request. The 83-year-old man suffered from terminal prostate cancer. His 78-year-old wife, although suffering from severe rheumatism, was not terminally ill. But she did not want to live without her husband. This became the first official, public instance of co-euthanasia in Western Europe. The death announcement that relatives placed in the newspaper stated that they “choose to end it together.”
Euthanasia is legal in the Low Countries under two conditions: The request must be made by an adult of sound mind, and the patient must have an incurable disease that causes unbearable suffering. Although there is no cure for rheumatism, the Belgian woman did not meet these conditions. However, she would have had to move to a nursing home after her husband was gone. So horrified was she by this prospect that, combined with her age-related ailments, it was deemed by the doctors to constitute “unbearable suffering.”
One can empathize with her. Apart from the wish not to be alone in one’s later years, credible stories abound of elderly people left unwashed in bed to vegetate, as nursing homes fail to muster the money, staff, or interest for proper care. But, empathy notwithstanding, this de facto legalization of “euthanasia for love” shows us that another taboo has bitten the dust. A mere nine years after euthanasia was legalized, the strict conditions for its use are already showing major cracks.
Other taboos vanished earlier, some even before legalization. Since a 1994 decision of the Dutch high court, “mental suffering” has been accepted as a reason for allowing euthanasia. This followed a case in which a doctor gave a lethal overdose to a 50-year-old woman who had been chronically depressed after a difficult divorce and the death of her two sons. In 1998, a retired Dutch socialist senator claimed to be tired of life and, therefore, to have the right to die.
His doctor agreed that, although he was not clinically depressed, his weariness of life had no cure, and proceeded to deliver a lethal dose of barbiturates. For this, the doctor was eventually convicted of culpable assisted suicide. But the Dutch high court took the view that clinical depression alone can be a sufficient justification for euthanasia. Finally, in June of this year, the Dutch medical association stated that decline caused by age ought to be considered sufficient reason to euthanize a patient.
The Financial Times recently (and correctly) referred to the Netherlands as the “California of Europe”: Where Holland goes, the rest of the Continent — and even the British Isles — will follow. A 2008 study of the Swiss death clinics Exit and Dignitas claimed that many of those who committed suicide there suffered from weariness of life rather than a terminal medical condition. Since its founding by a human-rights lawyer in 1998, Dignitas has become an important European center for suicide tourism.
Across Europe, pressure groups are pushing for legalization of euthanasia and assisted suicide. In Spain, support for legalization was strengthened by an Academy Award–winning film about the life and assisted death of Ramón Sampedro, who was paralyzed from the neck down after diving into shallow water. In Britain this June, the BBC aired a documentary narrated by Sir Terry Pratchett, one of the world’s most successful fantasy writers, who visited Dignitas. We see a British motor-neurone-disease sufferer walk in to the clinic with his wife, sit down on a sofa, and drink a deadly cocktail of barbiturates. He mumbles and moans, begs for water — which is refused, lest it dilute the poison — and, finally, dies. Pratchett has been diagnosed with Alzheimer’s, and has since announced his plan to complete the necessary forms for Dignitas’s assisted-suicide waiting list, saying, “The only thing stopping me [from signing them] is that I have . . . a bloody book to finish.” The BBC was criticized for airing what amounted to its fourth pro-euthanasia documentary. Yet the BBC was merely following the script: In February of this year, the British director of public prosecutors said his office would be less likely to prosecute cases of assisted suicide in which the motive was compassion and not a desire for personal gain.
#page#A slippery-slope argument is a fallacy, except when it is not. The gradual shedding of taboos is precisely what opponents of legal euthanasia have always warned about. From first being recognized as a regrettable practice that should be allowed only in the most exceptional cases and under strict regulations, euthanasia is increasingly being presented as a full-blown human right. Note that we are not talking merely about the right to die. Euthanasia involves others: doctors, and perhaps family, friends, or strangers — those who must help you die. Of course, if you have a right to be killed, someone else may be given the duty to do the deed. And if you grant the right to the terminally ill, can you deny it to anyone else — given that rights are, by definition, universal?
In the Netherlands, this change of perception is giving rise to misgivings even among those who have been in the vanguard of the legalization movement. Els Borst, the minister originally responsible for introducing the 2002 law legalizing euthanasia — who infuriated Christians in the parliament by saying Jesus’s last words, “It is finished,” after the bill was passed — now has some regrets. She believes we have done things the wrong way around, and should have focused instead on the improved possibilities for palliative care: “We first listened to the political and societal demand in favour of euthanasia. Obviously, this was not the proper order.” (These statements followed the publication two years ago of an influential book by Dutch anthropologist Anne-Mei The, which concluded that many patients ask to die “out of fear,” because of an absence of effective pain relief.)
Many Dutch doctors are also changing their approach. Instead of informing patients about euthanasia, they first tell them about other forms of care. Doctors have found that many very ill patients will agree to whatever they suggest — whether death or treatment. But not all patients. As one doctor recently told a journalist: “Patients no longer request euthanasia, they demand it as a right. We never wanted it that way. It’s as if we doctors are being pushed to cross borders.” Last year, doctors granted euthanasia requests to only 25 people suffering from dementia — a mere fraction of those requesting it for that reason. The reluctance of some medical professionals is prompting demands for a new clinic for assisted suicide, where patients can go if their doctors refuse to cooperate.
But an opposite trend toward full legalization also exists, and it involves not the sick but the healthy. A group of prominent people over age 70 — including writers, artists, and politicians — are urging that the law allow anyone over 70 to be legally euthanized if he or she so chooses. Their demand is that euthanasia no longer be considered a medical decision, and they want the right to die to be included in the Dutch Constitution. “There already is a human right to life, but there shouldn’t be a duty to live,” as former European commissioner Frits Bolkestein put it. The idea is: I am the captain of my own ship. Why can’t I sink it?
It is a profound theological truth that life is a gift, and receiving it is a task. Ownership is not a correct metaphor for our lives. But even if it were, this wouldn’t free one from responsibility. If I own a Rembrandt, that doesn’t give me the right to use it to light my cigar, and we can imagine a sensible law against such arson. Permitting euthanasia or assisted suicide is a world away from making it a constitutionally guaranteed right. At the moment, the question arises mostly with the elderly and the severely ill. But where can one draw the line? If 70, why not 50? If 50, why not 35? Creating a new constitutional right to die would render these questions illegitimate in public discourse.
#page#A state recognizing an inalienable right to die could not be anything approaching a true community defined by mutual rights and duties. With fully negotiable relations to the political community, its citizens could hardly be political beings in the Aristotelian sense (one wonders whether they could be considered human at all, since, for Aristotle, being social enters into the basic definition of man). As citizenship is increasingly seen as a matter of rights without duties, the state becomes a slave to the wishes of the radically free individual, who can turn in his passport or — in this case — demand death at will. With a right to be killed, the most basic duty to others — to remain alive within reason — is rejected.
There are also curious practical consequences. If there is in fact a right to be killed, may the rapist avoid his term by requesting death? Most criminals would never choose death over life, but the point is instructive and could apply, by analogy, elsewhere. A second practical consequence concerns personal relations. Imagine a friend comes to you and says that she is thinking of committing suicide. Naturally, you would urge her to seek help, and, if things got worse, you might seek help for her, even against her will. But imagine now that death is a right, guaranteed by the state. What is then the appropriate response? What is then the politically correct response? As with abortion, the convention may become to treat suicide as a private matter, to be removed from the realm of public morality and discourse.
Lawmakers must be cautious. After suicide was decriminalized in Britain in 1961, the number of successful and attempted suicides quickly rose. Causation or correlation? We don’t know. But it could get worse yet.
The Hindu custom of suttee, in which the wife of a deceased husband immolates herself on his funeral pyre, was famously banned by the British in 1829. In the West, the Vikings had similar customs. Now, in the California of Europe, an appeal to human rights is being used as an argument that doctors should be allowed to kill wives who want to join their husbands in death. It’s difficult to say whether Indian or Viking widows freely chose to die, but it’s quite possible that many of them did. It takes some imagination to envision a culture in which couple-euthanasia becomes a social expectation rather than a purely individual choice. But it does not take a whole lot of imagination. A millennium after Christians converted the Vikings and banned the practice, it may be worth asking whether Western suttee is sneaking in through the back door.
– Mr. Boomsma is a member of the Amsterdam City Council. Mr. Price is a researcher and teacher at Leiden University Law School and Blackfriars Hall, Oxford.