Memorandum by Dr Bert Keizer
EUTHANASIA IN THE NETHERLANDS
Euthanasia is the handing or administering of
an overdose to a patient at his or her request. It is allowed
under the following conditions:
The patient suffers unbearably without
any prospect of recovery.
The request for death is not uttered
in the course of a psychiatric disease such as dementia or depression.
The request is durable and consistent
ie not uttered in a flash of despair.
The request is put in writing.
The doctor calls in a colleague who
is not in any way involved in the case and this second doctor
evaluates the above and puts her or his findings in writing.
Death is brought about in a humane
manner using the type of medication particulalrly suited to such
a course of action.
After the patient´s death the
doctor reports to the authorities in the figure of the coroner
who is called in to assess the procedure.
These conditions sound pretty straightforward,
and yet, it has taken us some 30 years of intense social debate
before we were agreed about them. Many people are pro euthanasia
when asked in passing, but when it comes to working out a proper
procedure which can be made to work in practice, it turns out
to be a very complicated matter.
The patient's suffering being unbearable
involves a hopelessly subjective judgment. This is not the
case when it comes to the prospect of recovery. Doctors know the
expected course of a serious disease and can give an objective
estimate of the prognosis.
As to durablilty: when a patient asks
for death on Tuesday and would be handed the overdose on Wednesday
the doctor involved would be in deep trouble. A question of this
complexity, an answer with such a grave consequence, these are
not matters that can be decided overnight.
Depression is often used in the manner
of a Catch-22: anyone asking for death must be suffering from
a depression and this depression must be treated, not the patient
killed. This is wrong for two reasons: many patients asking for
death are not depressed, and, secondly: the hidden suggestion
that depressions can be treated easily is of a horrible flippancy.
It sounds strange but it takes some skill to
let a patient die humanely. Therefore the use of certain
drugs is strongly advised instead of outlandish often jolting
and sometimes agonzing ways of ending a patient´s life.
It is useless to worry about the slippery slope.
Once a society has decided that euthanasia is allowed in certain
cases, one is on it. Thus in Holland we have given up the condition
that a patient must be in a terminal situation. Next, mental suffering
was allowed to be unbearable and in some cases to be without any
prospect of revovery. Then one's future dementia was suggested
as a reason for a request for death. And lastly the suffering
of extreme old age with all it entails in terms of social isolation,
loss of children and bodily decay was put up as sufficient reason
in itself to ask for death. Unsuccesfully, as it turned out, because
the Dutch judiciary decided in the latter case that euthanasia
was not allowed and condemned a GP accordingly. Only a provisional
sentence was pronounced and the doctor was praised by the court
for his frankness about his doings. In that praise the awkwardness
of the entire situation was neatly expressed.
Was legalisation a success in Holland?
Yes, if one considers the unsavoury kinds of
messing around doctors inevitably fall into when not being overlooked
by colleagues or society at large. Under the rule of law, patient
and doctor both feel safer, the one in asking, the other in supplying
No, legalisation failed if one realises that
inspite of all the work done in Dutch society still only 54 per
cent of cases are being duly reported. There is some slight consolation
in the fact that the number of duly reported cases in Britain
is 0 per cent, a figure assuredly not reflective of reality, because
we know that the practice of euthanasia is a given, ever since
the days of the Hippocratic oath. We had better realise that the
practice was abjured in that spurious oath precisely because it
The problem of euthanasia has not been solved
in the Netherlands. But if we have achieved anything it is the
growing realisation, also internationally, that there is such
Finally, I believe, on the grounds of the more
than 1,000 deathbeds I attended as a physician, that euthanasia
is a blessing in certain exceptional situations, yet I would rather
die in a country where euthanasia is forbidden but where doctors
do know how to look after a dying patient in a humane manner,
than I would in a country where palliative medicine is ignored
but euthanasia can be easily arranged.
About the author.
A A Keizer BA MD born 1947 in Amersfoort Holland.
Lived in England from 1968-1972. Studied philosophy
in Nottingham University. Then medicine at the Univerity of Amsterdam.
Qualified as a doctor in 1981, worked shortly in Kenya Africa,
and has been working as a geriatrician in Amsterdam for 23 years.
Published a collection of personal sketches
and philosophical essays about his work as a doctor in a nursing
home in 1994 in the Netherlands. The book was translated into
German, Spanish, Japanese, Danish, Swedish and French.
The author translated his work into English
under the title of Dancing with Mister D published in 1996
by TransworldDoubleday in London.
2 August 2004