Select Committee on Assisted Dying for the Terminally Ill Bill Written Evidence

Memorandum by Dr Bert Keizer


  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 euthanasia.

  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 occurred.

  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 a problem.

  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 Transworld—Doubleday in London.

2 August 2004

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