Now that Gov. Jerry Brown has signed the End of Life Option Act, my thoughts go back more than 20 years to the early days of assisted dying in the Netherlands. And I can’t help but feel we — the Dutch — were naïve on this issue.
In 1994, the Dutch were the first in the world to officially legalize assisted dying. It was a modest beginning, just as California’s is now. With no country going before us, assisted dying was formalized in a special clause in the Burial and Cremation Act. If a number of safeguards were kept, doctors acting in accordance with them would not be prosecuted. A separate euthanasia law followed in 2001, not differing much from the 1994 clause and with Belgium following its northern neighbor in 2002.
Five regional review committees, consisting of a lawyer, a physician and an ethicist, keep an eye on the practice and assess whether each case of assisted dying has been in accordance with the law. I served on one of the committees from 2005-2014 and reviewed around 4,000 cases. Given the widespread support for assisted dying in the Netherlands, I was convinced that legalizing assisted dying was the wisest and most respectful route.
In the first 13 years following 1994, the Netherlands seemed to have found the means to organize assisted dying. Then, for unknown reasons, the numbers started going up, year after year, from 2007 on. It was as if the country had needed the first decade to get used to the whole idea of an organized death.
In the years of my membership, the review committee saw a rise in the number of reports from 1,800 to close to 5,500 last year. Now about one in 25 deaths in the Netherlands is the consequence of assisted dying with, by the way, suicide rates going up as well.
Whereas assisted dying in the beginning was the odd exception, accepted by many — including myself — as a last resort, it is on the road to becoming a preferred, if not the only acceptable, mode of dying in the case of cancer. Public opinion has shifted dramatically toward considering assisted dying a patient’s right and a physician’s duty. A law that is now in the making obliges doctors who refuse to approve assisted dying to refer their patients to a willing colleague. Pressure on doctors to conform to patients’ or relatives’ wishes can be intense.
Other developments have taken place as well. The Dutch Right to Die Society founded a network of traveling euthanizing doctors, thus taking assisted dying out of the patient-doctor relationship. There is a strong public movement toward legalizing euthanasia for children 1 to 11 years of age. Whereas in the first years hardly any patients with psychiatric illnesses or dementia appear in reports, these numbers are now sharply on the rise. Cases have been reported in which a large part of the suffering of those given assisted dying consisted of being aged, lonely or bereaved.
Hearing of Brown’s decision, and without doubt any of his good intentions, my thoughts go back to our own pioneering years. As I said, I think we have been naïve.
The Dutch and Belgian examples show that a law that makes possible an assisted death may well create its own dynamics. Clearly the “supply” of assisted dying creates new “demand.” Right to die advocates see the Dutch law not as a respectful compromise but as a first step toward more radical rights, such as a lethal pill for anyone over 70. The Dutch Right to Die Society now offers course material to high schools, where my teenage kids go, intended to broaden their support for euthanasia as a normal death. This would be unthinkable were it not for the existence of the present law.