A License to kill?

When Dr Ben Zylicz examined the 50-year-old woman at the clinic where he worked in the Netherlands, he knew immediately that she did not have long to live. Cancer had spread beyond her breast to her bones, liver and lungs.

Carefully, the Polish-born oncologist explained to the woman that he could lessen her pain with drugs, and he offered her a hospital room. Dr Zylicz sensed, however, that she was fearful of the Netherlands' policy allowing doctors to end the lives of terminally ill patients. "I am a Catholic," she said. "My religious beliefs would never allow me to accept euthanasia."

Dr Zylicz assured the woman that he would take care of her, and finally she agreed to be admitted to the hospital. After 24 hours of morphine treatment she was free of pain. Though she knew death was close, the woman was at ease, able to see her husband and family.

Later, however, a nurse phoned Dr Zylicz at home with some distressing news. After he left the hospital, another doctor had entered the patient's room and asked her husband and sister to leave. He then ordered an increase in her morphine dosage, but refused to confirm the order in writing. Within minutes she was dead.

Dr Zylicz demanded to be told what had happened. "It could have taken another week for her to die," his colleague said. "I needed the bed."

Global Issue.

In Britain and around the world, people are wrestling with the question of humane death--especially in the face of painful terminal illnesses. A law permitting assisted suicides for terminally ill patients took effect in Australia's Northern Territory in July last year. Four people died under the controversial law, which was overturned by a private member's bill in the Australian Federal Parliament less than 12 months later.

The dilemma has become more complicated during recent years, as advanced medical technology has enabled doctors to keep patients alive much longer in even the most extreme cases. Of course, patients have the right to refuse medical treatment at any time; requesting lethal injections is another matter.

Rebel Doctors.

Under current UK law, doctors can only administer to terminally ill patients strong doses of painkiller to relieve suffering, but not with the intention to end a life. The British Medical Association voted overwhelming to oppose legalizing euthanasia for the time being at its annual conference in July.

Two British doctors, Dave Moor, a Newcastle upon Tyne GP, and Michael Irwin, retired and now chairman of the Voluntary Euthanasia Society, sparked controversy by admitting to having helped dozens of terminally ill people to die with strong doses of painkillers, ostensibly to try to relieve patients' pain. Their opinion is that this practice is widespread. Dr Moor was subsequently arrested, released on bail and is awaiting a coroner's court verdict on the death of one of his patients.

Alarming Precedent.

As the debate continues, advocates of assisted suicide and euthanasia find a role model in the Netherlands, the only country that permits both practices.  A closer look reveals the truth about the practice of euthanasia in the Netherlands.

The Royal Dutch Medical Association officially endorsed euthanasia in 1984, and issued strict guidelines on how to perform it: the patient's condition must be one of unbearable suffering that cannot be relieved, and the patient must freely request to die. When a patient does ask, the doctor should not proceed without consulting an independent doctor. Then each case must be reported as an "unnatural death" to local officials. Doctors who don't follow the guidelines can be imprisoned for up to 12 years.

Approved by parliament, the guidelines were meant to protect and empower terminally ill patients. But evidence suggests that they empower doctors instead.

Though Dutch patients are supposed to decide for themselves, they are sometimes influenced by doctors. "If doctors judge someone's quality of life to be low," says Dr Haasnoot, a Dutch GP, "they ask, 'Why should we add to the suffering?'"

A survey commissioned by the Dutch government estimated that only 3,600 people died in 1995 as a result of assisted suicide or euthanasia. But this only included cases where the patient requested death. The survey did not count as euthanasia or doctor-assisted suicide the 900 cases in which patients' lives were ended without their request, and nearly 1,900 deaths in which doctors increased painkilling drugs with the explicit intention of hastening death.

A 64-year-old woman, told in 1988 she had advanced ovarian cancer, wished to die at home. When she awoke one morning covered in what looked like red pinpricks, her husband took her to hospital and then left. Returning to the hospital next day to take his wife home, he took a short walk while he waited for the doctor to attend to his wife. When the husband returned to her room, she was unresponsive. Three hours later she died--from lethal drugs the doctor had injected into her intravenous drip.

The husband believes a doctor proposed the injection and his wife was swayed. "She always thought that doctors knew best," he said. "It wasn't euthanasia--it was murder." But there was no investigation since he did not want the doctor to be prosecuted.

Scant Protection.

"Because euthanasia is politically correct, prosecutors are often unwilling to press charges," says Dutch criminologist Chris Rutenfrans. Since 1981 only 20 doctors have faced the courts. Nine were convicted. Of those, six received suspended sentences, and three were given no punishment at all.

Critics say euthanasia supporters selectively prosecute cases only to extend the limits of what is acceptable. In June 1994, for example, the Dutch supreme court ruled on a case in which psychiatrist Boudewijn Chabot had assisted the suicide of a 50-year-old woman. She was not terminally ill or in physical pain, but she was depressed. None of the doctors who rendered "second opinions" saw her in person. Nevertheless, the court accepted for the first time what was previously a crime: helping a physically fit patient to die.

Stretching the Limits.

Dr Herbert Hendin, medical director of the American Foundation for Suicide Prevention, has studied euthanasia in the Netherlands. He notes that "what was intended as a solution for exceptional cases has become a routine way of dealing with terminal cases. The Netherlands has moved from euthanasia for the terminally ill to euthanasia for the chronically ill, from euthanasia for physical illness to euthanasia for psychological distress, and from voluntary to involuntary euthanasia."

Lord McColl of Dulwich, who sat on the House of Lords Committee on Medical Ethics, stated: "We asked doctors in the Netherlands what it was like when they did their first euthanasia case. They said they agonized over it. The second case was much easier and by the third it was a piece of cake. We found that chilling." Already, the Netherlands' euthanasia guidelines offer scant protection to mentally ill people and newborn babies. Researchers from the Centre for Bioethics and Health Law at the University of Utrecht found that more than 40 per cent of all mentally handicapped patients who died in 1995 did so after a doctor's decision to withdraw treatment, increase painkilling drugs or give lethal injections.

In that same year, doctors were charged with killing two handicapped newborns. The courts ruled that the doctors had no option but to kill. The survey,  commissioned by the Dutch government reports that doctors now kill about 15 "non-viable" newborn babies a year.

In some cases, a patient's "right to die" has subtly become a duty to die. "I frequently see people pressurized into euthanasia by exhausted and impatient relatives," says Amsterdam psychiatrist Frank Koerselman. He tells of a woman whose relatives had gathered in Amsterdam for her planned euthanasia. One came from overseas. When the patient had last-minute doubts, the family said, "You can't have her come all this way for nothing." Instead of ensuring that the patient's true wishes were observed, the doctor carried out the euthanasia.

Another Way.

In the Netherlands, the key alternative to euthanasia--palliative care--is largely unavailable. Originated in Britain 30 years ago when the first modern hospice opened in London, this philosophy of total care for terminally ill patients and their families offers spiritual comfort and the control of physical and mental pain, without seeking either to hasten or postpone death. Today almost all communities in the United Kingdom and many in Europe and the US provide such care, often in hospices.

Dr Robert Twycross, a leading authority on palliative care at the University of Oxford, recalls a cancer patient who drank excessively to escape the pain and mental distress caused by his illness, and finally demanded to be put to death. After pain treatment, the patient changed his mind, saying, "It wasn't me speaking. It was the alcohol."

"Depression often overlaps and complicates terminal illness," Dr Twycross says. "As the patient comes out of depression, the demand for euthanasia evaporates."

Britain has 207 hospices with 3,068 beds. But the Netherlands has no more than half a dozen independent hospices with up to 36 beds. "Unfortunately, the Dutch discovered euthanasia before they discovered palliative care," says Dr Zylicz.

Ineke Verloop learned last October that neither surgery nor chemotherapy was likely to cure her cancers of the throat and stomach. But the two options available to her--a hospital or a nursing home--did not appeal to the 65-year-old widow, who feared her own wishes would not be respected there. I'm not afraid of death, Ineke Verloop thought, but I don't want someone else to decide how I should die. She seriously considered euthanasia.

Like most Dutch people, Ineke knew little about the option of palliative care. Then an acquaintance told her about Hospice Rozenheuvel.

Five weeks later, Ineke was sitting in the Rozenheuvel sun lounge. She considered herself blessed. "When I came here, I could hardly walk or talk, and I hadn't eaten for a month," she recalled. "After ten days, I chat, walk and feel relaxed. I know
I'm not leaving here alive, but I feel like a human being."  Ineke Verloop died peacefully a few weeks later. She had been cared for by a doctor with a special sense of mission--Ben Zylicz.

Five years before, soon after his patient died as a result of euthanasia administered by another doctor, Zylicz left his hospital post to dedicate himself to an alternative. "As a doctor, I saw lives taken for reasons that had little to do with healing," he says. "Now I am able to help patients in a humane and caring way.

"I only hope that others--both doctors and patients--will have that chance."

Source: Brian Eads, Reader Digest, September 1997. 

http://www.readersdigest.co.uk/magazine/EWIS-4QAMJM.htm

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