Position Statement on Euthanasia

The word euthanasia literally means “good death”. It therefore carries within it a positive connotation, as if it is desirable. In practice, however, the term means the termination of a human life by a physician or paramedic. In non-medical English this would be called killing or murder.

To further clarify our position, at the end of this document are listed some situations which are commonly associated or confused with euthanasia.

Many people believe that euthanasia is freely available in the Netherlands. People from other countries even contact MeTZelf thinking that they can come to this country to be euthanized. Most Dutch people believe that our euthanasia law gives us the right to choose our own death. None of this is true.

What we have in the Netherlands is a law affording immunity to physicians who terminate their patients’ lives provided certain highly circumscribed conditions are met. Among these conditions are that the patient must request euthanasia himself, be competent, not mentally ill, be suffering intolerably from physical illness, and be expected to die soon. The law further stipulates that the physician must consult with another physician first, that he must perform the euthanasia himself (not relegate it to a nurse), and that he must afterwards report it to the proper authority for review.

There is no “right to euthanasia” because the physician is not under any obligation to perform it. In fact, physicians’ refusal to perform euthanasia is a commonly heard complaint.

Conversely, it is not uncommon that, for instance, staff in nursing homes, hasten a person’s death by withholding food and/or liquids, or by stepping up “pain treatment”, often expressly against the wishes of the person or his family. The ensuing death is subsequently registered as “natural”.

Another method of hastening death gaining popularity among physicians today is “terminal sedation” euphemistically called “palliative sedation”. This is the practice of keeping the person in an artificial coma until he dies. The person is not administered food or liquids. Any person held in a coma this way would die soon, not only an ill person. Physicians use this method to circumvent the euthanasia law, believing it to be legal and reporting to the authorities not required. Unfortunately to our knowledge no test case has been handled in the courts as yet.

Our euthanasia law was inaugurated ostensibly to encourage transparency of a practice that was going on anyway. However, such transparency was not achieved. There has been no rise in reporting of such deaths. By registering the death as “natural” the physician circumvents the euthanasia bureaucracy and shields himself from legal scrutiny.

MeTZelf’s viewpoint is that euthanasia is always inadmissible. No one has the right to take another person’s life, even when that person begs for his life to be taken. It is immaterial to us that the person taking the life is a physician, or that the person whose life is being taken is ill. The termination of a life by a physician using drugs is morally not different from the termination of a life by a hit man using bullets. It is furthermore impossible to be certain of the person’s wish to die, and legal killing would be exceedingly susceptible to abuse.

But what about “the right to die”?

In the Netherlands everyone has “the right to die” because there is no law prohibiting dying. Likewise there is no law prohibiting suicide. However, in practice, legal restraints interfere with a person’s choice to terminate his life:

Should the person not wish to, say, jump off a tall building, or be incapable of doing so, and prefer death by pharmaceuticals instead, he will run into the prohibition of free trade in drugs. He can achieve his goal only by either persuading the physician to provide/administer these drugs, or by deceiving the physician into doing so.
Should the person make his wishes or plans to terminate his life known in advance, or should he try to take his life and fail, he risks involuntary psychiatric confinement and treatment.

The first restraint would be alleviated by revoking restrictions on trade in drugs; the second by revoking commitment laws. MeTZelf opposes both restrictions on free trade in drugs and forced psychiatric commitment and/or treatment.

The prohibition of free trade in drugs is not justified by the risk of suicide. In the first place, in practice it doesn’t work. Tens of thousands of people across the world commit suicide with prescription drugs every year. Clearly prescription laws do not prevent this. Secondly, it makes no more sense to restrict access to drugs by a doctor’s prescription than it does to restrict access to tall buildings, ropes, knives, railroad tracks, or any other possibly lethal situation by a doctor’s prescription.

Some bloggers in the US, in particular those who identify themselves as Christians, have labeled MeTZelf a “pro-suicide” organization. This a misinterpretation of our views. We do not endorse suicide. What we posit is:

Suicide is a moral issue, not a medical issue. Physicians have no special skills or training which equip them better than non-physicians to determine who has a right to take his own life and who does not. Nor are physicians or anyone else equipped to change people’s mind about wanting to terminate their lives. On the contrary, the trauma and humiliation of psychiatric detention, solitary confinement, and forced treatment (drugs, ect) will add nothing to anyone’s will to live. In fact, statistics bear out that people are more likely to commit suicide during or shortly after forced psychiatric treatment than when left alone.
One's moral position on suicide is one’s own responsibility, and not that of the physician or the state.

When a person who has attempted suicide is found, and if this person is not conscious or capable of refusing treatment, we consider this a medical emergency, and every intervention necessary to save the person’s life is justified. Medical staff cannot and must not postpone life-saving treatment pending an investigation into the person’s wishes. If, however, the person is capable of refusing medical treatment and does so while understanding the consequences of this refusal, then treating him against his wishes constitutes assault.

In summary:

We consider euthanasia – the termination of another person’s life -- inadmissible, regardless of the circumstances;
Although we do not endorse suicide, we posit that the state cannot and should not try to prevent suicide by deprivation of liberty (involuntary commitment, involuntary treatment, and prohibition of free trade in pharmaceuticals).

Appendix:

1	An ill person refuses medical treatment that is likely to prolong his life.	Not euthanasia.
2	A physician discontinues certain medical treatment which he believes will not prolong the ill person’s life.	Possibly euthanasia, for instance if the ill person does believe the treatment will prolong his life.
3	Caregivers withhold food and/or fluids from an ill person who is expected to die soon anyway.	Euthanasia. Caregivers cannot know when someone will die. Withholding food and/or fluids will shorten anyone’s life, irregardless of his state of health.
4	Medical heroics and/or food and/or fluids are withheld from a person in coma who is not expected to regain consciousness.	Possibly euthanasia. We cannot be certain that a person will never regain consciousness. Furthermore, (the absence of) consciousness itself is disputable, as we learn from the Terry Schiavo case.
5	Administration of increasing doses of morphine or similar drugs, knowing that this will diminish the person’s consciousness and hasten death.	Possibly euthanasia. Note that when a person is heavily drugged, we cannot be certain that he is suffering less pain, rather than that he has become incapable of expressing his suffering. The pain relief argument therefore does not justify the risk to his life. However, if, having been properly informed, he administers the drug to himself, then it is his own decision which it is his right to make.
6	The administration of a lethal dose of drug or other lethal treatment with the express purpose of bringing on death, when requested by a (presumably ill) person.	Euthanasia.
7	The administration of a lethal dose of drug or other lethal treatment with the express purpose of bringing on death in someone who did not request it, including someone incapable of requesting it (“mercy killing”).	Euthanasia.
8	Keeping a person in an artificial, drug-induced coma until death.	Euthanasia.
9	Providing a person who so requests with (a) drug(s) with which he can terminate his own life.	Not euthanasia unless the person is tricked or pressured into taking the drugs.

See also our letter to the editor published in the British Medical Journal.

MeTZelf welcomes feedback to this article.