The Times of London 2/26/00
BY DANIEL MCGRORY
THE last request made by Bernard Straaten was to die with dignity.
He was 68, his cancer was inoperable and, after lengthy discussions with his his wife and two sons, Bernard persuaded his family doctor in Rotterdam that he was a suitable candidate for euthanasia.
With his family around him, the retired teacher said his tearful farewells then gently nodded for the doctor to give him the barbiturate that would ease him into a coma. His wife, Annilise, held his hand as the doctor, a long time family friend, administered the lethal injection. Minutes later he was pronounced dead.
Annilise, 62, has no regrets about the decision. "He was bedridden, incapable of doing anything for himself and it was pitiful to watch his pain. This wasn't life anymore."
The doctor's behaviour is still illegal in The Netherlands but there is little prospect of prosecution. All he needs do is convince a coroner that he followed guidelines which insist his patient made a voluntary and competent request, and that his suffering was unbearable and unrelenting.
The Dutch parliament is expected to end this ambiguity next month when it debates a bill to legalise euthanasia.
Professor van der Maas: "strict criteria followed"
Professor Paul van der Maas, who led the first study into his country's
euthanasia policy, said: "There should be little argument as we have been
practising it for over 20 years and there is proven overwhelming support
from the public and the medical profession." He rejects the idea there
is death on demand in The Netherlands. "Barely a third of all requests
are performed. Euthanasia is not given to spare pain, it is to preserve
a patient's dignity. The vast majority would have only days to live anyway,"
Professor van der Maas said.
"Physicians follow strict medical criteria. There are some dubious cases but by being open and discussing this subject we have tightened up procedures and made sure doctors are trained to perform euthanasia".
This was not always the case. Disturbing evidence his team at Rotterdam's Erasmus University uncovered in a report to this month's New England Journal of Medicine showed that patients have not always had a swift and painless death.
Doctors, who were given immunity from prosecution for assisting his study, admitted to botching a quarter of cases when they helped a patient to commit suicide. One in eight patients had what researchers describe as "problems with completion", meaning it took longer for them to die than doctors expected or they woke from what they believed was a fatal coma.
Others suffered fits or vomiting as they failed to swallow the drugs meant to kill them and in almost 20 per cent of assisted suicides the doctor had to step in and administer a lethal injection.
Professor van der Maas says these failures were mainly in the early years of euthanasia. "We have got better at administering death, though euthanasia should not become a separate medical specialty."
From his office on the 20th floor of the university hospital the professor points to the syllabus for medical students who receive tuition - ethical and practical - in euthanasia.
Most cases are now carried out in the patient's home by local GPs who need another doctor independently to agree that euthanasia is appropriate.
It is believed over 50,000 have died in The Netherlands since it was decriminalised in 1984. The last official figures from 1995 show 3,200 euthanasia cases for that year and another 400 assisted suicides. Doctors believe the numbers have not varied since then.
Any increase has mainly come from Aids sufferers who have sought help from the well organised voluntary groups in Holland to find doctors willing to end their lives, or prepare the lethal mix of drugs that help them painlessly commit suicide. Most doctors draw little distinction between them delivering the fatal injection or sitting by while a patient drinks the fatal dose the doctor hands them.
The British Medical Association will host a closed door conference next week on assisted suicides. For weeks doctors, and other interested parties, have been contributing to a BMA website and submitting reports,
A spokesman yesterday explained: "We are trying to find a consensus. Some see it as helping a patient who is terminally ill, others object to it as back door euthanasia." A report will later be published in the British Medical Journal though few expect it to achieve the desired consensus.
Professor van der Maas said: "I have attended medical conferences in Britain and heard doctors admit to giving the morphine jab that is meant to ease pain, except that it kills their patient. Isn't that euthanasia?"
Opponents of euthanasia in Holland admit that they face a hopeless task of preventing its legalisation, though they have seized on the evidence of botched cases to argue euthanasia does not deliver the swift and dignified end it promises.
Dr Karel Gunning, president of the World Federation of Doctors who Respect Human Life, said: "We are a minority but we must speak out. This is spoiling medicine and changing the nature of what a doctor does.
"If you give doctors the power to kill there is no limit. Doctors make decisions to kill or shorten life in 20per cent of deaths in this country we believe, and that is a huge number".
He recounts a case where the family of a cancer patient were grieving by his bedside while the doctor was packing away his case when the man woke up. "His eyes were bulging, he couldn't breathe, he was having convulsions. He began to vomit back some of the medication meant to kill him and in all the chaos a doctor had to push away relatives so he could administer a lethal injection while the man was struggling. No official action was taken against the doctor."
Controversial cases have tested the boundaries of euthanasia's application, none more so than that of a 25-year-old woman who had suffered anorexia for 15 years and who had been in hospital and through therapy without success. She repeatedly begged her doctor to help her die and threatened violent suicide if he would not. She went so far as to videotape her plea for euthanasia and the doctor agreed.
He was charged with murder but acquitted after the court was shown the girl's video testimony.
Boudewijn Chabot, a psychiatrist, was treating a 50-year-old woman with a 20-year history of depression after the death of her two sons. She had already attempted suicide when she came to Chabot who told her that if he could not treat her he would help her to die rather than risk her attempting some violent suicide.
In September 1991 the woman took a lethal dose of drugs prescribed by Chabot. The psychiatrist was charged with assisting suicide and his case went to the Supreme Court which last year found him guilty of professonal negligence but he was given a suspended sentence.
Critics such as Professor Roel Kuiper say such cases show how euthanasia is out of control in The Netherlands. He is director of the scientific study centre for the RPF, one of the smaller Christian parties in parliament. He said: "The shame is that it's not a big deal in Holland anymore. We have grown to accept it."
He believes many doctors still lie about the true number of euthanasia cases they perform and falsify statistics of the handicapped infants killed each year. Officially it is ten, but Professor Kuiper said: "So many statistics and studies on euthanasia are manufactured to promote it is as a sound idea.
"This recent evidence of botched cases will alarm people because we are always being told that euthanasia and assisted suicide is quick and painless. Euthanasia supporters will accuse us of just adding emotion to the debate.What we should consider is that our society can't comfort people any more. In Holland we just offer them a quick way out."
Studies show that each year 25,000 terminally ill patients talk to their doctors about euthanasia, only 9,000 make the initial request and 3,000 go on to receive it. Most of the rest died from natural causes though doctors admit some do change their minds.
Only 4 per cent of doctors say they will have nothing to do with euthanasia. Another 9 per cent say they will not administer it but if a patient asks, they will refer them to a doctor who will. Three per cent of GPs who have administered it admit that because of the trauma they suffered they would be reluctant to do so again.
The botched cases came mainly in the late 1980s and early 1990s when doctors used opiates such as morphine, which are unpredictable.
Critics say that assisted suicide is euthansia by another name. The doctor makes up the fatal dose of drugs but the patient by their own hand takes it. Doctors are required to stay by the patient until they die. They also seek the assent of patients that if they are taking longer than is expected, or showing signs of distress, the doctor will administer a lethal injection.
In an anonymous office block in central Amsterdam is the headquarters of the NVVE - the Dutch Voluntary Euthanasia Society - which now has 100,000 recruits who pay £11 a year. Volunteers visit members, particularly the elderly, to help them fill out detailed euthanasia statements which include the patient's choice of how long they want to be in a coma before they receive the fatal injection. They can elect for assisted suicide or for a physician to administer euthanasia.
They tick off which disabilities they refuse to live with. There is also a clause about blindness or deafness which "make it impossible or virtually impossible for me to perform what are worthwhile actitivities".
Martine Cornelisse, a psychiatrist and a membership coordinator with group, said: "We don't just sit here and wait for people to come to us. We stimulate hospitals and nursing homes to raise the subject with patients while they are still rational and clear. We want the young and healthy to make living wills in the event of them being paralysed or in a coma after an accident.
"It is high time we legalised what has been accepted practice for years."