/ 21 February 1997

Holland’s use and abuse of death

Charles Krauthammer in Washington

IN 1991 in the Dutch city of Assen, a perfectly healthy 50-year-old woman asked her doctor to help her die. Her two sons had died, one by suicide, one by cancer. She wanted to join them. After many hours of consultation, Dr Boudewijn Chabot consented. He was at her side when she swallowed the lethal pills he prescribed for her death.

In Holland, physician-assisted suicide is for all practical purposes legal, but Chabot was tried anyway because this woman wasn’t terminally ill.

She wasn’t even ill. In fact, she wasn’t even psychiatrically ill, a point that at trial Chabot made in his own defence. She was as lucid as she was inconsolable.

The three-judge court in Assen acquitted Chabot. So did an appeals court. So did the Dutch Supreme Court. Thus, notes Dr Herbert Hendin (in his indispensable study of euthanasia in Holland, Seduced by Death: Doctors, Patients and the Dutch Cure), has Holland “legally established mental suffering as a basis for euthanasia”.

In January the United States Supreme Court was asked to decide whether physician- assisted suicide should be legal in the United States, as it is in Holland. The two cases before the court both involved the terminally ill. But the deployment of these heart-rending cases of terminal illness is part of the cunning of the euthanasia advocates. They are pulling heart strings to get us to open the door. And once the door opens, it opens to everyone, terminally ill or not.

How do we know? During oral argument, Judge David Souter asked that question in one form or another at least four times: once you start by allowing euthanasia for the terminally ill, what evidence is there that abuses will follow?

The answer, in a word, is Holland. We’re not even talking here about the thousand cases a year – in the US that would translate into 20 000 cases a year – of Dutch patients put to death by their doctors without their consent. (Most, by the way, are killed not for reasons of pain but, as the doctors put it, for “low quality of life” or because “all treatment was withdrawn but the patient did not die”.) We’re talking about Dutch doctors helping the suicide of people not terminally ill, not chronically ill, not ill at all but, like the woman in Assen, merely bereft.

Eugene Sutorius, the prominent Dutch attorney who defended Chabot, said after winning his case: “Euthanasia, which started with terminal illness, has moved to a different plane.” And so it must. Why? Because in moving to “a different plane” the Dutch were not being perverse. They were being logical.

By what logical principle should the relief of death be granted only the terminally ill? Such a restriction is itself perverse. After all, the terminally ill face only a brief period of suffering. The chronically ill, or the healthy but bereft – they face a lifetime of agony. Why deny them the relief of a humane exit?

The litigants before the US Supreme Court, however, claimed the right to assisted suicide on the grounds not of mercy but of liberty – the autonomy of individuals to determine when and how they will die.

But on what logical grounds can this autonomy be reserved only for the terminally ill? Why not for every mentally competent adult? At the Supreme Court, the lawyers for the euthanasia side, Kathryn Tucker and Laurence Tribe, turned somersaults trying to answer the question.

Tribe offered a riff on the stages of life: “Life, though it feels continuous to many of us, has certain critical thresholds: birth, marriage, child-bearing. I think death is one of those thresholds.” It nearly got him laughed out of court when Justice Scalia cut him off with: “This is lovely philosophy. Where is it in the Constitution?”

Tribe had no answer because there is no answer. If assisted suicide is a right for the terminally ill, there is no argument that can be made to deny it on grounds of mercy or autonomy or non-discrimination to anyone else who might request it.

That is why the Supreme Court decision in these two cases will be so fateful.

That is why euthanasia advocates are so passionate about them. They know this is the beginning of something much larger: nothing less than historic legitimation – through the active, legal, socially blessed participation of the medical profession – of suicide.

In modern society, suicide is no longer punished (denial of burial on church grounds, denial of inheritance to the family). But it is still discouraged. When you see someone on a high ledge ready to jump, you are enjoined by every norm in society to tackle him and pull him back from the abyss. Americans are now being asked to become a society where, when the tormented soul on the ledge asks for help in granting him relief, they oblige him with a push.

They do it in Assen.

– The Washington Post