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Death on demand: has euthanasia

gone too far?
Countries around the world are making it easier to
choose the time and manner of your death. But doctors
in the world’s euthanasia capital are starting to worry
about the consequences

By Christopher de Bellaigue
Last year a Dutch doctor called Bert Keizer was summoned to the house of a
man dying of lung cancer, in order to end his life. When Keizer and the nurse
who was to assist him arrived, they found around 35 people gathered around the
dying man’s bed. “They were drinking and guffawing and crying,” Keizer told me
when I met him in Amsterdam recently. “It was boisterous. And I thought: ‘How
am I going to cleave the waters?’ But the man knew exactly what to do. Suddenly
he said, ‘OK, guys!’ and everyone understood. Everyone fell silent. The very
small children were taken out of the room and I gave him his injection. I could
have kissed him, because I wouldn’t have known how to break up the party.”

Death on demand: has euthanasia gone too far? – podcast

Keizer is one of around 60 physicians on the books of the Levenseindekliniek, or

End of Life Clinic, which matches doctors willing to perform euthanasia with
patients seeking an end to their lives, and which was responsible for the
euthanasia of some 750 people in 2017. For Keizer, who was a philosopher
before studying medicine, the advent of widespread access to euthanasia
represents a new era. “For the first time in history,” he told me, “we have
developed a space where people move towards death while we are touching them
and they are in our midst. That’s completely different from killing yourself when
your wife’s out shopping and the kids are at school and you hang yourself in the
library – which is the most horrible way of doing it, because the wound never
heals. The fact that you are a person means that you are linked to other people.
And we have found a bearable way of severing that link, not by a natural death,
but by a self-willed ending. It’s a very special thing.”

This “special thing” has in fact become normal. Everyone in the Netherlands
seems to have known someone who has been euthanised, and the kind of
choreographed farewell that Keizer describes is far from unusual. Certainly, the
idea that we humans have a variety of deaths to choose from is more familiar in
the Netherlands than anywhere else. But the long-term consequences of this idea
are only just becoming discernible. Euthanasia has been legal in
the Netherlands for long enough to show what can happen after the practice
beds in. And as an end-of-life specialist in a nation that has for decades been the
standard bearer of libertarian reform, Keizer may be a witness to the future that
awaits us all.

In 2002, the parliament in the Hague legalised euthanasia for patients

experiencing “unbearable suffering with no prospect of improvement”. Since
then, euthanasia and its close relation, assisted dying, in which one person
facilitates the suicide of another, have been embraced by Belgium and Canada,
while public opinion in many countries where it isn’t on the national statute,
such as Britain, the US and New Zealand, has swung heavily in favour.

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The momentum of euthanasia appears unstoppable; after Colombia, in 2015,

and the Australian state of Victoria, in 2017, Spain may be the next big
jurisdiction to legalise physician-assisted death, while one in six Americans(the
majority of them in California) live in states where it is legal. In Switzerland,
which has the world’s oldest assisted dying laws, foreigners are also able to
obtain euthanasia.

If western society continues to follow the Dutch, Belgian and Canadian

examples, there is every chance that in a few decades’ time euthanasia will be
one widely available option from a menu of possible deaths, including an “end of
life” poison pill available on demand to anyone who finds life unbearable. For
many greying baby boomers – veterans of earlier struggles to legalise abortion
and contraception – a civilised death at a time of their choosing is a right that
the state should provide and regulate. As this generation enters its final years,
the precept that life is precious irrespective of one’s medical condition is being
called into question as never before.

As the world’s pioneer, the Netherlands has also discovered that although
legalising euthanasia might resolve one ethical conundrum, it opens a can of
others – most importantly, where the limits of the practice should be drawn. In
the past few years a small but influential group of academics and jurists have
raised the alarm over what is generally referred to, a little archly, as the “slippery
slope” – the idea that a measure introduced to provide relief to late-stage cancer
patients has expanded to include people who might otherwise live for many
years, from sufferers of diseases such as muscular dystrophy to sexagenarians
with dementia and even mentally ill young people.

Perhaps the most prominent of these sceptics is Theo Boer, who teaches ethics at
the Theological University of Kampen. Between 2005 and 2014, Boer was a
member of one of the five regional boards that were set up to review every act of
euthanasia and hand cases over to prosecutors if irregularities are detected.
(Each review board is composed of a lawyer, a doctor and an ethicist.) Recent
government figures suggest that doubts over the direction of Dutch euthanasia
are having an effect on the willingness of doctors to perform the procedure. In
November, the health ministry revealed that in the first nine months of 2018 the
number of cases was down 9%compared to the same period in 2017, the first
drop since 2006. In a related sign of a more hostile legal environment, shortly
afterwards the judiciary announced the first prosecution of a doctor for
malpractice while administering euthanasia.

It is too early to say if euthanasia in the Netherlands has reached a high-water

mark – and too early to say if the other countries that are currently making it
easier to have an assisted death will also hesitate if the practice comes to be seen
as too widespread. But it is significant that in addition to the passionate
advocacy of Bert Keizer – who positively welcomes the “slippery slope” – Boer’s
more critical views are being solicited by foreign parliamentarians and ethicists
who are considering legal changes in their own countries. As Boer explained to
me, “when I’m showing the statistics to people in Portugal or Iceland or
wherever, I say: ‘Look closely at the Netherlands because this is where your
country may be 20 years from now.’”
“The process of bringing in euthanasia legislation began with a desire to deal
with the most heartbreaking cases – really terrible forms of death,” Boer said.
“But there have been important changes in the way the law is applied. We have
put in motion something that we have now discovered has more consequences
than we ever imagined.”

Bert Keizer carried out his first euthanasia in 1984. Back then, when he was
working as a doctor in a care home, ending the life of a desperately ill person at
their request was illegal, even if prosecutions were rare. When a retired
shoemaker called Antonius Albertus, who was dying of lung cancer, asked to be
put out of his misery, Keizer found that two sides of himself – the law-abiding
doctor and the altruist – were at odds.

“Antonius wasn’t in pain,” Keizer told me, “but he had that particular exhaustion
that every oncologist knows, a harrowing exhaustion, and I saw him dwindle
before me.” In the event, Keizer, who as an 11-year-old watched his mother suffer
an excruciating death from liver disease, went with the altruist. He injected
40mg of Valium into Antonius – enough to put him in a coma – then gave him
the anti-respiratory drug that ended his life.

Keizer was not investigated after reporting an unnatural death at his own hand,
and his career did not suffer as he feared it might. But what, I asked him, had
prompted him to break the law, and violate a principle – the preservation of life
– that has defined medical ethics since Hippocrates? Keizer paused to brush
away a spider that had crawled uninvited on to my shoulder. “It was something
very selfish,” he replied. “If ever I was in his situation, asking for death, I would
want people to listen to me, and not say, ‘It cannot be done because of the law or
the Bible.’”

Over the past few decades the Bible has been increasingly sidelined, and the law
has vindicated the young doctor who put Antonius to sleep. As people got used to
the new law, the number of Dutch people being euthanised began to rise sharply,
from under 2,000 in 2007 to almost 6,600 in 2017. (Around the same number
are estimated to have had their euthanasia request turned down as not
conforming with the legal requirements.) Also in 2017, some 1,900 Dutch people
killed themselves, while the number of people who died under palliative sedation
– in theory, succumbing to their illness while cocooned from physical
discomfort, but in practice often dying of dehydration while unconscious – hit an
astonishing 32,000. Altogether, well over a quarter of all deaths in 2017 in the
Netherlands were induced.
MPs in Victoria, Australia, embrace after the passing of the Voluntary Assisted
Dying bill in 2017. Photograph: David Crosling/EPA

One of the reasons why euthanasia became more common after 2007 is that the
range of conditions considered eligible expanded, while the definition of
“unbearable suffering” that is central to the law was also loosened. At the same
time, murmurs of apprehension began to be heard, which, even in the
marvellously decorous chamber of Dutch public debate, have risen in volume.
Concerns centre on two issues with strong relevance to euthanasia: dementia
and autonomy.

Many Dutch people write advance directives that stipulate that if their mental
state later deteriorates beyond a certain point – if, say, they are unable to
recognise family members – they are to be euthanised regardless of whether they
dissent from their original wishes. But Last January a medical ethicist called
Berna Van Baarsen caused a stir when she resigned from one of the review
boards in protest at the growing frequency with which dementia sufferers are
being euthanised on the basis of a written directive that they are unable to
confirm after losing their faculties. “It is fundamentally impossible,” she told the
newspaper Trouw, “to establish that the patient is suffering unbearably, because
he can no longer explain it.”

Van Baarsen’s scruples have crystallised in the country’s first euthanasia

malpractice case, which prosecutors are now preparing. (Three further cases are
currently under investigation.) It involves a dementia sufferer who had asked to
be killed when the “time” was “right”, but when her doctor judged this to be the
case, she resisted. The patient had to be drugged and restrained by her family
before she finally submitted to the doctor’s fatal injection. The doctor who
administered the dose – who has not been identified – has defended her actions
by saying that she was fulfilling her patient’s request and that, since the patient
was incompetent, her protests before her death were irrelevant. Whatever the
legal merits of her argument, it hardly changes what must have been a scene of
unutterable grimness.

The underlying problem with the advance directives is that they imply the
subordination of an irrational human being to their rational former self,
essentially splitting a single person into two mutually opposed ones. Many
doctors, having watched patients adapt to circumstances they had once expected
to find intolerable, doubt whether anyone can accurately predict what they will
want after their condition worsens.

The second conflict that has crept in as euthanasia has been normalised is a
societal one. It comes up when there is an opposition between the right of the
individual and society’s obligation to protect lives. “The euthanasia requests that
are the most problematic,” explains Agnes van der Heide, professor of medical
care and end-of-life decision-making at the Erasmus Medical Centre in
Rotterdam, “are those that are based on the patient’s autonomy, which leads
them to tell the doctor: ‘You aren’t the one to judge whether I am to die.’” She
doesn’t expect this impulse, already strong among baby boomers, to diminish
among coming generations. “For our young people, the autonomy principle is at
the forefront of their thinking.”

The growing divisions over euthanasia are being reflected in the deliberations of
the review boards. Consensus is rarer than it was when the only cases that came
before them involved patients with late-stage terminal illnesses, who were of
sound mind. Since her resignation, Berna Van Baarsen has complained that
“legal arguments weigh more and more heavily” on the committees, “while the
moral question of whether in certain cases good is done by killing, threatens to
get snowed under”.

In this new, more ambiguous environment, the recent dip in euthanasia

numbers doesn’t seem surprising. Besides their fear of attracting prosecutors’
attention, some doctors have been irked by the growing public perception that
they are no-questions-asked purveyors of dignified death, and are pushing back.
For Dutch GPs, fielding demands for euthanasia from assertive patients who
resent the slightest reluctance on the part of their physician has become one of
the more disagreeable aspects of their job.

“In the coldest weeks of last winter,” Theo Boer told me, “a doctor friend of mine
was told by an elderly patient: ‘I demand to have euthanasia this week – you
promised.’ The doctor replied: ‘It’s -15C outside. Take a bottle of whisky and sit
in your garden and we will find you tomorrow, because I cannot accept that you
make me responsible for your own suicide.’ The doctor in question, Boer said,
used to perform euthanasia on around three people a year. He has now stopped
altogether.

Although he supported the 2002 euthanasia law at the time, Boer now regrets
that it didn’t stipulate that the patient must be competent at the time of
termination, and that if possible the patient should administer the fatal dose
themselves. Boer is also concerned about the psychological effect on doctors of
killing someone with a substantial life expectancy: “When you euthanise a final-
stage cancer patient, you know that even if your decision is problematic, that
person would have died anyway. But when that person might have lived decades,
what is always in your mind is that they might have found a new balance in their
life.”
In November 2016, Monique and Bert de Gooijer, a couple from Tilburg, became
minor celebrities when a regional paper, the Brabants Dagblad, devoted an
entire issue to the euthanasia of their son, an obese, darkly humorous,
profoundly disturbed 38-year-old called Eelco. His euthanasia was one of the
first high-profile cases involving a young person suffering from mental illness. Of
the hundreds of reactions the newspaper received, most of them supportive, the
one that made the biggest impression on the de Gooijers came from a woman
whose daughter had gone out one day, taking the empty bottles to the store, and
walked in front of a train. “She envied us,” Monique told me as I sat with her and
Bert in their front room, “because she didn’t know why her daughter had done it.
She said: ‘You were able to ask Eelco every question you had. I have only
questions.’”

Privately, even surreptitiously undertaken, suicide leaves behind shattered lives.

Even when it goes according to plan, someone finds a body. That openly
discussed euthanasia can cushion or even obviate much of this hurt is something
I hadn’t really considered before meeting the de Gooijers. Nor had I fully
savoured the irony that suicide, with its high risk of failure and collateral
damage, was illegal across Europe until a few decades ago, while euthanasia,
with its apparently more benign – at least, more manageable – consequences,
remains illegal in most countries.

Whatever the act of killing a physically healthy young man tells us about Dutch
views of human wellbeing, the demise of Eelco de Gooijer didn’t traumatise a
train driver or a weekender fishing in a canal. Eelco was euthanised only after
long thought and discussions with his family. He enjoyed a good laugh with the
undertaker who had come to take his measurements for a super-size coffin. He
was able to say farewell to everyone who loved him, and he died, as Monique and
Bert assured me, at peace. There might be a word for this kind of suicide, the
kind that is acceptable to all parties. Call it consensual.

“You try to make your child happy,” Monique said in her matter-of-fact way, “but
Eelco wasn’t happy in life. He wanted to stop suffering, and death was the only
way.” Eelco came of age just as euthanasia was being legalised. After years of
being examined by psychiatrists who made multiple diagnoses and prescribed a
variety of ineffective remedies, he began pestering the doctors of Tilburg to end
his life.

Euthanasia is counted as a basic health service, covered by the monthly premium

that every citizen pays to his or her insurance company. But doctors are within
their rights not to carry it out. Unique among medical procedures, a successful
euthanasia isn’t something you can assess with your patient after the event. A
small minority of doctors refuse to perform it for this reason, and others because
of religious qualms. Some simply cannot get their heads around the idea that
they must kill people they came into medicine in order to save.
 Protesters in the Hague in 2001, while the Dutch government was debating the
legalisation of euthanasia, which passed in 2002. Photograph: Serge
Ligtenberg/AP

Those who demur on principle are a small proportion of the profession, perhaps
less than 8%, according to the end-of-life specialist Agnes van der Heide. The
reason why there is no uniformity of response to requests for euthanasia is that
the doctor’s personal views – on what constitutes “unbearable suffering”, for
instance – often weigh decisively. As the most solemn and consequential
intervention a Dutch physician can be asked to make, and this in a profession
that aims to standardise responses to all eventualities, the decision to kill is
oddly contingent on the mercurial human conscience.

A category of euthanasia request that Dutch doctors commonly reject is that of a

mentally ill person whose desire to die could be interpreted as a symptom of a
treatable psychiatric disease – Eelco de Gooijer, in other words. Eelco was
turned down by two doctors in Tilburg; one of them balked at doing the deed
because she was pregnant. In desperation, Eelco turned to the
Levenseindekliniek. With its ideological commitment to euthanasia and cadre of
specialist doctors, it has done much to help widen the scope of the practice, and
one of its teams ended Eelco’s misery on 23 November 2016. A second team
from the same clinic killed another psychologically disturbed youngster, Aurelia
Brouwers, early last year.

Ideally euthanasia is a structure with three struts: patient, doctor and the
patient’s loved ones. In the case of Eelco de Gooijer, the struts were sturdy and
aligned. Eelco’s death was accomplished with compassion, circumspection and
scrupulous regard for the feelings of all concerned. It’s little wonder that the
Dutch Voluntary Euthanasia Society, or NVVE, vaunts it as an example of
euthanasia at its best.

After leaving the de Gooijers, I drove northwards, bisecting hectares of plant

nurseries, skirting Tesla’s European factory, to a conference organised by the
NVVE. Apart from being the parent organisation of the Levenseindekliek, the
NVVE, with its membership of 170,000 (bigger than any Dutch political party)
and rolling programme of public meetings, is one of the most powerful interest
groups in the Netherlands. The conference that day was aimed at tackling
psychiatrists’ well known opposition to euthanasia for psychiatric cases – in
effect, trying to break down the considerable opposition that remains among
psychiatrists to euthanising disturbed youngsters like Eelco and Aurelia.

The conference centre on the outskirts of Driebergen stood amid tall conifers
and beehives. I was offered a beaker of curried pumpkin soup while the session
that was underway when I arrived – titled “Guidelines for terminating life on the
request of a patient with a psychiatric disorder” – came to an orderly close in the
lecture hall. Precisely three minutes behind schedule, the Dutch planned-death
establishment debouched for refreshments.

I had met my first NVVE member quite by chance in Amsterdam. After watching
her mother die incontinent and addled, this woman of around 70 signed an
advance directive requesting euthanasia should she get dementia or lose control
of her bowels. These conditions currently dominate the euthanasia debate,
because so many people in their 60s and 70s want an opt-out from suffering they
have observed in their parents. When I mentioned to the woman in Amsterdam
the reluctance of many doctors to euthanise someone who isn’t mentally
competent, she replied, bristling: “No doctor has the right to decide when my life
should end.”

At any meeting organised by the NVVE, you will look in vain for poor people,
pious Christians or members of the Netherlands’ sizeable Muslim minority.
Borne along by the ultra-rational spirit of Dutch libertarianism (the spirit that
made the Netherlands a pioneer in reforming laws on drugs, sex and
pornography), the Dutch euthanasia scene also exudes a strong whiff of upper-
middle class entitlement.

Over coffee I was introduced to Steven Pleiter, the director of the

Levenseindekliniek. We went outside and basked in the early October sun as he
described the “shift in mindset” he is trying to achieve. Choosing his words with
care, Pleiter said he hoped that in future doctors will feel more confident
accommodating demands for “the most complex varieties of euthanasia, like
psychiatric illnesses and dementia” – not through a change in the law, he added,
but through a kind of “acceptance … that grows and grows over the years”. When
I asked him if he understood the scruples of those doctors who refuse to perform
euthanasia because they entered their profession in order to save lives, he
replied: “If the situation is unbearable and there is no prospect of improvement,
and euthanasia is an option, it would be almost unethical [of a doctor] not to
help that person.”

After the Levenseindekliniek was founded in 2012, Pleiter sat down with the
insurance companies to work out what they would pay the clinic for each
euthanasia procedure its doctors perform. The current figure is €3,000, payable
to the clinic even if the applicant pulls out at the last minute. I suggested to
Pleiter that the insurance companies must prefer to pay a one-off fee for
euthanising someone to spending a vast sum in order to keep that person, needy
and unproductive, alive in a nursing home.

Pleiter’s pained expression suggested that I had introduced a note of cynicism

into a discussion that should be conducted on a more elevated plane. “There’s
not an atom in my body that is in sympathy with what you are describing,” he
replied. “This isn’t about money … it’s about empathy, ethics, compassion.” And
he restated the credo that animates right-to-die movements everywhere: ‘I
strongly believe there is no need for suffering.’

That not all planned deaths correspond to the experiences of Bert Keizer or the
de Gooijer family is something one can easily forget amid the generally positive
aura that surrounds euthanasia. The more I learned about it, the more it seemed
that euthanasia, while assigning commendable value to the end of life, might
simultaneously cheapen life itself. Another factor I hadn’t appreciated was the
possibility of collateral damage. In an event as delicately contractual as
euthanasia, there are different varieties of suffering.

Back in the days when euthanasia was illegal but tolerated, the euthanising
doctor was obliged to consult the relatives of the person who had asked to die.
Due to qualms over personal autonomy and patient-doctor confidentiality – and
an entirely proper concern to protect vulnerable people from unscrupulous
relatives – this obligation didn’t make it into the 2002 law that legalised
euthanasia.

This legal nicety would become painfully significant to a middle-aged motorcycle

salesman from Zwolle called Marc Veld. In the spring of last year, he began to
suspect that his mother, Marijke, was planning to be euthanised, but he never
got the opportunity to explain to her doctor why, in his view, her suffering was
neither unbearable nor impossible to alleviate. On 9 June, the doctor phoned
him and said: “I’m sorry, your mother passed away half an hour ago.”

Marc showed me a picture he had taken of Marijke in her coffin, her white hair
carefully brushed and her skin glowing with the smooth, even foundation of the
mortuary beautician. Between her hands was a letter Marc had put there and
would be buried with her – a letter detailing his unhappiness, resentment and
guilt.
Marijke, who was euthanised at 76, with a letter from her son, written after her
death, detailing his upset at her decision. Photograph: Marc Veld

There is little doubt that Marijke spent much of her 76 years in torment,
beginning with her infancy in a Japanese concentration camp after the invasion
of the Dutch East Indies, in 1941, and recurring during her unhappy adulthood
in the Netherlands. But Dutch doctors don’t euthanise people because of
depression – even if the more extreme advocates of the right to die think they
should. As a result, it isn’t uncommon for depressives or lonely people to
emphasise a physical ailment in order to get their euthanasia request approved.
During his time on the review board, Theo Boer came across several cases in
which the “death wish preceded the physical illness … some patients are happy
to be able to ask for euthanasia on the basis of a physical reason, while the real
reason is deeper”.

In Marijke’s case, the physical reason was a terminal lung disease, which, Marc
told me, she both exacerbated and exaggerated. She did this by cancelling
physiotherapy sessions that might have slowed its progress, bombarding her GP
with complaints about shortness of breath and slumping “like a sack of potatoes”
whenever he visited. “To be sure of being euthanised,” Marc said drily, “you need
above all to take acting lessons.”

What torments him today is that his mother died while there was hope that her
illness could be slowed. “If she had cancer and was feeling pain and it was the
last three months of her life, I would have been happy for her to have euthanasia.
But she could have lived at least a few more years.”
Defenders of personal autonomy would say that Marc had no business
interfering in his mother’s death, but beneath his anger lies the inconsolable
sadness of a son who blames himself for not doing more. Marijke’s euthanasia
was carried out according to the law, and will raise no alarms in the review
board. It was also carried out without regard to her relatedness to other human
beings.

For all the safeguards that have been put in place against the manipulation of
applicants for euthanasia, in cases where patients do include relatives in their
decision-making, it can never be entirely foreclosed, as I discovered in a GP’s
surgery in Wallonia, the French-speaking part of Belgium.

The GP in question – we’ll call her Marie-Louise – is a self-confessed idealist

who sees it as her mission to “care, care, care”. In 2017, one of her patients, a
man in late middle-age, was diagnosed with dementia and signed a directive
asking for euthanasia when his condition worsened. As his mind faltered,
however, so did his resolve – which did not please his wife, who became an
evangelist for her husband’s death. “He must have changed his mind 20 times,”
Marie-Louise said. “I saw the pressure she was applying.”

In order to illustrate one of the woman’s outbursts, Marie-Louise rose from her
desk, walked over to the filing cabinet and, adopting the persona of the
infuriated wife, slammed down her fist, exclaiming, “If only he had the courage!
Coward!”

Most medical ethicists would approve of Marie-Louise’s refusal to euthanise a

patient who had been pressured. By the time she went away on holiday last
summer, she believed she had won from her patient an undertaking not to press
for euthanasia. But she had not reckoned with her own colleague in the practice,
a doctor who takes a favourable line towards euthanasia, and when Marie-Louise
returned from holidays she found out that this colleague had euthanised her
patient.

When I visited Marie-Louise several months after the event, she remained
bewildered by what had happened. As with Marc, guilt was a factor; if she hadn’t
gone away, would her patient still be alive? Now she was making plans to leave
the practice, but hadn’t yet made an announcement for fear of unsettling her
other patients. “How can I stay here?” she said. “I am a doctor and yet I can’t
guarantee the safety of my most vulnerable patients.”

While for many people whose loved ones have been euthanised, the procedure
can be satisfactory and even inspiring, in others it has caused hurt and inner
conflict. Bert Keizer rightly observes that suicide leaves scars on friends and
family that may never heal. But suicide is an individual act, self-motivated and
self-administered, and its force field is contained. Euthanasia, by contrast, is the
product of society. When it goes wrong, it goes wrong for everyone.
Even as law and culture make euthanasia seem more normal, it remains among
the most unfamiliar acts a society can condone. It isn’t enough that the legal
niceties be observed; there needs to be agreement among the interested parties
on why it is taking place, and to what end. Without consensus on these basic
motivations, euthanasia won’t be an occasion for empathy, ethics or compassion,
but a bludgeon swinging through people’s lives, whose handiwork cannot be
undone.

Two years ago the Netherlands’ health and justice ministers issued a joint
proposal for a “completed life” pill that would give anyone over 70 years of age
the right to receive a lethal poison, cutting the doctor out of the equation
completely. In the event, the fragmented nature of Dutch coalition politics
stopped the proposal in its tracks, but doctors and end-of-life specialists I spoke
to expect legislation to introduce such a completed-life bill to come before
parliament in due course.

‘My death is not my own’: the limits of legal euthanasia

Assuming it could be properly safeguarded (a big assumption), the completed-

life pill would not necessarily displease many doctors I spoke to; it would allow
them to get back to saving lives. But while some applicants for euthanasia are
furious with doctors who turn them down, in practice people are unwilling to
take their own lives. Rather than drink the poison or open the drip, 95% of
applicants for active life termination in the Netherlands ask a doctor to kill them.
In a society that vaunts its rejection of established figures of authority, when it
comes to death, everyone asks for Mummy.

Even those who have grave worries about the slippery slope concede that
consensual euthanasia for terminal illness can be a beautiful thing, and that the
principle of death at a time of one’s choosing can fit into a framework of care.
The question for any country contemplating euthanasia legislation is whether
the practice must inevitably expand – in which case, as Agnes van der Heide
recognises, death will eventually “get a different meaning, be appreciated
differently”. In the Netherlands many people would argue that – for all the
current wobbles – that process is now irreversible.

Christopher de Bellaigue will chair a discussion on euthanasia at the Dutch

Centre in London EC2 on 23 Wednesday Jan at 7pm. See dutchcentre.com. This
article was supported by funding from the Pulitzer Center for Crisis Reporting

• This article was amended on 23 and 24 January 2019. A previous version

referred to “muscle-wasting diseases such as multiple sclerosis”, where muscular
dystrophy was meant. It was further amended because an earlier version said the
decision to allow euthanasia was “contingent on a single, mercurial human
conscience”. Dutch law states that at least two doctors must be involved in any
request for assisted dying.

• Follow the Long Read on Twitter at @gdnlongread, or sign up to the long read
weekly email here.

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something we have to maintain and build on for every year to come.

The Guardian is editorially independent, meaning we set our own agenda. Our
journalism is free from commercial bias and not influenced by billionaire
owners, politicians or shareholders. No one edits our editor. No one steers our
opinion. This is important as it enables us to give a voice to those less heard,
challenge the powerful and hold them to account. It’s what makes us different to
so many others in the media, at a time when factual, honest reporting is critical.