Death becomes them

Human Life Review, Winter 1999 by Johnson, Philip

For many years, Dr. Ben Zylic ran the only hospice in Holland, a converted former hunting lodge near Arnhem, dedicated to the care of the terminally ill and modelled on those in Britain established by Dame Cicely Saunders in 1967.

His institution is no longer alone. The Dutch government has recently provided L10 million to set up a proper hospice movement and soon Holland will boast five palliative care academic centres. This is a significant development in the only country in the world where euthanasia is practised on a routine basis. It is happening at a time when Dutch GPs are to get even greater latitude to dispatch their patients, a development that has so alarmed 10,000 Dutch men and women that they have taken to carrying "please-don't-kill-me" cards.

Dr. Zylic, who is visiting Britain shortly to apprise a House of Lords gathering of the perils of placing a foot on the slippery slope to euthanasia, would like to think the development of a hospice movement marks a turning-point in Holland, but he knows better than that. "The problem is that the government sees palliative medicine as acting in concert with euthanasia, not as a replacement," he says. "I have a feeling that the government is paying us this money to keep our mouths shut.

The truth is that most Dutch people support their country's "voluntary" euthanasia laws, and it is conceivable that Britain is about to go the same way. Indeed, an issue that has been largely dormant in this country is shortly to be reawakened.

In the new year, the trial will take place of a Newcastle GP accused of murder. The case of Dr. Dave Moor has become a cause celebre on Tyneside. At a preliminary hearing, hundreds of supporters marched through the city and gathered outside the court demanding that the charge be dropped. The 51-year-old doctor is accused of killing an 85-year-old patient, retired ambulanceman George Liddell, in July last year. Dr. Moor is being supported by the Voluntary Euthanasia Society, which sees the case as a potential legal watershed.

The British Medical Association is to hold a special conference to decide if doctors should help terminally ill patients to end their lives. Last month, a group of doctors formed a new campaign of opposition to euthanasia. Its leaders warned that "many thousands of people" would be at risk if doctors were legally allowed to hasten death either by administering or withholding drugs.

Even the government is making tentative moves in this area. The Lord Chancellor, Lord Irvine, is planning to place "living wills" on a statutory footing, while at the same time offering assurances that euthanasia will not be made legal in Britain. Yet it is often forgotten that it remains an offence in Holland.

The basis of current practice was laid down 25 years ago, when the Royal Dutch Medical Association for the first time accepted that euthanasia should be allowable. There followed a succession of legal actions, effectively protecting doctors from conviction provided they observed certain guidelines: the patient should be in unbearable pain; the death request should be voluntary; alternatives should be available; and more than one person should be involved in the decision.

In the 1980s, the Dutch Supreme Court held that a doctor who in certain circumstances kills a patient may successfully invoke the defence of necessity to justify his action. This defence is unique: normally, necessity is invoked as justifying a breach of the law in order to save lives-for instance, pushing someone out of the path of an oncoming car-not to end them.

One of the doctors involved in the landmark cases of the 1980s is Pieter Admiraal, an anaesthetist now living in retirement in The Hague. He has become the country's best-known campaigner for euthanasia, and oversaw many deaths even before he admitted to prosecutors in 1982 that he had carried out the killings.

"It is still illegal," said Dr. Admiraal. "You are always guilty. But my case and others were tests of whether doctors should be punished. In my case, involving a multiple sclerosis sufferer who could not swallow, it was decided she was suffering unbearably, and the prosecution was stopped."

The courts accepted that patients did not necessarily have to be in a terminal phase of their lives for euthanasia to be allowed. Five years ago, this was extended in a celebrated court action involving a doctor who killed a patient suffering from depression, but who was otherwise physically healthy. Hilly Bosscher, 50, said she wanted to die after the deaths of her two children and the subsequent break-up of her marriage.

For Dr. Amiraal, this is not a "slippery slope," however it may look from outside. He says the rules prevent doctors dispatching people who may have merely become a nuisance to their families, though there have been stories to suggest this is happening. He believes euthanasia should be fully legalised to avoid doctors being criminalised. Although it is a requirement that they inform the public prosecutors when euthanasia is performed, many of them do not.