Hilly Bosscher endured 25 years of repeated beatings by an alcoholic husband before the marriage ended in divorce. One of her two sons committed suicide at 20; the other died of lung cancer at the same age. When the 50-year-old former social worker from the Dutch town of Ruinen went to see psychiatrist Boudewijn Chabot, she had but one desire: she wanted to dieand she wanted the doctor to help her.
Over the next four months, Chabot tried to ease Bosscher's depression and change her mind about suicide, but she did not respond to counseling and refused medication. Having already made an attempt to kill herself by overdosing on drugs, she thought about other methods. "Rope only offers a 70% chance of success,"she worried."I do not know about the train. And I would resent it-- the mess."
Chabot consulted with seven colleagues, all of whom concurred that Bosscher's prognosis was dismal. Finally, Chabot agreed to help her. On Sept. 28, 1991, he handed Bosscher 20 sleeping pills and a toxic liquid mixture. Along with this deadly cocktail, she swallowed some medicine to prevent nausea. Then she lay down on her bed; a friend, Chabot and another doctor sat by her side. She kissed a portrait of her sons and, while Bach played on a tape recorder, peacefully drifted into death.
The Netherlands boasts one of the worlds most liberal policies on mercy killing, but the Bosscher case caused a sensation. Never before had a physician reported helping a depressed but otherwise healthy patient commit suicide. Of the estimated 2,300 cases of euthanasia and 400 cases of assisted suicide in Holland each year, virtually all involve patients suffering from a terminal illness or unbearable physical pain. Officials charged Chabot with violating the strict guidelines that permit doctors to help patients end their lives. Last week, in a landmark decision, the country's highest court ruled that though Chabot neglected to have another physician personally examine Bosscher, the psychiatrist would not be punished. "The ruling,"says Chabot's lawyer, Eugene Sutorius, "recognizes the right of patients experiencing severe psychic pain to choose to die with dignity."Contends Chabot:" Intolerable psychological suffering is no different from intolerable physical suffering."
In the U.S., where debate flares around Dr. Jack Kevorkian and assisted suicide for the terminally ill, the Dutch decision troubles ethicists. "Terminal illness at least gives you some line to draw," says Arthur Caplan, director of the University of Pennsylvania's Center for Bioethics. Critics are worried that Holland has pointed the way to "assisted suicide on demand."Can one say no to a despairing Vietnam vet or rape victim?"If you're worried about the slippery slope, this case is as far down as you can get," warns George Annas, health-law professor at Boston University.
Still, critics recognize that the issue is far tougher when it moves from abstract principles to the reality of a desperate patient."I do not know if I made the right choice," says Chabot,"but I believe I opted for the lesser of two evils."