Frans Swarttouw, former chairman of the Fokker aircraft company and one of the Netherlands' most colorful businessmen, bid an unusual farewell to his countrymen a few weeks ago. Stricken with throat cancer, the executive, 64, who once characterized an entrepreneur as "a guy who works hard, drinks himself into the ground and chases women," said he had stopped his painful therapy and opted out of a life-saving operation that would have left him an invalid. "I want to be able to draw the line myself," he said on TV. Three days later, he was put to death by a doctor. "His last evening at home was so cozy," his wife said. "Frans gave himself another quarter of an hour: 'One last gin and tonic and a cigarette, then we'll get down to work.'"
The touch of bravura was uniquely Swarttouw, but the candor about voluntary death was typically Dutch. While euthanasia and physician-assisted suicide remain taboo subjects in much of Europe and are contentious topics in the U.S., they have been openly debated and researched for more than 20 years in Holland, which has a record of pragmatism in dealing with thorny social issues like drugs and abortion. Euthanasia is still, under Dutch law, a crime punishable by up to 12 years in prison. But in fact, the Netherlands has tolerated the practice for more than a decade, and the number of cases has risen dramatically over the past five years. Have the Dutch found a sensible and humane way of dealing with the unbearable pain and suffering that often comes at the end of life? Or is this a policy run amuck?
The government has established official guidelines, and physicians who follow them are not prosecuted. "The euthanasia debate is far from over, but there is an acceptance of the phenomenon," says Gerrit van der Wal, professor of social medicine at Amsterdam's Free University. "There's less discussion of the pros and cons, and more about how to control it."
Van der Wal was co-director of a major independent study published late last year on assisted suicide (in which the doctor gives a patient the means to end life) and euthanasia (in which the doctor terminates life at the patient's request). It concluded that there were about 3,600 cases in 1995 in Holland (pop. 15.5 million), a jump from the 2,700 cases estimated in 1990. Another 900 deaths fell into the troublesome category of "termination of life without the request of the patient."
Euthanasia is far more prevalent than assisted suicide (the Dutch make little moral or legal distinction between the two). Most patients were ill from cancer, and the large majority had less than a month to live. While more patients sought euthanasia or help with suicide in 1995 than before, doctors remained hesitant, turning down two-thirds of the requests.