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The euthanasia movement was launched by a celebrated 1973 case of a doctor who helped her mother die and was then acquitted of criminal charges. That year the Dutch Voluntary Euthanasia Society, NVVE, was founded, and today its 88,000 members carry "euthanasia passports" and lobby for more liberalization. The Dutch Royal Society of Medicine endorsed guidelines in 1984, and today's de facto decriminalization represents a compromise between euthanasia foes and advocates of full legalization. Periodic controversies roil the debate. In 1994, for instance, the Dutch TV station IKON's filming of the death by euthanasia of a man with Lou Gehrig's disease in a documentary, Death on Request, brought a denunciation from the Vatican.
Both supporters and critics of assisted suicide and euthanasia point to Holland to bolster their arguments. "It's terrible medicine," says psychiatrist Herbert Hendin, executive director of the American Foundation for Suicide Prevention in New York City, whose recent book, Seduced by Death, brands Dutch policy a failure. The Dutch establishment, however, was reassured by the latest study. To address the biggest problem it found--more than half the doctors didn't report euthanasia cases to the public prosecutor as required--the government proposes that instead, doctors would report to a panel of legal, medical and ethical experts to make sure these guidelines were followed: the patient must be suffering unbearably from an incurable disease; he or she must make repeated requests for euthanasia; the doctor should know the patient well enough to ensure the request is voluntary, and the doctor must consult with another physician.
The Dutch claim their system has built-in safeguards. For one, most people still rely on a family doctor,which reduces the risk of routinized euthanasia by an impersonal system. For another, Holland's welfare state is alive and well. Nursing care for the chronically ill is good, and everyone's medical expenses are covered, so finances are not a factor.
Inevitably, of course, there are abuses, and flagrant ones are prosecuted. Sippe Schat, a doctor from northern Friesland, goes on trial later this month for the alleged murder of a 72-year-old cancer patient who had seemed in good spirits just before she died in a nursing home. According to prosecutors, Schat simply gave her a lethal shot of insulin without consulting anyone and left her to die alone, allegedly telling a nurse as he left, "If she hasn't died by 7 a.m. tomorrow, give me a call."
What about the 900 people euthanized without asking for it? Admits Van der Wal, "We don't like these cases, but we don't deny them either." The study found that about half the patients had earlier discussed euthanasia. Many were in great pain in the last days of life and were given morphine, which eased their suffering but also hastened death. The government has proposed tighter controls of these nonrequest cases, but practitioners say Holland's candor has merely thrown light on a common, if little discussed, medical practice. "Doctors all over the world shorten the lives of patients under the cover of pain reduction, and only we are stupid enough to talk about it," says Bert Keizer, a nursing home physician in Amsterdam, whose memoir about his life among the dying, Dancing with Mister D, was a best seller.