(3 of 3)
Keizer says he grants only one of the five or so "serious" euthanasia requests he gets a year. "The process is so stressful that most physicians do whatever they can to avoid getting involved in euthanasia cases," he says. "It's still as emotional and difficult as ever, but the current climate makes it easier to discuss with the patient."
That's just the problem, insists Amsterdam psychiatrist Frank Koerselman, one of the few in Holland to buck the consensus. "Patients are scared by pain and the loss of their dignity, so they immediately start talking about active euthanasia," he said. "They are badly informed about alternatives." In particular, says oncologist Zbigniew Zylicz, who runs a hospice for dying cancer victims outside Arnhem, "the knowledge and practice are very low for palliative care," the art of easing pain in the final stage of a terminal illness. Zylicz estimates that a quarter of the 400 or so dying patients he has treated asked first for euthanasia. After counseling and skilled use of painkillers, all but two agreed to die naturally. "We could cut the number of euthanasia cases to 50," he says. Acknowledging such arguments, the government recently called for more emphasis on palliative care.
For many terminally ill patients and their families, it's having the option that counts. When Annemie Douwes Dekker's husband Hink was first told he had multiple sclerosis in 1978, his family doctor agreed to discuss the possibilities of euthanasia if and when the time came. "That was a great help to us," Annemie recalled. Five years later Hink, then 50, had been in a nursing home for a year and was deteriorating rapidly, losing his ability to communicate and control bodily functions. Yet, says his widow, now 62 and living in Haarlem, "he had a strong heart; he could have gone on living for years."
When Hink first asked to be put to death, the doctors refused, but after a few more months and more requests, Douwes Dekker remembers, "They said, 'Your husband is ready for it.'" That weekend he came home from the nursing home to be with the family, and the doctor administered the poison. "He just faded away," she says. "I'm convinced we did the right thing. He died a good death."
That's what euthanasia means in Greek, good death. For the Netherlands, it's also good policy. Other countries will have to decide for themselves, but surely the Dutch style of open debate about a painful and difficult topic is the best way to do so.
--With reporting by Barbara Smit/Amsterdam