Abstract
The Netherlands was the first country to legalize voluntary euthanasia. Dutch law forbids euthanasia by another person, with the exception of a medical doctor. The physician has to meet requirements of due care, such as: the patient has made a voluntary and well-considered request, and suffers unbearably without prospect of improvement.
This practice is based on three principles: the value of human life, beneficence or mercy, and individual autonomy. The doctor’s mercy is the decisive value. This paternalistic approach contrasts with the moralistic Christian doctrine of the sanctity of life, which absolutely bans suicide and euthanasia. In the same vein, Locke argued that the ‘natural’ rights to life and to freedom are inalienable; therefore, Lockean liberalism forbids euthanasia. Indeed, the freedom to sell oneself into slavery appears to be unacceptable. However, voluntary euthanasia differs from voluntary slavery in relevant respects. A fully liberal approach that centralizes individual autonomy permits voluntary euthanasia, provided the voluntariness is adequately guaranteed.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 1.
But the Pythagoreans and Platonists rejected suicide.
- 2.
See https://en.wikisource.org/wiki/The_City_of_God/Book_I/Chapter_20. Accessed 31 Aug 2016.
- 3.
See http://www.newadvent.org/fathers/1315.htm. Accessed 31 Aug 2016. Naturally, God allows some exceptions, such as killing during a war on His command and capital punishment on the basis of a just law.
- 4.
Quoted in https://nl.wikipedia.org/wiki/Aktion_T4 Action T4. Accessed 4 Aug 2016.
- 5.
‘Euthanized’ in an improper meaning of the word; the intention was not to give them a good death. The victims included human ‘freaks’, see Chap. 7 on Freaky Justice, and particularly note 9.
- 6.
In line with the civilization theory of Norbert Elias .
- 7.
- 8.
Unlike its liberal stance toward pornography, the 1886 legislature had a moralistic view of suicide, assisted suicide and euthanasia. It considered suicide a punishable act, but found it pointless to ban it.
- 9.
Rechtbank Leeuwarden 21 februari 1973, NJ 1973, 183.
- 10.
HR 27 november 1984, ECLI:NL:HR:1984:AC8615.
- 11.
HR 21-06-1994, NJ 1994, 656.
- 12.
ECLI:NL:HR:2002:AE8772.
- 13.
As summarized in the Summary of the Second Evaluation of the Euthanasia Law (Heide 2012, p. 19).
- 14.
Trouw, November 4, 1998.
- 15.
- 16.
Cohen-Almagor was troubled by the pro-choice conformism among Dutch scholars: ‘My first fourteen interviewees were, on the whole, in favour of the policy, and I felt a growing unease in encountering such unanimity of opinion. This conformity worried me. Plurality and diversity of opinion are good for society, leading to a more comprehensive understanding of the issues, as well as a higher level of truth, as John Stuart Mill used to say’ (id., p. 175).
- 17.
The anthropologist France Norwood adverts to a further advantage of the extensive practice of deliberation and cooperation between doctor, patient and family: ‘The Dutch seem to have created something that alleviates some of the failing constructions of self-identity and social disconnection that occurs prior to death’ (Norwood 2007, p. 164).
- 18.
Rietjens et al. (2009) arrive at a similar conclusion: ‘Two decades of research on euthanasia in the Netherlands have resulted in clear insights into the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have resulted. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, 80% of euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Almost all unreported cases involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not’ (Rietjens et al. 2009, p. 282).
- 19.
The official reports are based on a definition of euthanasia that does not match sections 293 and 294, particularly the legal requirement of ‘life termination’. Doctors often do not report cases because they have used morphine or dormicum and do not consider there to have been a life termination. And they are right in holding this view because mostly they use a dose that is in accordance with normal medical practice in palliative care, and is therefore covered by the medical exception. Or they give a higher dose that often is not the real cause of the patient’s death—the lethal effects of morphine are overestimated. Even if their intention was to shorten the patient’s life, their action actually did not terminate his life. Therefore it falls outside the provisions of the law.
- 20.
Also see Windstrup (1980).
- 21.
Hume also rejects Augustine’s argument that suicide is prohibited by the Bible: ‘There is not a single text of scripture, which prohibits it. (…) Thou shalt not kill is evidently meant to exclude only the killing of others, over whose life we have no authority. That this precept like most of the scripture precepts, must be modified by reason and common sense, is plain from the practice of magistrates, who punish criminals capitally, notwithstanding the letter of this law’ (Hume 1974, p. 595).
- 22.
Also see Beauchamp (1976), who discusses Hume’s objections as an immanent critique of Thomas’ view.
- 23.
As a prosecutor in the war crime trials after the Second World War, in several cases Langemeijer demanded capital punishment. In Capital Punishment (1946) he advocated this radical sanction if restricted to exceptional situations. ‘Our generation has become so accustomed to death that the diffidence—that evidently for preference should shield life—will not be affected negatively any more by a limited number of death penalties for acts that always in some way or another imply disregard of life’ (Langemeijer 1946, p. 194).
- 24.
As we will see in the final section, Den Hartogh’s view has recently evolved into a more liberal direction.
- 25.
To be more precise, the taboo only allows for very specific exceptions, such as self-defence.
- 26.
Rachels would prefer the case law model to the Dutch Euthanasia Law. He finds proposals to institutionalize detailed procedures to evaluate euthanasia requests too complex and cumbersome.
- 27.
Pretty v UK, 29/4/2002.
- 28.
As we will see in Chap. 8 on Slavery and Public Reason, Locke made a curious exception, which again associates death with slavery: ‘Indeed having by his fault, forfeited his own Life, by some Act that deserves Death; he, to whom he has forfeited it, may (when he has him in his Power) delay to take it, and make use of him to his own Service, and he does him no injury by it. For, whenever he finds the hardship of his Slavery out-weigh the value of his Life, ‘tis in his Power, by resisting the Will of his Master, to draw on himself the Death he desires’ (Tr 2, 4, 23; Locke 1988, p. 284). Critics accuse Locke of implicitly justifying colonial slavery. Also see Chap. 2.
- 29.
Feinberg does not discuss the inalienability of the right to physical integrity, because of the peculiarity of the possible motives for self-harm. In Metamorphoses VIII 875-878 Ovid (1971) gives a poetic example of the pathological case of Erysichthon , who is possessed of an insatiable gluttony. Erysichthon devours everything within reach: ‘At last, when the strength of the plague had consumed all these provisions, and but added to his fatal malady, the wretched man began to tear his own flesh with his greedy teeth and, by consuming his own body, fed himself’.
- 30.
This argument abstracts from the Dutch model with its paternalistic physician’s monopoly.
- 31.
Which also argues for revocability of contracts in other existential domains. For instance, I may not irrevocably bind myself to a contract that permits another person to kill me on December 31, 2030, irrespective of how I will feel about it by then.
- 32.
For Popper’s solution to the paradoxes of freedom, democracy, and tolerance, see Chap. 12.
- 33.
I do not discuss non-voluntary euthanasia at life’s beginning (for instance, new-borns with spina bifida or hydrocephalus) and ending (dementia), nor in the intermediate period (coma, mental disorder). Generally, substitute decisions should be made from the supposed interests of the person.
- 34.
Den Hartogh defends the indirect paternalism of the Euthanasia Law with the argument that it is not affected by Feinberg’s objection against direct paternalism, notably that the subject is treated like an incompetent child. After all, indirect paternalism only forbids the cooperation of others. But the refusal of another person to cooperate with your plan does not reduce you to an incompetent actor, says Den Hartogh, for it is your autonomous right to decide for yourself. ‘Such a refusal only shows concern, not a lack of respect’ (Den Hartogh 2000, p. 182). Right, but the indirect paternalism of the Euthanasia Law goes much further than allowing euthanasists to refuse cooperation on the basis of their autonomous judgment. It binds them to legal criteria as to the character of my suffering. This is pure legal paternalism: I am not free to try to find someone who is willing to cooperate on my terms.
- 35.
Although she did meet the requirement of accumulated geriatric complaints.
- 36.
Haas v. Switzerland (2011) 53 E.H.R.R. 33.
- 37.
Vink (2014) argues that obtaining the lethal drugs may not be legal, but may still be legitimate.
- 38.
In the US state of Oregon one can obtain lethal drugs with a prescription from a GP, but only if one is suffering from a terminal disease and has a life expectancy of a maximum of six months. Active euthanasia by a physician is not allowed.
- 39.
Section 294 should remain in effect, argues Den Hartogh , to indicate that helping with suicide is punishable unless the helper can prove his innocence; that is, the burden of proof is reversed in order to protect against abuse.
References
Aquinas T (2007) Summa Theologica. Cosimo, New York
Beauchamp TL (1976) An analysis of Hume’s essay “on suicide”. Rev Metaphys 30(1):73–95
Cohen-Almagor R (2004) Euthanasia in the Netherlands. Kluwer, Dordrecht
Commissie Remmelink (1991) Medische beslissingen rond het levenseinde. SDU, The Hague
Feinberg J (1986) Harm to self. Oxford University Press, Oxford
Feinberg J (1987) Harm to others. Oxford University Press, Oxford
Fye W (1994) The history of euthanasia debates in the United States and Britain. Ann Intern Med 121(10):793–802
Gomez CF (1991) Regulating death: euthanasia and the case of the Netherlands. Free Press, New York
Gorsuch NM (2006) The future of assisted suicide and euthanasia. Princeton University Press, Princeton
Hartogh G den (2000) Euthanasia. Reflections on the Dutch discussion. In: Cohen-Almagor R (ed) Medical ethics at the dawn of the 21st century. Annals of the New York academy of science, vol 913, pp 174–187
Hartogh G den (2006) Euthanasie en het recht op leven. In: Exter A den (ed) De Euthanasiewet: grondrechten onder druk? Damon, Budel, pp 21–47
Hartogh G den (2009) Gij zult niet doodslaan. Alg Ned Tijdschr Wijsb 101(3):164–195
Hartogh G den (2012) The regulation of euthanasia: how successful is the Dutch system? In: Youngner J, Kimsma GK (eds) pp 351–391
Hartogh G den (2014) Hulp bij zelfdoding door intimi. Een grondrechtsconforme uitleg van artikel 294 Sr. Nederlands Juristenblad 89(24):1598–1605
Heide A van der, Legemaate J, Onwuteaka-Philipsen B, Bolt E, Bolt I, Delden H van, Geijteman E, Snijdewind M, Tol D van, Willems D (2012) Tweede evaluatie Wet toetsing levensbeëindiging op verzoek en hulp bij zelfdoding. ZonMw, Den Haag
Hendin H (1998) Seduced by death: doctors, patients, and assisted suicide. Norton, New York
Hodson JD (1981) Mill, paternalism, and slavery. Analysis 41(1):60–62
Hume D (1974) Essays. Oxford University Press, Oxford
Kennedy J (2002) Een weloverwogen dood. De opkomst van de euthanasie in Nederland. Bakker, Amsterdam
Kennedy JC (2012) The lateness of the Dutch euthanasia debate and its consequences. In: Youngner SJ, Kimsma GK (eds) Physician-assisted death in perspective: assessing the Dutch experience. Cambridge University Press, Cambridge, pp 3–20
Keown J (2002) Euthanasia, ethics and public policy: an argument against legislation. Cambridge University Press, Cambridge
KNMG (1984) Standpunt inzake euthanasie [Position on euthanasia]. Medisch Contact 31:990–997
Langemeijer GE (1946) De doodstraf. Nederlandsch Juristenblad (12): 193–197
Langemeijer GE (1973) Inleiding tot de studie van de wijsbegeerte des rechts. Tjeenk Willink, Zwolle
Langemeijer GE, Enschedé CJ, Veen TW van (1986) Euthanasie heeft geen wetgeving nodig. Ned Tijdschr Geneeskd 130:223–225
Locke J (1988) Two treatises of government. Cambridge University Press, Cambridge
McMahan J (2002) The ethics of killing: problems at the margins of life. Oxford University Press, New York
Mill JS (1977) Utilitarianism, on liberty, essay on Bentham. Collins/Fontana, Glasgow
Minois G (1999) History of suicide: voluntary death in western culture. John Hopkins University Press, Baltimore
Norwood F (2007) Nothing more to do: euthanasia, general practice, and end-of-life discourse in the Netherlands. Med Anthropol 26(2):139–174. https://doi.org/10.1080/01459740701283165. Last accessed 7 Nov 2017
Onwuteaka-Philipsen B, Legemaate J, Heide A van der, Delden H van, Evenblij K, El Hammoud I, Pasman R, Ploem C, Pronk R, Vathorst S van der, Willems D (2017) Derde evaluatie Wet toetsing levensbeëindiging op verzoek en hulp bij zelfdoding. ZonMw, Den Haag
Ovid (1971) Metamorphoses I. William Heinemann, London
Pans E (2006) De normatieve Grondslagen van het Nederlandse Euthanasierecht. Wolf Legal Publishers, Nijmegen
Raad van State (1986) Advies van de Raad van State. Kamerstuk Tweede Kamer 1985–1986 kamerstuknummer 18331 onder nummer C. Rijksoverheid, Den Haag
Rachels J (1986) The end of life: euthanasia and morality. Oxford University Press, Oxford
Rietjens JAC, Maas PJ van der, Onwuteaka-Philipsen BD, Delden JJM van, Heide A van der (2009) Two decades of research on euthanasia from the Netherlands: what have we learnt and what questions remain? J Bioeth Inq 6:271–283
Schopenhauer A (2004) The essays of Arthur Schopenhauer; Studies in Pessimism. http://www.spiritual-minds.com/philosophy/assorted/Philosophy%20-%20Arthur%20Schopenhauer%20-%20Studies%20In%20Pessimism.pdf. Accessed 5 Sept 2016
Seneca (2016) Moral letters to Lucilius. Letter 70 https://en.wikisource.org/wiki/Moral_letters_to_Lucilius/Letter_70. Accessed 7 Aug 2016
State Commission on Euthanasia (1985) Rapport van de Staatscammissie Euthanasie. Staatsuitgeverij, The Hague
Till-d’ HAH van, Bourouill A de (1970) Medisch-juridische aspecten van het einde van het menselijk leven. Kluwer, Deventer
Velleman JD (1999) A right of self-termination? Ethics 109(3):606–628
Vink T (2014) De weg naar zelfeuthanasie. Wellicht niet legal, evenmin illegal, maar wel legitiem? Filosofie Praktijk 35(3):60–75
Vink T (2016) Self-euthanasia, the Dutch experience: in search for the meaning of a good death or Eu Thanatos. Bioethics 30(9):681–688
Weyers H (2004) Euthanasie: het proces van rechtsverandering. Amsterdam University Press, Amsterdam
Weyers H (2012) The legalization of Euthanasia in the Netherlands: revolutionary normality. In: Youngner J, Kimsma GK (eds) (2012), pp 34–36
Williams S (1873) Euthanasia. Pop Sci Mon 3:90–96. https://en.wikisource.org/wiki/Popular_Science_Monthly/Volume_3/May_1873/Euthanasia. Last accessed 7 Nov 2017
Windstrup G (1980) Locke on suicide. Polit Theo 8(2):169–182
World Medical Association (2013) Resolution on Euthanasia. http://www.wma.net/en/30publications/10policies/e13b/. Accessed 18 Aug 2016
Wouters C (1993) Euthanasie in historisch-sociologisch perspectief. In: Govaart G, Rolies J (eds) Solidariteit met stervenden. Euthanasie: vragen bij een geregelde kwestie. Gooi & Sticht/Thomas More Academie, Baarn, pp 73–88
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Maris, C. (2018). I Have No Regrets: Dutch Euthanasia. In: Tolerance : Experiments with Freedom in the Netherlands. Law and Philosophy Library, vol 124. Springer, Cham. https://doi.org/10.1007/978-3-319-89346-4_6
Download citation
DOI: https://doi.org/10.1007/978-3-319-89346-4_6
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-89344-0
Online ISBN: 978-3-319-89346-4
eBook Packages: Law and CriminologyLaw and Criminology (R0)