The Netherlands studies fail to demonstrate that permitting physician-assisted
suicide and euthanasia will not lead to the nonvoluntary euthanasia of
children, the demented, the mentally ill, the old, and others. Indeed, the
persistence of abuse and the violation of safeguards, despite publicity and
condemnation, suggest that the feared consequences of legalization are exactly
its inherent consequences.
Third, the Boudewijn Chabot case raises a warning flag. Chabot, a psychiatrist,
participated in the suicide of a depressed fifty-year-old woman in 1991. Her
first son had committed suicide a few years earlier. Then her father had died.
Under the stress her marriage dissolved. In May of 1991 her second son died of
cancer, and less than three months later the woman reached Chabot through the
Dutch Voluntary Euthanasia Society, seeking someone to help her end her life.
She refused antidepressants and additional psychotherapy. She was never seen by
another physician in consultation. When Chabot discussed the case with seven
colleagues, at least two suggested that he not assist in the suicide. The Dutch
Supreme Court ultimately opted not to penalize Chabot, reaffirming the
permissibility of providing assisted suicide and euthanasia on grounds of
mental suffering alone. The Amsterdam Medical Disciplinary College did
reprimand him, however.
A statement by Else Borst-Eilers, the Dutch Minister of Health, raises concerns
about how euthanasia will come to be viewed once it is routine: "There are
situations in which the best way to heal the patient is to help him die
peacefully, and the doctor who in such a situation grants the patient's request
acts as the healer par excellence." The logic of understanding voluntary
euthanasia as "healing" begins to justify using euthanasia for children, the
incompetent, the mentally ill, and others who are suffering or who we imagine
are suffering in some fashion. As we have seen, there is a very strong tendency
among people who are healthy to extrapolate from the suffering of others in
ways that those who are in fact suffering would not countenance.
Many in favor of legalization urge caution in applying the experience of the
Netherlands to the United States, citing the many significant geographic,
cultural, and political differences between the countries. The differences
suggest, though, that the kinds of departures from agreed-upon procedures that
have occurred in the Netherlands are likely to be even more commonplace in
America. Whatever the emerging cultural, ethnic, and religious diversity of the
Netherlands, it pales in comparison to the raucous diversity of the United
States. And the Dutch have relative income equality, whereas income inequality
in the United States is among the greatest in the developed world. Such
diversity and inequality make it harder to share norms and to enforce them. The
Dutch are also a law-abiding people who view government social supports,
interventions, and regulations as legitimate. America is a land founded on
opposition to government, where candidates for office campaign against
government legitimacy. If the law-abiding Dutch violate their own euthanasia
safeguards, what can we expect of Americans?