The right to die is nowhere better established than in the Netherlands. Even as other societies struggle through the infancy of their euthanasia debates, the Dutch are poised to enshrine the practice in law for the first time--and to extend the right of a person as young as 12 to choose to end his or her suffering.
Euthanasia and doctor-assisted suicide have been practiced here since the early 1980s. A 1993 law made the practice criminal, punishable by as much as 12 years in jail, but it specified conditions under which a doctor could all but guarantee protection from prosecution.
Those conditions have now been rewritten and codified as law in a bill before parliament.
"There comes a moment when the jurisprudence"--a succession of judicial decisions allowing the practice--"has to be brought into the law," said Otto P.G. Vos, a member of parliament who specializes in the issue.
When the governing majority in parliament votes on its bill, probably not before next year, the Netherlands will take another step beyond mainstream thinking about euthanasia.
A likely flash point in the debate--and some say a possible casualty of it--will be the provisions covering the rights of young teenagers. "For 12- to 15-year-olds, parental agreement is required," according to a Justice Ministry statement issued when the new law was introduced on Tuesday. "But in the case of a refusal by one of the parents, the request of a minor may be accepted if the doctor is convinced that this will mean avoiding serious suffering."
A 1998 study by the Erasmus Institute in Rotterdam found that 92 percent of the Dutch people supported euthanasia. Most recent polls in the United States suggest it is supported by slightly more than half the American public. About 200,000 Dutch carry a piece of paper declaring their wish to die quickly and painlessly if, because of illness and incapacity--physical or mental--no prospect exists for a normal, dignified life.
This is much to the dismay of a hardy minority of Dutch, mainly practicing Christians, who oppose mercy killing.
"We think life is given by God. A person should not take the life of another," said Pieter van Duyvenboden, a consultant to the anti-euthanasia Netherlands Patients Society. "If people are really suffering, they should improve their palliative care. People shouldn't die sooner, they should suffer less."
Clemence Ross van Dorp, of the opposition Christian Democrats, mocked the proposed provisions for young teenagers. "Dutch law doesn't consider them responsible until they have reached the age of majority," she said, "but the government still wants to consider them as adults in matters of life and death."
The Royal Dutch Medical Association embraced the legislation. A spokeswoman, Karen Hagelstein, said "we think there will not be many requests of 12-year-old children."
Public support for the new law reflects the Netherlands' characteristically frank approach to nettlesome social issues. The country's official look-the-other-way approach to prostitution and soft drugs, for example, holds them simultaneously illegal and permissible under strict conditions.
"We like to debate every possible issue and find a practical solution. We are merchant and reverend at the same time," said Eugene Surtorius, a lawyer who has represented a handful of doctors prosecuted--and regularly acquitted--on mercy killing charges.
The Dutch may be at the leading edge in their approach to euthanasia, but Europe and the world are not standing still. Switzerland, Sweden, Denmark, Australia and Colombia all have adopted laws and practices that attempt to regulate a practice that goes on in virtually every country illegally.
Heavily Catholic Belgium is poised to change its laws. China recently began permitting mercy killings of terminally ill patients.
In the United States recent efforts to change euthanasia laws have been most pronounced in Oregon, whose law is being contested before the Supreme Court. Jack Kevorkian, a Michigan doctor who has taken part in 130 assisted suicides, was convicted of murder in March after taking part in the latest, which had been videotaped and broadcast on television.
The Dutch law is written to make it all but impossible for nonresidents to benefit from state-funded euthanasia procedures.
Nico Mensing van Charante, a doctor in family practice in Amsterdam for 23 years, resents the image the Netherlands has developed because of its position on euthanasia.
"I'm not pro or con on this issue. I'm a doctor dealing with suffering patients," he said. Mensing van Charante said he had performed 15 to 18 such procedures, usually assisting in a patient's suicide: "Most patients do it themselves, in their homes. It's their decision. It's their responsibility." He scoffed at foreign caricatures of Dutch doctors penciling in euthanasia cases as if they were appendectomies.
"It takes days and days and weeks out of your rhythm. It's heavy stuff," he said. Mensing van Charante said he and 21 other doctors in Amsterdam who consult on euthanasia cases gather regularly to share their experiences, debate their work and explore what "unbearable suffering" means.
"We are not a bunch of murderers. We are doctors concerned with our patients," he said.
According to the results of a study on euthanasia practices, about 3,600 mercy killings were performed in the Netherlands in 1995--and of those patients, mental incapacity prevented 1,000 from explicitly asking to die. Even the official euthanasia figures--about 3 percent of all deaths in the Netherlands--probably represent fewer than half the actual number of cases.
The study said only 41 percent of the doctors who performed mercy killings reported them to the coroner's office, certifying that all the procedures had been followed.
The new law will attempt to remedy that situation. It "will offer us the possibility to augment the quality of what we're doing and see what's happening among the people who do not report," Surtorius said. On the other hand, the Netherlands might find itself publishing dramatic statistics suggesting, misleadingly, that the new law had more than doubled the euthanasia rate.