The Netherlands, an outsider's view.

The Netherlands, an outsider's view.

#31magenglish

“Euthanasia is a matter of dignity and respect of the relationship between doctor and patient”

Flip Sutorius, a general practitioner from Haarlem, talks about "Termination of Life on Request" bill

by Massimiliano Sfregola

translation: Tommaso Bagna

 

Holland is a Country well known for its “legalizations” and for its pragmatism regarding ethics but, even if some liberal policies, such as those about prostitution and cannabis, have been brought up way before here than in the rest of the world, euthanasia and the Dutch way of seeing it keep being a unique case, even 15 years after its introduction. Up to now, only in the Benelux Union the painless death performed by a doctor is allowed, while, except Switzerland where the ‘assisted suicide’ is legal, in the rest of the world euthanasia remains a taboo topic.

“For a matter of ethics about this thorny topic, religious culture has certainly influenced the decisions of governments” Flip Sutorious, huisart of Haarlem, tells 31mag. Sutorious is among the group of Dutch doctors who since the 80s accepted to practice euthanasia. The decriminalization approved by the Dutch parliament in 2002, in fact, did nothing more than write down legally what was already happening since the 70s. “The Toetsing levensbeëindiging op verzoek en hulp bij zelfdoding (Putting an end to a life on request and Assisted Suicide), did not recognize the right of the patient to decide about his own life”, explains Sutorious, “but it only established when and where a doctor who chose to perform euthanasia is not punishable. It is a matter of dignity and respect of the relationship between doctor and patient.”

The current law states that the ‘yes’ given to a request for euthanasia must be approved also by a second scientific opinion. Only after the patient’s death, a provincial commission, composed of healthcare, bioethical and legal experts has the task of verifying if the national protocol was respected or not. “The Commission has to ensure that we followed the rules, meaning that it was decided by the patient himself and that his intolerable pain couldn’t get any better.” Sutorious continues: “With the increase of the requests for euthanasia, however, there are many ethical issues that fell upon my colleagues and me. Many of them, for example, despite being in favour of it, prefer not to deal with requests coming from patients with psychiatric illnesses.”
Even if this is a model that, internationally speaking, has brought to strong controversies, the Dutch way to ‘releasing from suffering’ enjoys almost unanimous support from the population: according to a survey dated 2013 realized by the program Eenvandaag, regulated euthanasia would see favourable more than 90% of the citizens.

Can we do an analysis of how it is going 13 years after the reform? “Euthanasia cases have increased dramatically in the last few years, but also requests for palliative care have” says Sutorious “especially for terminally ill patients.” According to the regional toestsingscommissies euthanasie, in 2014 there were 5306 patients who chose the sweet death, almost the double compared to 2010, but only the 3% of the deaths in the Netherlands. Even if the “pro-life” associations see these data as the failure of the law principles, a study of the Vrije Universiteit of Amsterdam together with the CBS Institute of Statistics says that the cases of euthanasia at the fringes of legality did not increase at all and justifies this raise in demand with the aging of the population.
For the doctor of Haarlem, the transparency regarding these practices and the possibility to openly discuss about the end of life were two of the greatest achievements of the reform: “Everyday, physicians accept requests for euthanasia all around the world but the risks of legal consequences for them and the absence of protocols make it very difficult to respect the choices of the patient. In the Netherlands, we have very young doctors specialized in this field that can rely on the knowledge gained during these 13 years of practice”, he states “before 2002, we were working with informal procedures just written on a sheet of paper: often we didn’t know the correct amount of sleeping pills and barbiturates to use and it could happen that an injection wasn’t enough.”

Sutorious and his experienced colleagues have accompanied many patients in the last moments before their sweet death. “I’ll never get used to it” he continues “I was really close to each of them, I knew their stories and their families. Emotionally it ‘s a great responsibility because people are opening their hearts to you, showing you their real pain. However I have always to keep my professionalism and stick to the patient’s decisions”. This is an intense experience that markes both the doctor and the man, changing his own approach to life and death. What never changes, says Sutorious, is the sense of empathy towards the patients: “For the old ones, seriously ill and bedridden for years, it means liberation, in addition to the end of suffering. They lived their lives, know their limits and only want their dignity to be respected. But when you have in front of you young patients, it tears you apart ” he says, deeply touched,” these are people who would still have a life in front of