By deciding to make euthanasia legal in certain circumstances, the Dutch would claim that they have simply codified in law what was acceptable practice there for some 25 years. The patient must have clearly, voluntarily and repeatedly asked to die; there must be unbearable suffering; there must be no reasonable alternative, and a second opinion must be sought.
The Dutch would like to believe this is model legislation, and not open to abuse. However, two surveys carried out by the Dutch government in 1990 and 1995 make disturbing reading. They reveal that, of all reported euthanasia deaths, 30.76 per cent in 1990 and 22.56 per cent in 1995 involved patients who did not give their explicit consent to be killed. There is no reason to believe that this will change with the new legislation.
The legislation allows children over 16 to request death without parental consent, and a written request will be admissible for the first time, so it loosens rather than tightens restrictions.
Despite the fact that euthanasia without explicit consent is in clear breach of the guidelines agreed between the Ministry of Justice and the medical profession, almost no prosecutions follow. Some 20 doctors were charged in the 1990s, but almost all the charges were dropped. Some cases are controversial, even in the Netherlands
for example, the assisted killing of former senator Edward Brongersma, who had no serious illness, but at 86 was "tired of life".
The physician involved was acquitted of murder, as was a physician involved in the death of a 50-year-old healthy woman, described as suffering from pathological grief over the death of her two sons. These last two cases are in clear breach of existing guidelines, yet the courts refused to convict. It is not surprising that many Dutch people have made living wills requesting that they do not receive involuntary euthanasia.
There is a myth that euthanasia is synonymous with death with dignity. The New England Journal of Medicine, which editorialises in favour of euthanasia, described as deeply disturbing the results of a survey by Dutch researchers. This research found a euphemistic "failure to complete" in 16 per cent of physician-assisted suicides and in 6 per cent of euthanasia cases. In other words, the patient did not die as planned. In some cases, the patient experienced distressing complications.
The editorial in the February 24th, 2000 edition pointed out: "This is information which will come as a shock to the many members of the public - including legislators and even some physicians - who have never considered that the procedures involved in physician-assisted suicide and euthanasia might sometimes add to the suffering they are meant to alleviate and might also preclude the peaceful death being sought".
While the methods cited in the survey were usually lethal combinations of drugs, the worries raised by the editorial apply even more to the removal of so-called artificial feeding, where a patient is deprived of hydration and nutrition - water and food. Death by dehydration is painful and, even when cushioned by drugs, is hardly death with dignity. There have been several notable cases in recent years. Without in any way wishing to judge the families involved and not knowing how I would react in such a situation myself, these cases raise grave questions.
Tube feeding has been around for over 100 years. It is only recently that it has become categorised as an extraordinary measure. In the 1980s, a 92-year-old American woman called Mary Hier, who had lived in mental hospitals for more than half her life, and who thought she was the Queen of England, needed a gastrostomy tube replaced. When her caregivers approached her legal guardian for consent, it was refused.
The case went to court, and the court upheld the guardian's decision, ruling that implanting the tube was a "highly risky and highly intrusive procedure". Ironically, the case was reported in a Boston newspaper at the same time as it carried a story on a 94-year-old woman who had had "minor surgery", performed on an out-patient basis for a "nutritional problem". The other woman? Rose Kennedy. The surgery? Insertion of a gastrostomy tube. For Mary Hier, elderly, deluded and without family, it was "highly invasive and highly risky".
For Rose Kennedy, matriarch of the Kennedy clan, it was "minor surgery". The judgment in the Mary Hier case was subsequently overturned, and she lived comfortably for many years after, happily signing herself Mary Hier, Queen of England.
IN Oregon, the only other place where physician-assisted suicide (PAS) is legal, there have been instances where insurance companies have agreed to pay for it but not for ongoing care. Last year, a startling 63 per cent of physician assisted suicide patients in Oregon (compared to 26 per cent in 1999 and only 12 per cent in 1998) cited fear of being a "burden on family, friends or care-givers" as a reason for their suicide.
In Ireland, thanks to the hospice movement, we have seen that there is always an alternative to euthanasia, that palliative care can ensure death with dignity. However, this is a costly alternative, and the disgraceful state of our health services shows that there is often a failure to treat ordinary patients with dignity, let alone those who are terminal.
This is where the crucial questions lie. How do we ensure that people receive adequate care, including the very best of pain control, enabling them to live and die with dignity? We may criticise the Dutch, but some years ago I was approached by a nurse in a general hospital outside Dublin who feared that she was witnessing a creeping acceptance of euthanasia.
Basically, if an elderly patient had a concerned and actively involved family, everything possible was done. If they did not, the patient could become the victim of dubious judgments about quality of life.
Yet again, it is the most vulnerable who are most at risk. Is this the kind of society we wish to build? On this Easter Saturday, I truly hope not.
bobrien@irish-times.ie