Assisted suicide: can we learn from Germany?

As the United States' public discussion of euthanasia and assisted suicide grows increasingly volatile, our interest in the Netherlands - the only country that openly permits the practice of euthanasia - has grown enormously. How do they do it? we ask. What drugs do they use? How many cases of euthanasia are performed in a year? Is there abused? In asking these questions, and in listening to the legions of bioethicists and reporters and concerned physicians who have been to the Netherlands to scrutinize this practice, we are in effect regarding the Netherlands as a kind of natural laboratory for our own possible experiments in right-to-die legislation. Should we legalize euthanasia, as was on the ballot in the state of Washington in 1991 and is proposed for the ballot in California in 1992? Let us look to the Netherlands, we say.[1] Of course, examining euthanasia in the Netherlands has led to considerable controversy about just what is to be observed there - some claim there is virtually no abuse, others insist abuse is widespread[2] - and about the degree to which what we learn can be translated to the U.S., given differences in law, health care systems and other social factors,[3] but all parties seem to agree that whatever is happening in Holland, it has important lessons for us. However, voluntary active euthanasia is not the only form of aid-in-dying on the ballot in the United States. Initiative 119 and the proposed California legislation would also legalize physician-assisted suicide. Yet although the Netherlands also now tolerates physician-assisted suicide under the same legal device that it tolerates euthanasia, the rates of practice are quite different: while Netherlands are the result of euthanasia, they about 0.3 percent involve physician-assisted suicide.[4] It is euthanasia in the Netherlands that has attracted the world's notice; assisted suicide has played only a very minor supporting role. Yet in the United States, there seems to nearly as much - or perhaps more - public sympathy for assisted suicide as for active euthanasia. In a Boston Globe/Harvard survey of U.S. attitudes toward death and dying taken in October 1991, for example, 54 percent of a national sample of 1,311 adults over age eighteen said that if they had an illness with no hope of recovery and were suffering a great deal of physical pain, they would or probably would consider asking their doctor to administer lethal drug or a lethal injection; and 53 percent said that in the same circumstances they would or probably would ask their doctor to prescribe a lethal drug that they could decide to take later on.[5] Significantly, the opposite to Initiative 119 in the state of Washington focused almost exclusively on the dangers of euthanasia, not assisted suicide; prevent "medical homicides," was the cry[6], but little was said about restricting a patient's freedom to choose suicide - which, in Washington as in almost all other states, is not illegal. Given the currently chaotic and increasingly callous nature of health care financing in the United States, prefering assisted suicide to active euthanasia is not, I think, an unrealistic position. Because the U.S. is so sensitive (as it should be) to the risks of abuse, and because permitting assisted suicide would require a less dramatic change in the law, I think that the United States will come to accept assisted suicide in the relatively near future, officially as well as tacitly, but is likely to resist legalizing active euthanasia for a longer time. But is this is so, then there is something ironic about insight into issues of Netherlands for insight into issues of aid-in-dying: the Netherlands evidently prefers euthanasia to assisted suicide. What lessons can we learn from a country that sees things the other way around? Germany openly permits the practice of assisted suicide, but rejects euthanasia. Thus it is in a sense the observe of the Netherlands; hence despite many other differences, the lessons to be learned here should be at least equally, or perhaps more, instructive for us. …