By Keith B. Richburg Washington Post Foreign Service
PARIS, Nov. 28 - The Netherlands' main legislative body today approved a bill to legalize doctor-assisted suicide, again displaying the Dutch penchant for pushing the boundaries of conventional thinking on contentious social topics.
Today's vote by the lower house of parliament would essentially legalize what has been a long-standing practice in the Netherlands. Doctors now are virtually never prosecuted for assisting in thousands of suicides of terminally ill patients each year; the new law essentially lays out guidelines to regulate the termination of life.
The bill, which passed 104 to 40 over the objections of small Christian parties and the Catholic Church, now will be considered by the upper chamber, where approval is considered largely a formality.
The measure, which the Dutch say would be the world's most tolerant regarding physician-assisted suicide, could take effect next year.
The Netherlands measure would be the first such national law, though some local governments have taken similar steps. In Australia, the Northern Territory adopted a law legalizing euthanasia in September 1996, but it was struck down by the federal parliament in Canberra the following year. In the United States, Oregon has a voter-backed law permitting some assisted suicides.
From his office in Southfield, Mich., Mayer Morganroth, attorney for the "suicide doctor," Jack Kevorkian, now serving a prison sentence for second-degree murder in an assisted suicide, welcomed the Dutch vote. He said in a statement that he and his client "have felt all along that foreign countries and the states of the United States will come to the conclusion through compassion and understanding that such choice should be available to all people."
Under the Netherlands' measure, a doctor would be allowed to perform an assisted suicide if convinced the patient's request was well-considered, if the patient's suffering was "unbearable," and if the doctor consulted with another, independent physician who also examines the patient. The doctor would not be allowed to recommend suicide as an option, and must make all other alternatives known.
A regional "review committee" would recommend a doctor-assisted suicide for criminal prosecution only if there were signs that not all those criteria were met.
The measure also allows for "advanced directive," meaning that a patient could make a written declaration stating a wish to die when he or she has reached a certain point, such as the advanced stage of a terminal disease. Doctors would be free to act on those written declarations once all the other criteria are met.
Dutch officials say the law is not intended to allow foreigners to come to the country seeking to die. The requirements for a close, long-term doctor-patient relationship would make that virtually impossible, they contend.
An earlier draft, which drew the most criticism, would have allowed children as young as 12 to request euthanasia in certain cases without the consent of their parents. But that section was changed so that children age 12 to 15 would need parental consent.
The Dutch health minister who pushed the bill, Els Borst, said the goal was to bring physician-assisted suicide into the open so it could be more easily regulated and controlled. "Doctors should not be treated as criminals," she said. "This will create security for doctors and patients alike."
Speaking to the Associated Press in The Hague after passage of the bill, she said, "Something as serious as ending one's life deserves openness."
Acknowledging common practices and decriminalizing them has become a hallmark of the modern Netherlands. To some, the country is a laboratory for progressive social experimentation. To others it is an outpost of dangerous radicalism.
The Dutch have the most liberal drug laws in Europe, allowing, for example, marijuana to be purchased legally at licensed "coffee shops." Prostitution has long been legal; this year brothels were legalized and made subject to government regulation and regular inspections.
Earlier this year the Netherlands became the first country to legalize same-sex marriage.
The Netherlands has sometimes drawn its neighbors' ire; some countries complain that their youths cross the border to evade strict drug controls at home.
But none of those other measures has provoked the intense debate, or the harsh reaction, that today's euthanasia vote did. After the bill was passed, Vatican spokesman Joaquin Navarro-Valls said, "Again, we are faced with a law of the state which opposes the natural law of human conscience." Other protests have come from the small Calvinist opposition in parliament.
Bert Dorenbos of the Cry for Life group was quoted telling the Reuters news agency, "In the Netherlands, your life is no longer safe." He compared the Dutch "line of reasoning" to Nazi disregard for human life.
The Dutch public, however, has seemed open to the idea of assisted suicide. A 1998 poll by the Dutch Voluntary Euthanasia Society found that 92 percent of Hollanders supported the practice. In 1999, there were 2,216 reported cases of euthanasia and assisted suicides in the Netherlands, although many advocates believe the true figure is far higher, with most cases going unreported. About 200,000 Dutch people carry documents declaring that they wish to die quickly and painlessly if physical or mental illness strikes and prevents them from having a normal life.
(Our thanks to Sylvia Gerhard for forwarding this article and John Hoffsess and "Nothing But the News" for posting it.)
The Hague (deutsche Presse-Agentur), Nov. 28 - The lower house of the Dutch parliamentapproved a law Tuesday that would legalize euthanasia.
The law, which is supported by the government, would make Hollandthe first country in the world to legalize mercy killing.
Deputies in the lower house of parliament voted 104-40 to adopt the legislation.
Before coming into force, it needs to be approved by the upperhouse or Senate, but this is seen is a formality.
Euthanasia has been tolerated for many years in the Netherlands, but has been illegal. The new law will make it legal for a doctor to administer a lethal drug to end a patient's life, subject to very strict criteria.
The legislation calls for doctors to act only if a patient is suffering unbearable and unremitting pain, and after patients who have clearly expressed a wish to die have been well briefed on the implications of the decision.
The law calls for doctors to inform a three-member commission of each case of mercy killing. The commission will consist of a doctor, a lawyer and an expert on ethical issues.
The legislation is designed to regulate the practice of mercy killing. According to official statistics 2,216 cases were reported in the Netherlands last year in which doctors either ended patients' lives at their express request or helped patients to commit suicide.
According Dutch media reports, doctors had reported only half the cases.
Health Minister Els Borst said that 90 per cent of all euthanasia cases so far involved patients suffering from cancer. Doctors took action in only a third of the requests.
Rabbi Raphael Evers of the Netherlands Israelite Community in Amsterdam was critical of the new legislation. He rejected claims that euthanasia was humanitarian, noting that the Bible describes euthanasia as murder even if it is carried out in compliance with a patient's wishes.
The German Hospice Association in Dortmund was ``appalled'' at the legislation being adopted in the neighbouring Netherlands, saying the new regulations were open to ``abuse''.
The German Hospice Association claimed that some 4,000 people a year died as a result of euthanasia in the Netherlands, ``1,000 of them without (the patient's) assent''.
According to a study conducted by Erasmus University in Rotterdam there were complications in one in four cases of euthanasia . There were repeated cases of euthanasia patients waking from comas.
Copyright (c) 2000, dpa 28-11-00 1036EST
OUR THANKS TO John Hofsess jh@rights.org and "Nothing But the News" for forwarding this article.
By MARLISE SIMONS
PARIS, Nov. 28 - The Dutch Parliament voted today to allow doctors to help end the lives of seriously ill patients who have asked to die. The bill, which is expected to become law next year, would make the Netherlands the first country to legalize (euthanasia) and doctor-assisted suicide, practices that are already in wide use, though technically a crime.
The lower house approved the bill 104-40; endorsement by the Senate is virtually assured.
The action was immediately criticized by the Vatican. "It is a very sad record for the Netherlands to become first to want to approve a law that goes against human dignity," said the Vatican spokesman, JoaquÃn Navarro-Valls. The law will pose a "very serious question of conscience, which doctors will have to face."
But years of intense debate and opinion polls have shown wide support among the Dutch public and the medical profession for the bill, which aims to clarify and define a practice that is already widely accepted. Dutch doctors have helped thousands of terminally ill people die during the last decade, usually by supplying or administering lethal doses of barbituates.
"Doctors and healers everywhere have helped people put an end to their suffering and helped them die," said Rob Jonquiere, director of the Netherlands Association for Voluntary Euthanasia, which . . . has more than 100,000 members. "This will end a gray area. We don't want something of this importance to go on underground."
The new legislation, which was introduced by the ministers of justice and of health, applies only to physicians and not to others who might help a person die or commit suicide.
It incorporates guidelines drawn up in recent years by the Royal Dutch Medical Association. They stipulate that a patient's request to die must be voluntary and persistent, and made while the person is lucid. The physician must be convinced that the patient is facing interminable and unbearable suffering. The doctor may not suggest death as an option. In all cases, physicians must seek a second medical opinion before helping a patient to die, and they must report the cause of death as euthanasia or suicide.
Physicians will remain accountable for their actions. What is new, as euthanasia is decriminalized, is that physicians will not be accountable to a prosecutor but to a panel of peers, including legal, medical and ethical experts.
Under the new legislation, no one has a right to euthanasia. Every doctor has a right to refuse to cooperate if a patient asks for help to die.
One clause in an earlier draft of the legislation that would have permitted terminally ill children 12 or older to choose to die was dropped after it caused a public outcry. As passed today, the law would require young people from 12 to 16 to have parental consent. From age 16, they may put the question to their doctor without their parents' approval.
The measure is likely to draw particular scrutiny in other countries wrestling with the questions of doctor-assisted suicide and euthanasia.
In Belgium, France and Switzerland, the issue has been under intense debate among legislators and in the news media. In 1996 the Northern Territory in Australia approved, but later revoked, a law allowing medically assisted suicide. In the United States, Oregon permits doctors in certain cases to help patients end their own lives.
In the Netherlands, there have been calls for regulating euthanasia for three decades. These demands increased in 1973, when a doctor brought on the death of her aged, dying mother and was punished symbolically with a one-year suspended sentence.
Since then, few doctors have been been prosecuted. But studies suggest that only half or fewer of the incidents of euthanasia or assisted suicide are reported, implying that doctors misrepresent the actual cause of death.
According to preliminary figures, a reported 2,216 patients were assisted by doctors last year in bringing about death, but the actual number is believed to be closer to 5,000. Almost nine out of ten of the reported cases involved people in the terminal stage of cancer.
At the same time, doctors continue to refuse many requests, either because they are opposed in principle or because they feel the request is not justified. According to national surveys, about two of three people who ask doctors to bring on their deaths are refused.
Although the Netherlands is unusually open to social experiments, the complex moral, ethical and legal issues involved in ending a life keep resurfacing. Polls show that 10 percent of the population, and 10 percent of physicians, are adamantly opposed to the law.
Even those who support the principle of euthanasia or assisted suicide are deeply divided, with some arguing that the law is too restrictive and should allow terminally ill patients to receive life-ending drugs without a doctor's approval.
The new bill did not clearly address the question of patients with dementia or Alzheimer's disease. The current practice is that doctors seek written confirmation of a patient's wish to die. But the question remains what to do when a patient who has written the request while sound of mind is later found to be suffering from dementia.
The Health Ministry said dementia itself can never be a valid reason for ending a person's life. The patient would have to be suffering from intolerable physical pain, it said, and the dementia could only be at a very early stage for a patient's request for euthanasia or assisted suicide to be accepted.
AMSTERDAM (Reuters) Nov 28 - The Dutch lower house of parliament voted Tuesday to legalize euthanasia, the first country to do so, after decades of unofficially tolerating mercy killings.
The vote was 104 to 40, a spokeswoman for the parliament told Reuters.
Australia's Northern Territory legalized medically assisted suicide for terminally ill patients in 1996, but repealed the law the following year.
A series of Dutch court rulings and government guidelines since the 1970s has given more leeway to doctors to help a patient die, but the criminal code was never amended. This gray area left open the possibility of doctors being prosecuted for murder.
Supporters of the Dutch bill, including many doctors, say it champions patients' rights. Opponents, including the opposition Christian Democrats, say they fear it could be abused.
The Dutch parliament set the following guidelines:
The physician must be convinced the patient's request is voluntary and well-considered.
The physician must be convinced the patient is facing unremitting and unbearable suffering.
The patient does not have to be terminally ill. The patient must have a correct and clear understanding of his situation and prognosis.
The physician must reach the conclusion, together with the patient, that there is no reasonable alternative that is acceptable to the patient. The decision to die must be the patient's own.
The physician must consult at least one other independent doctor who has examined the patient.
The physician must carry out the termination of life in a medically appropriate manner.
VATICAN CITY (Reuters English News Service), Nov 28 - The Vatican slammed the Dutch parliament's vote on Tuesday to legalise euthanasia , saying it violated human dignity.
The historic 104-40 vote in Amsterdam's lower chamber made the Netherlands the first country to vote to legalise the controversial practice after decades of unofficially tolerating mercy killings.
The law is expected to be put to a vote in the upper chamber next year. Approval there is seen as a formality.
"It is a very sad record for the Netherlands to become first to want to approve a law that goes against human dignity," said Vatican spokesman Joaquin Navarro-Valls.
"The first problem this law poses is a very serious question of conscience, which doctors will have to face up to," he told Reuters. "Again, we are faced with a law of the state which opposes the natural law of human conscience," he said.
He said the Dutch law went against international declarations on medical ethics that had been adopted for years by the medical community. The Roman Catholic Church teaches that life begins at the moment of conception and ends at the moment of natural death.
