Assisted Suicide In The Netherlands: A Tale Of Two Women

My home country, Holland, is famous for its tulips, clogs, windmills and cheese. Those are not the reasons this tiny patch of land appears in the news so often, though — that has more to do with its controversial stance on issues like decriminalized marijuana, homebirth, legal sex work, and... euthanasia.

Currently legalized in three European Union countries — Belgium and Luxemburg as well as the Netherlands — assisted suicide is something many people are quick to condemn. My own feelings are a little mixed too, if I have to be honest. Indeed, ending life by appointment comes with a goosebump-inducing factor. At first sight, it may appear to be an invasion on the sacredness of human life. Assisted suicide is so much more than a political issue, however. It is about the dignified end of people who are losing their faculties or are in an awful lot of pain. It is about honoring the wishes of those who simply don't want to go on.

Euthanasia In Holland: The Procedure

The Dutch "euthanasia law" allows physicians to assist patients end their lives, if they meet certain conditions. Euthanasia and assistance with suicide is permitted solely under the following circumstances:

• The physician is satisfied that the patient's request to end their life was made voluntarily of their own will, and carefully considered.
• The patient's suffering is unbearable and not improvable.
• The physician has fully informed the patient of their situation and prognosis.
• The physician and patient collaboratively concluded that there is no other reasonable solution. 
• The physician has consulted at least one other, independent, physician, who has also met with the patient. This second physician has given a written report about the situation and consented to the patient's wish to end their life, in accordance with the law.
• The physician has to offer the assistance with suicide in a careful, ethical manner. 

Euthanasia requests can be considered only if they are made by the patient themselves, not by relatives or friends. The latter can only bring the patient's "declaration of intent" to the physician's attention. It's important to understand that assisted suicide is neither a patient's right nor a physician's obligation under Dutch law. Physicians who don't feel comfortable participating in ending patients' lives do not have to do so, and can instead refer the case to another doctor.

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What does this look like in practice? Over the last few years, I've encountered two cases in which people strongly preferred a dignified death over a life they thought was no longer worth living. First, I'll share what happened to my friend's daughter. Then, I'll share what happened to my friend herself. While my friend's daughter was granted her wish to end her life and ended up with a physician-assisted death, my friend's request to die was declined. Her road was longer, despite the fact that her wish to die was even stronger. 

Suzanne's Doctor-Assisted Road To Death

Suzanne — my dear friend Danielle's daughter — was diagnosed with Pick's Disease, a rare form of dementia similar to Alzheimer's, when she was 57-years old. While medication can delay the progression of the disease, there is no cure for Pick's Disease. This condition progressively and inevitably robs patients of their independence and cognitive awareness. Being a very independent individual, Suzanne didn't like the prognosis much and wanted to die a humane death before her disease took her dignity away. 

She opted to set up a "statement of intent" declaring her wishes in the early stages of the disease, while she was still able to make legal decisions for herself. She discussed her wish to die in dignity with her partner at length. While nobody likes the thought of their significant other dying, he understood that Suzanne did not want to live her last days in a daze, completely dependent on him and the healthcare system. After a lot of discussion, he was very supportive of her choice. The next step was a discussion with her family doctor. Family doctors are always the first line of care in the Netherlands. They make key decisions together with patients, and refer to specialists only when necessary.

Suzanne's doctor was happy to help her reach a dignified end and prevent further suffering at the point where her life quality rapidly declined, but another doctor had to be found to approve Suzanne for physician-assisted suicide. In her case, this was a psychiatrist. The psychiatrist talked to Suzanne in private, without her partner, to discuss her wishes and to make sure euthanasia is truly what she wanted.

When the moment came that Suzanne found she could no longer play the piano, or remember her musical pieces, or even be alone at home any more because she'd wander the streets in confusion, or take care of her personal hygiene, she and her partner decided it was time. She still had lucid moments, but Suzanne had had enough.

Suzanne was surrounded by all her friends and family on the day of her death. It happened during one of her relatively good days, and she threw a party. Everyone had a nice time, though the atmosphere was melancholic. She folded a hundred origami cranes to give to her loved-ones, and she did manage to play a short piece on the piano. 

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Then, her mom, husband, and the two doctors went into a small side room that had been specially prepped. The doctor first administered a sleeping drug, and then the injection that caused her death. It only took about 10 minutes, and she went into her death smiling. She was 59 years old. 

Danielle: Terminal Dehydration After Her Euthanasia Request Was Declined

Suzanne's mom Danielle, my friend, was one strong lady. Earlier in life, she had survived and managed to escape an abusive marriage. Later on, her life's mission became to care for her new husband, who was disabled. When she was in her 90s, she felt that she had lived long enough and nothing else could be added. 

Danielle had progressive macular degeneration that left her unable to see much at all despite treatment. She also had heart problems, and she used to faint so frequently that carrying out everyday tasks like shopping and paying bills became difficult. She gradually became unable to look after her husband, and felt she had contributed all she could to the world. 

Then, she had a really bad spell in which her mobility declined and she could not get out of bed any more. Because her husband could not take care of her, she and her healthcare team decided to go the hospice route. Her family doctor was willing to participate in aiding her with her suicide wish but because you need a second opinion, it did not go ahead. Several appointments were set up, but the doctors decided she did not qualify.

Consultants at the hospice advised her about the possibilities. She decided to go with "terminal dehydration", which means hardly any water and little to no food. The volunteers at the hospice were wonderful to her. They waited on her hand and foot, sat with her, and made coffee and tea for her visitors. Danielle had her sons and other relatives with her over the duration of the terminal dehydration period, which lasted about 25 days. 

She got weaker and weaker, but was very happy the whole time. Danielle was ecstatic that she could finally peacefully leave this world. Her mouth was kept wet with little sips of water or by sucking on a fruit, so she would be comfortable. During the process, she was able to say goodbye to everyone, give everyone a personal keepsake, and divide her possessions up.

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There was some uncertainty about whether they wanted her body or not. When they decided they did, Danielle was very happy that she could donate her body to science, so she could still be useful in some way. In her final goodbye, her body was driven past her house in a hearse. At her request, she was wrapped in her favorite batik cloth.