BOOK REVIEW News Weekly
Dutch warning on where euthanasia leads
, March 28, 2015
DO YOU CALL THIS A LIFE?
Blurred Boundaries in the Netherlands’ Right-to-Die Laws
by Gerbert van Loenen
(Ontario, Canada: Ross Lattner)
Paperback: 208 pages
Reviewed by Paul Russell
“What do you want to do when you leave school?” A casual conversation starter I think I’ve probably had with each of my children at some point — even repeatedly. It had an additional context when I raised it with Joseph recently in a quiet moment.
Joseph, in his 14 years, has had probably more prospective careers than most of us could think of, ranging from a long period when he was convinced he would be a priest to only recently wanting to “go into business” operating a pizzeria out of our kitchen (Mum had other ideas!).
Sometimes this kind of exchange is simply banter — a time-filler exploring the thoughts and ideas of a child with ever-expanding horizons as the world opens up before him or her.
“A firefighter, Dad!”, to which I reply: “But Joseph, the fire brigade probably won’t accept someone with Down syndrome, mate. It just won’t happen.”
Okay — I know! That sounds like a harsh response, but it’s not. Joseph and I have great conversations about all sorts of things; and I am confirmed in my belief that, as he grows up, like all children, he needs to learn to make distinctions between daydreams and reality.
My wife Anne and I are also as firmly committed to providing him with the very best educational and emotional platform we can. But we’ve done that for all our children, so that’s hardly surprising, even if fleshing that out requires a somewhat different approach from the others.
The question of disability is a consistent theme throughout Dutch author Gerbert van Loenen’s book, Do You Call This a Life? Blurred Boundaries in the Netherlands’ Right-to-Die Laws.
Ostensibly chronicling and analysing the history and progression of the Dutch experience with euthanasia, van Loenen in his crisp prose refers constantly to the challenging and changing of concepts in Dutch academia and politics in relation to the worth of human life.
In summary, he says that once human life is valued only in subjective terms of relative merit or worth, there is an inexorable extension of application of euthanasia laws, from a limited cohort to almost anyone.
It is unfortunately all too common an experience of those living with disability and their families that there will have been occasions when the kind of subjective evaluation, “I would rather be dead than…”, raises its ugly head.
The Dutch are not alone here. But what the Dutch and the Belgians have effectively done with their respective euthanasia laws is enshrine the “Life Unworthy of Life” principle in both law and practice in respect to the most grave of matters: life and death.
I asked a Belgian colleague recently why there has been no apparent organised rebuttal of their euthanasia laws from the Belgian disability community. After all, such organisations exist every-where that euthanasia and assisted suicide laws have been debated in recent years, and the “disability voice” is a potent force.
He answered by saying that people living with disability in his country are well respected and have excellent supports focussed on helping people achieve their potential and independence. Good news! But he then added the caveat to the effect that the focus on achieving potential is highly utilitarian; that those who cannot jump this high hurdle in Belgian society are shunned and have no voice — echoes of the “useless eaters” of an earlier European society.
Van Loenen says something similarly chilling about Dutch society: “[Dutch] ethicist Hans Reinders describes how the physicians’ views on what makes life valuable may influence how they deal with their patients.
“Physicians and caregivers might believe that the valuable life consists in each individual developing into something greater. Writing about the care of people with mental disabilities, Reinders noted the tendency of caregivers to want these dependent individuals to develop, even the severely handicapped ones. If caregivers apply this way of thinking, it implies that the treatment must help the disabled individual improve.
“When this proves impossible, medical staff are confronted with their own limits. This is uncomfortable. Reinders quotes the German remedial educationalist Emil Kolb, who describes this phenomenon: ‘When there is nothing more to examine or to do, the researchers and doers are confronted with the possible futility of their own actions. And this must not be allowed to happen!’ Physicians cannot allow the disabled individual to simply be; they must help him to develop. Emil Kolb summarises this belief: ‘What does not become something, is nothing’.
“It is important how a physician views his own life, says Reinders, because this view affects the physician’s ideas on the value of a dependent disabled life. People who consider their own development and independence to be important and who see themselves as the author, creator of their own life story, filled with choices and possibilities, will have a problem with individuals who are dependent on other people and experience no development at all. ‘From the perspective of people who view their own existence as a project of which they themselves … are the author, a severely disabled life must inevitably seem completely pointless. A condition that appears to them like death, even if it does not coincide with it’.”
The Dutch and Belgians have comprehensively failed to make the distinction between human potential and the intrinsic dignity of the human person: What does not become something, is nothing. Indeed. Even the idea of “development and independence” here is tainted, because such development is not seen as a good end in itself but rather an expectation placed upon an individual by these societies, for membership.
Of course Anne and I want Joseph to experience the good things of life to the greatest extent possible; but not because access, equity and achievement provide a justification for his existence!
Van Loenen, an academic, writer and editor, presents us with a compelling and well-written look at the history and experience of the “Dutch experiment” that serves as a necessary warning to other jurisdictions. As Dutch Professor Theo Boer recently warned: “Don’t go there.”
The Canadian publisher of this first English translation from the original Dutch text deserves heartfelt thanks. Many outside Holland will be aware of the markers on the progress of the “Dutch experiment”; but few, including this present reviewer, will have previously had access to the breadth of activity and academic complicity that developed over the period before the 2001 passage of the Dutch law permitting both euthanasia and assisted suicide, and afterwards.
Van Loenen traces the beginning of the Dutch flirtation with euthanasia back to the appearance of a book, Medische macht en medische ethiek [Medical power and medical ethics] in 1969. According to van Loenen, the author, physician and scientist, Jan Hendrik van den Berg, started the Netherlands thinking about what he termed the sense and nonsense of differing courses of medical action.
The point Van den Berg tried to make in 1969 was that a distinction should be made between meaningful and meaningless life, says van Loenen.
“Van den Berg’s influential booklet bears this striking feature: disabled and ill individuals are only examples, objects in an argument. Whether they are mentally competent or not, able to speak or not, Van den Berg never gives them a voice. They are merely objects in a display of what medical power can lead to. Look, these people are still alive, but should we be pleased about it? Wouldn’t it have been better if the physician had never treated them? Wouldn’t it be better if the physician would let them or cause them to die now?”
Naysayers will click their tongues disapprovingly at the comparison of the beginnings of the Nazi Aktion T4 extermination program that saw the destruction of 75,000 disabled persons in three years, with this beginning of the “Dutch experiment” with euthanasia.
There is, however, a striking similarity between the effect on Dutch thinking that van Loenen attributes to Van den Berg’s book and that of the 1920 German book by Karl Binding and Alfred Hoche, entitled Allowing the Destruction of Life Unworthy of Life. Van den Berg, in his 1969 book, discussed various “hard cases” that, by van Loenen’s description, readily remind one of the first Nazi euthanasia case by decree of Hitler of “baby Knauer” in 1938.
Anthony Horvath, executive director of Athanatos, a Christian apologetics ministry based in Greenwood, Wisconsin, wrote a foreword to a 2012 English translation of Binding and Hoche’s book. Horvath made the observation that it was the authors’ couching of the discussion in pseudo-scientific terms that created its irresistible appeal for the Nazis. It enabled this otherwise outrageous proposition to be reconciled with German domestic law at a time in history when the economics of disposing of those whose very existence came at significant cost to society created an additional “rational” reason to proceed.
In what could just as easily apply to Van den Berg’s writings, Horvath summarised the errors that flowed from Binding and Hoche’s ideology:
• Deference to “experts”, including deference by “experts” to other “experts”, is dangerous.
• Allowing ethical considerations regarding life and death to be linked to the interests of the “social organism” (society or the state) is dangerous.
• Believing that there is one set of moral principles for the “individual” and another set for the “social organism” is dangerous.
• Asserting that certain ethical considerations, behaviours and attitudes flow directly from scientific data is dangerous.
• Behaving as though ideas — even grotesque, inhuman, ideas — can be carefully considered for their relative merits as though they have no consequences or implications is dangerous.
Van Loenen’s interest in this subject began at the time his partner, Niek, suffered a debilitating brain injury. He writes: “I started writing [this book] when circumstances changed me from an average Dutchman who thought of euthanasia as one of the crown jewels of our liberal country into someone who was shocked by the harsh tone used by the Dutch when they talk about handicapped life.” He recounts his experiences in chapter 8.
Here he gives us an insight into why he began this huge undertaking. The story underlines the significance of the work and provides the reader with a poignant context; but, in keeping with an obvious adherence to academic rigour, the rest of the text is scrupulously objective and avoids rhetoric.
Having said that, I would add that Do You Call this a Life? is no dry academic tome. Far from it! It is a lucid, yet compelling, read. It deserves to be on the bookshelves of every library and should be a compulsory text for students and politicians alike.
Ultimately, it is the story of a series of inexorable compounding errors based upon a false and dangerous premise. We should all learn to fear such an outcome.
Doctors deliberately killing their patients have been anathema in the profession since Hippocrates. Yet this time-honoured insight seems, sometimes, to be missing from this debate in talking about self-evident errors and where they may lead.
Van Loenen recently made a very telling point along these lines in a talk he gave in the United States. He said: “Making euthanasia and physician-assisted suicide legal started a development we did not foresee. The old limit ‘thou shalt not kill’ was abandoned, a new limit is yet to be found.”
Paul Russell is executive director of the Australian network, HOPE: Preventing Euthanasia & Assisted Suicide www.NoEuthanasia.org.au, and vice-chairman of the Euthanasia Prevention Coalition (EPC) International. The book is available at http://NoEuthanasia.org.au/books.html
The Euthanasia Prevention Coalition (EPC) International is hosting its first international symposium in the southern hemisphere. (Previous symposia have been held in New York, Vancouver, Edinburgh and Toronto).
Join us for an event not to be missed, featuring a dynamic mix of local and international speakers covering a wide range of topics all designed to help build our opposition to euthanasia and assisted suicide.
• Alex Schadenberg, international chairman of the Euthanasia Prevention Coalition (EPC) International. Its headquarters are in London, Ontario, Canada.
• Paul Russell, executive director of the Australian network, HOPE: Preventing Euthanasia & Assisted Suicide, and vice-chairman of EPC International.
• Renée Joubert, executive officer of Euthanasia-Free New Zealand.
• Dr Theo Boer, professor of ethics at the Protestant Theological University at Groningen.
• Dr Nick Cooling, senior lecturer at the University of Tasmania’s school of medicine. He has worked in medical education for over 15 years, including as Director of Training of the GP Training Program in Tasmania for eight years.
• Dr Paul Dunne AM, former head of palliative medicine in Tasmania and a senior palliative-care specialist with over 20 years’ experience.
• Sue Hanson, national director of Clinical Services for Calvary Care and chair of the palliative care National Standards Assessment Program (NSAP) steering committee.
• Craig Wallace, convenor of Lives Worth Living, a disability advocacy group speaking out about euthanasia and eugenics, and president of People with Disability Australia (PWDA).
• Nic Steenhout, executive director of Vivre dans la Dignité (Living With Dignity) in Montreal, Canada.
• Henk Reitsema, Dutch ethicist, trustee of L’Abri Fellowship International and involved with launching EPC-Europe.
• Dr Tom Mortier, author and lecturer in chemistry at Leuven University College, Belgium.
• Nancy Elliott, a former three-term New Hampshire State Representative, and organiser of Living With Dignity — New Hampshire.
Information on registration fees, conference dinner and accommodation is available online at: http://conf.noeuthanasia.org.au/