The Netherlands has the most liberal requirements—depression alone is considered a sufficient justification
To offer additional explanation here: the Dutch euthanasia legislation doesn't explicitly enumerate allowed conditions for termination, it merely requires the patient to be experiencing irremediable suffering.
While that may qualify as "most liberal" for the patient, I'm not convinced our legislation is really that progressive: the legislation merely shields a practitioner from homicide charges iff proper procedure is observed. But "proper procedure" cannot be vetted or signed-off before the act; a criminal investigation will always be opened (as it is required for all non-natural deaths), but will be dropped if a medical ethics board agrees (post facto!) with the practitioner's decision.
From the NVVE site (Dutch Society for Voluntary Termination) [1], a practitioner must:
- be convinced the patient's decision is voluntary and well-informed
- be convinced the patient is experiencing irremediable suffering
(literally "indefinite and unbearable suffering")
- inform the patient about their situation and prognosis
- agree with the patient that no acceptable alternatives exist
- collect at least one second opinion (from a non-treating phycisian)
that agrees with all the above
- perform the procedure according to medical standards
Approval really is the wrong word. The (legal) action towards the doctor for assisting in an unnatural death are shelved, if and only if the requirements are met. Clearing someone of wrongdoing is not the same as approving ones actions.
It is an interesting subject, really close to ones personal belief system. A recent documentary, which showed several cases of euthanasia in NL based on 'indefinite and unbearable suffering' of the mind (f.e. one lady was tired of her life at 90+ years), probably confirms opinions on both sides of the debate the same way.
For me, having witnessed two deaths by euthanasia (AIDS) and one without (cancer), I would grant any human the chance to plan their moment of death, even if the suffering is mental.
Since the (psychiatric) problems started 15 years ago, patient had been undergoing treatment, both in-patient and out-patient, from multiple treatment centers, along with intensive medication regiments. Her problems only got worse, and she had developed numerous somatic problems. She was fed through a feeding tube, needed a catheter to help with urination, and required regular colonic irrigations. Additionally, she was suffering from chronic anemia, electrolyte imbalance and renal failure.
Following her initial termination request two years ago, she received intensive trauma therapy. While initially succesful, the improvement proved temporary. Her attending psychiatrist stated there were no treatment options left, and no remaining options to improve her quality of life. This opinion was shared by a second psychiatrist and medical director from another institution. She was put on a palliative track.
Due to wasting syndrome, the patient was severely weakened, completely bed-ridden and required round-the-clock care for every aspect of her life. She continuously felt like she was dying, but death would not take her.
She received two independent assessments prior to termination. The first consultant, a psychiatrist, described her situation as irremediable due to the therapy-resistant disorders. Her deteriorating physical condition also added to her persistent mental anguish. He deemed the patient fully capable and her request for termination realistic and understandable. The second consultant, a general practitioner, confirmed the previous assessment that the patient was fully capable.
(edit: after reading that daily mail article, I'm beginning to see the value in not requiring a lengthy approval process. At least this way, the patients are spared the additional abuse of being used as pawns in a political power play)
You do not need to have Dutch citizenship, but you do need to be living in The Netherlands for at least four months, and you need to be undergoing prolonged treatment (the Dutch term is "behandelrelatie", a treatment relationship, which means you need to be seeing your doctor regularly).
Even then, you still need to find a doctor willing to perform the procedure. If they suspect a foreigner of "termination tourism", they will likely refuse.
There is a FAQ [1, Dutch only] that answers this:
Can a foreigner, living in The Netherlands, receive euthanasia in The Netherlands?
You can, provided you are currently under treatment from a doctor and there are sufficient reasons to consider your request.
Can a foreigner, living abroad, receive euthanasia in The Netherlands?
No, this is not possible; we advise you to contact one of our sister organisations in your own country to query local options. See [2] for contact information.
I don't understand why helping people who want to die is illegal in most countries. It's unfathomable why some people are against that. If I become deeply sick when I am of age I will probably also want to decide when I want to die and not die slowly and painfully.
People who are against letting people choose their own death is having a selfish and evil stance, there is no way to excuse that.
Because then your kids could forge a signature on a fake letter to get your inheritance money.
Because then companies that happen to profit from your death have an incentive to convince you that you should die, using manipulative advertising and marketing.
Because then people who are highly depressed might kill themselves with assistance from a doctor, when an alternate route could cure them.
Because then the doctor might forge evidence showing that you wanted to be killed and it could be hard for the police to track down. Maybe they only use the attack against certain high-reward targets.
Because then somebody who is impulsive might agree to be killed when he would've regretted it later if he were still alive.
I tend to be in favor of this for people who legitimately want to die, but there's something to be said for the simplicity of "The autopsy showed poison, so we have a murder case." I could be convinced to make it illegal if somebody found some really plausible attacks that could be used against me; and could be convinced to make it legal if we found and required a scientific test with a legally-enforcable chain-of-custody that proved I was in my right mind when I asked to be killed.
Those are all valid points. But oddly enough none of them seems to be a problem in Switzerland, where assisted suicide is legal since the 40s (as mentioned in the article).
On a sidenote: You can write a "Patientenverfügung" (loosely transelated: a patient's will), in which you stipulate that you don't want to be kept alive artificially in case of grave illnes.
This is respected by hospitals and doctors. Case in point was my mother, who had terminal cancer. The doctors gave her morphine to ease the pain and otherwise didn't do anything to prolong her suffering.
We have "living wills" in the United States and they're the same thing. The controversial issue is active euthanasia, not passive euthanasia. Mostly, anyway.
But what you describe for your mother is called Hospice here in the US. It is simply a lack of treatment when it is believed that treatment offers more suffering and no better outcome. It is the right of the patient to refuse treatment and enter into hospice care and be kept comfortable until they die. That is not assisted suicide.
That's an excellent point. Obviously we do know sometimes.
But GP's point was that we don't observe bad consequences from the laws in Switzerland, all I'm saying is that it wouldn't show up when someone commits suicide.
You can create legal structures to prevent most stuff like that pretty easily:
* Force everyone who wants assisted death to go through medical discussion alone with physiologists / doctors, require it to be at least 20 sessions or whatever seems enough.
* Only make it available and legal for people with chronic pain or other diseases that make life suck.
* Require several doctors to be present, that don't usually work with eachother or have any other specific connection to eachother.
* Require to let the patient "press" the button that injects the overdose or whatever method is used.
Etc etc. The point is to make the process complicated and to remove any doubt that this person in question didn't want to die. Of course, it isn't completely safe but so is life and that is kind of the point.
What do you do about someone with, say, Alzheimer's, who may want to end their life precisely because they are beginning to drift in and out of lucidity? Maybe Switzerland has it all figured out but it is not that easy.
One potential solution is ahead-of-time decision making.
When young and lucid, make the decision of what criteria would cause you to prefer physician-assisted suicide. Write that down in a document. Allow that document to have legal force.
In the US, we already have the notion of Advanced Health Care Directives, which allow for things like power of attorney, nominating a proxy decision-maker, and criteria were a caretaker is allowed, or even required, to stop providing life-extending treatment. Health care providers generally follow these directives if made aware of them.
Thinking about this sort of thing ahead of time is not something that people want to do. But, for people who do complete one (with sufficiently-rigorous criteria), it solves some of the ethical issues around consent and incapacity.
By the way, I strongly recommend more people complete an AHCD. I had to care for a close relative at the end of her life, and the fact that her wishes were written down on paper was an incomparable gift to me. This should really become more routine.
Go through the process and let death take you. It's better to help some people than to help no one at all. I don't have the perfect protocol of such a process, I am just writing an example to prove that my original point is valid.
I think people that have Alzheimer's and want to die should be able to be assisted.
OK, but you are sidestepping the issue here. As you've said, if you accept active euthanasia you'd probably consider the deterioration of Alzheimer's an acceptable reason. And most people take informed and uncoerced consent as important to the process. And yet how do you ensure that consent with someone who is losing their mental faculties?
As someone with experience of a relative with Alzheimer's, it's completely clear in every possible way that informed consent is no longer an option.
Alzheimer's creates a mental handicap that makes normal adult functioning impossible. You can literally ask the same question twice in two minutes and get two conflicting answers - with no memory of the previous answer, or even that the question was asked before.
In mid-stage Alzheimer's memory is so impaired that it's literally shorter than a spoken sentence. In late Alzheimer's even that disappears.
The solution in the UK is to hand over care decisions by Power of Attorney. If no relative is available for that, decisions are handed over to care and medical staff.
If assisted death is ever an option in the UK, it would have to be written into a living will while informed consent was still possible.
Obviously there are huge legal issues with that, especially if there's an inheritance involved.
That aside, people really do get to the point where they just want to die.
I've seen it twice now. In one case it was very clear indeed, and had been clear for at least a couple of years. In another it was less clear, but it was something my relative talked about openly.
Personally, having seen cancer and Alzheimer's close up, I'm really not convinced I'd want to wait around for a natural death from either.
I think most people would have a hard time accepting active euthanasia one the basis of documents prepared in the past, particularly when you consider the significant possibility of duress, forgery, etc.
Forgery - require a notarized document, a video, etc. Tons of documentation, why not.
Duress - could apply equally to euthanasia today too, couldn't it? If not, then take whatever magical anti-duress method we use now and apply it to this.
No. Alzheimer's is a form of dementia. Here is the description of "moderate" symptoms from Wikipedia:
> Behavioural and neuropsychiatric changes become more prevalent. Common manifestations are wandering, irritability and labile affect, leading to crying, outbursts of unpremeditated aggression, or resistance to caregiving.[26] Sundowning can also appear.[31] Approximately 30% of people with AD develop illusionary misidentifications and other delusional symptoms.[26] Subjects also lose insight of their disease process and limitations (anosognosia).[26] Urinary incontinence can develop.[26] These symptoms create stress for relatives and carers, which can be reduced by moving the person from home care to other long-term care facilities.[26][32]
The first one is hard to fix, actually. Family can be really shitty to you, to the point you feel useless and unwanted and really want to be gone. People do that to their parents today, and elderly commit suicide for that reason today!
Clinically available assisted suicide could further embolden people to be really terrible to their elderly parents, and private screening with a doctor doesn't fix this.
Per your second point, there is certainly a strong profit motive for keeping terminally-ill patients alive longer than they otherwise might want on the part of health-care providers. End-of-life care costs are no joke.
While it is true that end-of-life care costs are indeed out of control, to say that there is a "strong profit motive" for keeping terminally-ill patients alive seems to me a very, very cynical view.
One concern is, what if the person doesn't really want to die but the "care"givers want their ordeal to be over, or want to collect an inheritance, or collect an inheritance before it's all gobbled up by end-of-life care?
In genuine cases of wanting out, I support it, but I'm not sure how to design the right controls around it to be fully comfortable with it.
Note: It probably doesn't just bankrupt old people here… I've seen whole families affected by last-ditch efforts to squeeze out a few more months. Second mortgages. College funds. It's horrifying. (live in US, from Europe)
I think it's related to christian morality.
They belive something along the lines of "God gave you your life and only Him can decide when it should end"
It's mostly a vestige of religion. Life is considered sacred and it is not supposed to be your own choice whether you want to live or die but up to god in some form or other.
This then became enshrined in law as well as in medical practice (though in medicine there has long been a recognition that not all life extending medical practice is compatible with medical ethics doctors are still bound by the laws of the land and in plenty of cases doctors that assisted with suicide have been charged with murder).
Quite a few countries have now moved to the point where in the case of grave illness or pain you have the ability to request an end to your life.
There are plenty of fathomable reasons why some people are against that, just as there are plenty of fathomable reasons why others are for it. Anyone who professes not to understand half of a debate might reconsider their confidence on the issue.
Libertarian here, so I'm comfortable with people owning their own bodies and being solely responsible for what they do with it.
Having said that, I'd like to make the case for keeping it illegal because I believe there's a strong case to be made. Killing yourself should be a unique, extraordinary event in both your life and the lives of those around you. We should never make a system out of killing people, because systems can be gamed.
In a way, this is much the same discussion as the old "would you torture a terrorist to determine where a nuclear bomb was waiting to go off?"
Yes. Yes I would. I would consider such an act to be horribly immoral, and I might regret it to the day I die, but yes, I would. Likewise I'd take my own life or help people I love take theirs -- but I would worry over whether I did the right thing or not. If I were a religious person, I might consider my act immoral. But I'd still do it.
Once you create a system out of killing people -- people go in one side, forms get filled out, and dead people come out the other -- you've taken a step towards the state arbitrarily deciding who lives or dies based on its own system of value and not the individual's. So in a way, you give up much more in this fashion than if you simply outlawed it and never prosecuted. (Which is probably what happens 90% of the time in countries where assisted suicide is illegal.)
So yeah, I'd torture the terrorist. But I'd raise holy hell for any system of government where torture was a accepted way of doing things. Good grief, can you imagine what just a little tweaking would do to a system like that?
Speeding is illegal. If you want to speed on the way to the hospital because somebody you love is in danger? Speed. By all means, speed. I'll be the first person to protest any law enforcement person that tries to stop you.
But speeding should probably still be illegal for systemic reasons not related at all to your loved one being ill.
My stance is that I have that right. So do others.
I made an argument that from a systemic standpoint, it's better to make illegal and never prosecute than it is to create a governmental machine around it.
Please understand, I'm perfectly happy with it being legal. I'm simply trying to describe why there's a strong case for it remaining illegal (and un-prosecuted)
You realize that we're not talking about people freely deciding what to do with themselves, right? What we're talking about is a bunch of new laws, committees, and processes where a person's life can be terminated, sometimes directly by the state. I'd think this is a much worse situation than simply having officials look the other way.
If we were talking about removing all laws around what folks do with their lives, that'd be a different thing entirely. That's where we should be. But nobody is talking about that.
Funny how those who talk this sort of high and mighty talk rarely walk the walk.
Selective enforcement of laws is evil, unreliable and stupid - it's counter to the very reason we have laws.
I want it to be legal to end one's own life because the consequences of that choice are hard enough on one's family and loved ones. It need not be made harder.
What sort of choice do you want your family to face when it's your turn? Do you really want their hands tied by the risk of imprisonment when your time comes?
You may find this amazing, but not everyone shares your world view.
No one wants to suffer. And no one wants to see other people suffer. But the truth is suffering is a part of life.
Some people I know and love have suffered their last few years of life. And other people I know and love have taken their own lives. My personal experience is that the individuals who allowed death to come on its terms, instead of rushing to that conclusion, left everyone around them with more strength, peace, happiness, and personal growth.
The people who ended their life because they didn't want to suffer anymore left a wake of suffering and trouble around them when they went.
It's unfathomable why you wouldn't see the difference.
I don't find that amazing, because I knew it already.
As I wrote in my original post:
> People who are against letting people choose their own death is having a selfish and evil stance, there is no way to excuse that.
I understand that people oppose such freedoms, but I find it to be selfish and evil. Just look what you wrote:
> left everyone around them with more strength, peace, happiness, and personal growth.
Not everyone suffers to the same extent or has family and close friends at the end. The goal should be a life worth living not a continuation of cellular activity.
It's a failure of empathy to equate emotional pain that was going to happen anyway with the kind of pain drugs can't deal with. I really can't equate your stance to anything but sadism on a massive scale. Suffer, so I can avoid feeling bad for a little while and pretend the end is not so bad.
Beautiful story. I have several friends in the Netherlands whose parents (terminally ill, i.e. MLS, cancer) opted for euthanasia. They were all happy with the process and the outcome.
Unless advances in immunotherapy significantly change the outlook, I'd rather move back to my home country for a dignified death on my own terms.
I've seen too many cases where several rounds of chemo extended life by just a few months under dismal circumstances for the patient and their family. Lives revolved around hospital visits while -- depending on the type/stage/location of cancer -- chances of recovery are slim to none. False hope and misery. Bankruptcy. Why bother?
While I personally, regardless my health would never end my life...
...anyone that believes they would be able to deal level of suffering, mindlessness, toll on friends & family, etc. - should try experiencing it for themselves to see if they would be able to deal with it and provide aid to those they've forced to live on.
Everyone should have the right to die, to believe otherwise is inhuman.
Take luck out of the picture. Learn how to meditate. I find that when the suckiness of mortality intrudes upon my thoughts, twenty minutes of meditation clears my mind and prepares it for handling more immediate concerns.
Being trapped in negative patterns of thought can be unhealthy. It's best to break those patterns. Exercise is also very helpful.
Do you recommend looking into any specific more complicated theory or guidance into meditation, or do you think it's sufficient to focus on breathing while letting thoughts flow and be?
Each person's causes and conditions are different, so each bit of guidance has to be tailored to them. That said, I have found great support in Shambhala International. It's a Western Buddhist tradition grounded in the Vajrayana from Tibet. You can find a Center here: http://shambhala.org/centres/find-shambhala-centre/
One excellent text that comes from one of the parent lineages of Shambhala is the Tibetan Book of the Dead, which is basically a preparation for the Bardo, or the "in-between" stages after life. You can read more here: https://en.wikipedia.org/wiki/Bardo_Thodol
For Tibetans, the practice of meditation is simply the practice of preparing for death. You are becoming familiar with your mind so you will be able to see through the delusions that arise when your mindstream is no longer attached to a physical body.
Of course, you don't necessarily have to believe in rebirth to find value in these traditions. I have found the community aspects of Shambhala to be quite supportive, even when I had doubts, which in this tradition are expected to be plentiful, and are celebrated.
Here's a way of thinking about it that might make it a little lighter. First, you have to understand that the version of you at this moment is different from the version of you yesterday. You don't feel what you felt yesterday. All that is left are memories, which are somehow engraved in your brain. The part of you that survives is purely physical. So in a sense, dying and living are the same thing: you die at every femtosecond of living. Dying is not special. You (as anyone else) have been doing it for many years now.
If this doesn't work for you, then consider the following. We are all living beings, and sometimes some of us die, and sometimes new beings are born. But who says that those living beings aren't just one big living being? Our brains tell us so. But this view is only an artifact of the brain. If our brains were all interconnected more strongly, then I bet our brains would view us as one living being. So what you can take from this is that dying is just like losing a few brain cells. This is also something that you have been doing for years (in fact billions of years). So in this view, you never die until, of course, the universe ends.
This is an interesting theory that has its roots in solipsism: the belief the world vanishes the moment you close your eyes. The fact of the matter is that it (and solipsism) just don't seem to be true, not even to solipsists. If you truly believed you were dying at every second, you'd act in all sorts of ways against your long term survival, but here you are posting on the internet.
Even if we take the position as true, it seems entirely reasonable to perceive the end of the "chain" of "yous" to be a tragic event.
> But who says that those living beings aren't just one big living being? Our brains tell us so.
Well, our brains, as well as the general evidence we see in the world around us. If we were one giant interconnected entity, dying would probably be very different. However, there's very little reason to assume that as a given - I can't talk to my dead relatives through any of my living ones.
I think this argument is perhaps more simply stated as "you were never a large part of the human race, so your death will not matter in a large way either" which is quite true, in fact. My counterpoint would be that the death of the individual rightly remains terrifying to that individual. If I were the human race, I would correctly not concern myself with the death of a few of my brain cells (and I do not, regarding my own real brain cells), but I would regard the death of the human race (myself) as truly important.
I personally don't like thinking that I'm just one part of something much bigger. Yes it IS true, but I consider myself too uniquely different from every other person in this world. It's not vanity, because it's the same for everyone else. No matter who or where you are, you are a universe of its own. You have a mind and a character that will always be different and will never be fully comprehended by others - a snowflake, yeah I get that's cliché but it's true. And imagine that no matter how many billions of snowflakes there are, each one is different from another. Now that's mind-boggling. Whenever I get the "death dread", I think of this, and remember what a privilege it is to be in this world and experience these 'universes' - no matter how brief life may be.
Let's look at it another way, the enormity of death shows us the precious value of being alive. GO out and live your life! Go do what makes you happy and feel alive. If you couldn't die, you wouldn't know you were alive, like a rock.
Many of those who have come close to death claim to feel more alive than they ever have, unless they are drugged out by pain killers and such.
The doctor's response to the question if he'd recommend her mother to go through cancer treatment reminded me a lot of https://news.ycombinator.com/item?id=3313570 [How Doctors Die]... why is the standard answer still to make people suffer for extending their life just a few months or years?
> The doctor's response to the question if he'd recommend her mother to go through cancer treatment reminded me a lot of https://news.ycombinator.com/item?id=3313570 [How Doctors Die]...
Though I can't think of anything strongly against Switzerland at the moment, this is another reason for me to despise governments and law... where one can't even aid someone in ending their unnecessary, completely pointless suffering without getting their life ruined? Yet states often reserve the hypocritical "right" to execute the death penalty.
A sad read, worth it.
Lets flip the coin for a moment. Supposing you had a 30 year old family member who wanted to die. The choice she gives you is, i'll hang myself or jump in front of a moving car.. or you can let me die with my family surrounding me peacefully. Would you do it?
Note there is no mention of why she wants to die. If there is a cure or it can be fixed will you go along with it?
That seems like a rather unlikely scenario. People don't just decide they want to die on a whim. And it's not like in countries with legalized euthanasia you can just go to a doctor tomorrow morning, declare you're not feeling so well, and you'll be scheduled for termination later that afternoon.
I for one would not assist in any suicide without knowing why someone wants to die, and given that my country has a process that allows for legal euthanasia, I'm not sure why your hypothetical family member would ask me to commit this crime rather than going through official channels, especially since we are apparently so estranged that I was completely unaware of her struggles and death wish until this request. The best I can do in your scenario is warn the authorities of the suicide risk, and recommend that she does not throw herself in front of a car or train, because it's so extremely inconsiderate towards the driver and/or passengers, and is that really the way you wish to go / be remembered?
Oh, and perhaps recommend that if for whatever reason she does find the opportunity to kill herself, don't try to poison yourself unless you really know what you're doing. Killing yourself with an overdose of painkillers sounds like a really good idea at first, but it's likely that hanging yourself or cutting your wrists doesn't seem like such a bad way to go in hindsight, when you're dying of liver failure over the next few days.
Saddens me that we still cannot find solutions to bring them back to healthy. Instead of spending too much time on how law can understand it, we should find way to remove hurdles for medicine to progress.
Why? They haven't even proven human revival is possible. Until they do it is nothing more than vaporware. More of a scam. And this statement... "We believe that the damage caused by current cryopreservation is limited and can someday be repaired in the future." I don't really care what you believe when selling a scientific solution. What is proven? Why do you believe that? Good marketing? Actual data that shows it is limited?
But hey, by the time they fail to prove it correct you'll be dead and have no recourse or care. Thanks for the money.
If you're waiting for revival to be shown then your missing the point. The whole idea is to halt decay while there are problems that can't be solved yet. It's an ambulance ride to the future.
I did read part of the article but didn't finish because it is too depressing to read about someone murdering family out of ignorance. Thanks for letting me know how it ended.
To offer additional explanation here: the Dutch euthanasia legislation doesn't explicitly enumerate allowed conditions for termination, it merely requires the patient to be experiencing irremediable suffering.
While that may qualify as "most liberal" for the patient, I'm not convinced our legislation is really that progressive: the legislation merely shields a practitioner from homicide charges iff proper procedure is observed. But "proper procedure" cannot be vetted or signed-off before the act; a criminal investigation will always be opened (as it is required for all non-natural deaths), but will be dropped if a medical ethics board agrees (post facto!) with the practitioner's decision.
From the NVVE site (Dutch Society for Voluntary Termination) [1], a practitioner must:
[1] https://www.nvve.nl/wat-euthanasie/zorgvuldige-uitvoering