The American debate about medically assisted dying

A recent poll showed that 77 percent of Oregonians favor their Death With Dignity law, which permits doctors to provide terminally ill patients with medication that they may take if they choose to hasten death. The law in Oregon has been in effect for 14 years, and the evidence is clear that it is used sparingly and exactly as intended. A similar law has been in effect in Washington for three years, and is also popular. Evidently, where the public is familiar with the practice, Americans approve of it, just as the Dutch, Belgians and Swiss approve of their euthanasia laws. (Note that the laws in Oregon and Washington do not permit euthanasia, that is, the injection of a lethal medication by a doctor, only the right of certain patients to end their own lives by swallowing medication provided by their doctors.)

But it's not just lack of familiarity. There are two other reasons for the greater opposition in the U. S.

First, repeated surveys have shown that Americans are much more religious than Europeans and Canadians. In particular, the Catholic Church, as a matter of doctrine, is strongly opposed to helping patients in this way, no matter how great the suffering at the end of life. Church leaders often frame the issue as life versus death, but the real issue is the manner of dying, since the laws in Oregon and Washington apply only to patients who are unlikely to survive more than six months.

And second, Americans are more distrustful of their health care system -- for good reason. They are well aware that insurance companies increase their profits by stinting on medical services, and they suspect that the new health care law will also stint on services to rein in Medicare costs. So any practice that might save money raises the specter of rationing. In Europe and Canada, where there is universal, comprehensive and largely nonprofit health care, there is much less worry about abuse of right-to-die laws.

How and when to end one’s life should be a decision that a competent adult makes in consultation with his family and his doctors.

Unfortunately, most Americans still do not have this option. Some conservative political and religious figures, many also associated with the anti-abortion movement, have embraced opposition to assisted suicide as part of a broader “culture war” against progressive bioethics. At the same time, organizations like “Not Dead Yet” unfairly attempt to link voluntary assisted suicide with involuntary euthanasia. Although many religious leaders and disability-rights advocates favor assisted suicide, a public perception remains that these communities are opposed to legalization.

Alarmist predictions that assisted suicide will lead to the murder of vulnerable patients scare the public and poison debate on the subject. If many Americans remain uncomfortable with assisted suicide -- and polling data consistently shows that about half of us still do -- it is because they mistakenly believe that it will lead to forcible euthanasia of the disabled or elderly.

The more Americans know about the right-to-die movement, including the safeguards that reasonable people believe should be imposed as part of any system of consensual assisted suicide, the sooner aid-in-dying will be legalized in this country. A freedom-loving people would not want it any other way.

In 1996, the Northern Territory of Australia one of the most secular places in one of the world's most secular countries -- became the first place in the world to legalize voluntary euthanasia. In 2002, when the Netherlands legalized voluntary euthanasia, more than 40 percent of the Dutch denied any religious allegiance and only half claimed to be Christians. Oregon, the first U.S. state to allow assisted suicide, claimed that its lack of status as a "church state" meant that it had a unique moral flexibility.

Now more than a decade later, Australia has over-rode its north’s truancy, Oregon's enlightenment has spread ever so slightly to next door Washington, and three other states -- Massachusetts, New York and Pennsylvania -- have laws pending. Meanwhile, the Dutch have progressed the debate almost beyond recognition, suggesting end of life choices should not be the domain simply of the terminally ill.

As long as religion plays an important role in the lives of Americans, assisted suicide and voluntary euthanasia will be controversial in the United States. If the right to die is to become an elective option in the U.S. in the same way chemotherapy or radiation are for those with cancer, the starting point must be a reclaiming of control over one’s body from God.

How the Dutch Are Different

Petra M. de Jong, a pulmonologist, is the head of Right to Die Netherlands.

In the Netherlands, euthanasia and assisted suicide have been regulated by law since 2002. Euthanasia has been openly debated since the 1970s, by doctors, patients, attorneys, judges and politicians. This has been a decades-long process. Slowly, the legal system here became more lenient toward doctors performing euthanasia on humanitarian grounds, as requested by the patients. From this public debate, the euthanasia law and its criteria of due care have evolved: the doctor has to be convinced that the euthanasia request is voluntary and well-considered, and the patient’s suffering is hopeless and unbearable. The doctor has to consult at least one other, independent doctor who will see the patient and who will advise on the requirements of due care. The Royal Dutch Medical Association supports the law because it believes that doctors who fulfill the criteria are not criminals, but act out of mercy.

Since the 1960s health care in the Netherlands has developed enormously. People live longer and a wide range of treatments is possible. At the same time people’s mentality has changed: they want to decide themselves more and more about their lives. The relationship with the doctor is based less on hierarchy and more on equality. Church attendance has dropped; religion has become an individual experience that doesn’t necessarily clash with euthanasia.