Two years ago, Nelika Dumee's family gathered at her mother's home to share an event they had been discussing for a year: her mother's death by euthanasia.
The older woman, who had been diagnosed as terminally ill, said "I want to have the honor to have mercy killing." In a room filled with flowers and candles and "a lot of family talking," she said her goodbyes. Then her doctor administered a lethal injection.
"It was a nice death," recalls Mrs. Dumee. "It was respectful."
It was also technically illegal and morally controversial. For decades, mercy killing has existed in a legal gray area in the Netherlands, not prosecuted as long as doctors follow certain rules. But this fall the Dutch Parliament is expected to legalize the practice. That would give this country, which already has tolerant attitudes toward drugs and prostitution, the most liberal laws on euthanasia and assisted suicide in the world.
The proposed law includes a controversial measure that would allow terminally ill children as young as 12 to request mercy killing or assisted suicide, even if their parents object.
Other European countries, including France and Belgium, are considering proposals to allow euthanasia in certain cases. Switzerland already permits assisted suicide in some situations. In the United States, only Oregon now allows it, although an assisted-suicide initiative will be on the ballot in Maine in November.
As life spans increase and as medical technology and intervention make it possible to prolong life without necessarily improving the quality of it, more patients are expressing a desire to assert autonomy in death. In the Netherlands, and elsewhere, patients talk about the importance of maintaining dignity and control. And Dutch doctors say legalizing the procedure will make it easier to control.
Some 30,000 Dutch patients a year ask doctors about euthanasia, according to Rob Jonquire, managing director of the Dutch Voluntary Euthanasia Society. Of those, about 10,000 pose specific questions, saying, "I think I am at the end of my life." In 1995 (the last official survey), 3,600 people actually chose to end their lives, up from 3,200 in 1990.
"Many people ask for euthanasia because they are afraid," Dr. Jonquire explains during an interview in his office overlooking a picturesque Amsterdam canal. "They want to be master of the final moment."
Once a doctor agrees to help a patient, he notes, "fear fades away. You see people accepting the situation. Instead of having to euthanize the patient, the patient dies naturally."
Jonquire estimates that only about 8 percent of the Dutch population oppose euthanasia. "We think it's wrong for the small minority to prevent the large majority of people from acting according to what we think is a basic human right," he says.
Yet even some doctors reject the practice. "I base my life on the Bible, and I think it is not right," says Peter Hildering, president of the Dutch Physicians League, a 450-member anti-euthanasia group of mostly Christian doctors. "We try to make the Dutch public aware that it is not normal." In most cases, Dr. Hildering says, there are ways to relieve pain and suffering.
With the decline of the Christian Democrats as a political force, the new secular majority here has gradually pushed this field of law away from Christian theological beliefs.
The proposal to allow 12-year-olds to choose euthanasia, even if their parents object, is particularly contentious. Some experts predict that the final bill will raise that age to 16 or18.
Tom Vote, professor of pediatrics at the University of Amsterdam's Academic Medical Center, dismisses objections swirling around the children's issue as "a lot of to-do about nothing." He adds: "These are not children who want to die. They have shown that they want to live. Now they say, 'Listen, it's enough.' "
Jonquire agrees. He predicts such deaths will happen only once a year or less. "The choice is not between life and death, but rather, 'How am I going to die?'" Already, seriously ill children can refuse arduous treatments, such as chemotherapy.
Medical ethicist Henk Gochemsen disagrees with the low age limit. "Even if you allow euthanasia, it shouldn't be performed on minors without the consent of parents, and not below 18," he says.
Professor Gochemsen, director of the Professor Lindeboom Institute, Center for Medical Ethics in Ede, Netherlands, raises other objections, whatever a patient's age. From a medical-ethical standpoint, he says, euthanasia should not be part of a doctor's work. "It changes the patient-physician relationship. The unconditional trust of the patient that the doctor is there for life, for protection, will be undermined."
Gochemsen also expresses concern that as the practice of euthanasia grows, a larger part of it exists without control by legal authorities. He calls it "a dangerous situation."
Alan Meisel, professor of law and bioethics at the University of Pittsburgh School of Law, supports the legalization of physician-assisted suicide. But he warns about possible "serious problems" when doctors administer euthanasia. He cites accusations in the Netherlands that physicians have euthanized people who did not request it, or requested it but may not have been competent to do so.
"In a sense, I think the Netherlands skipped a step," Professor Meisel says. "They may have gone a little too far a little too fast." The first step, he suggests, should be requiring the patient to do it. "See how it goes, and see if there are abuses and ... how you might attempt to regulate them."
Dumee defends the decision by her mother, Maria Allart Dumee, to choose euthanasia. The doctor followed the rules: He sought a second opinion. He ascertained that her mother's decision was her own. And he believed she faced "unbearable" suffering.
"It is a beautiful memory for me, how she decided to say goodbye to life," Dumee says. "At the moment she was dying, she was praying. She asked us to take care of each other. She said, 'I'm ready for the journey.' "
Yet Dumee readily concedes that she "got reactions" from others. Some people asked, "Don't you feel you have killed your mother?" She calls that question "stupid," because the decision was her mother's. "My mother said, 'You must have quality in your life. When the quality goes away, I want to have the right to a humane death.' "
As the second anniversary of her mother's June 29 death approaches, Dumee says, "I am proud she made the decision that she didn't want to live with tubes."
Gochemsen offers an alternative to mercy killing: care that alleviates pain and suffering. "The most important thing now is to improve the quality and availability of good palliative care," he says. "Fortunately quite an effort is being made now to do that. Unfortunately, it should have been done 25 years ago." Studies show, he adds, that "most cases of euthanasia disappear when that is being done."
(c) Copyright 2000. The Christian Science Publishing Society