Euthanasia and Assisted Suicide - Should The United States Follow The Netherlands?

Advocates of assisted suicide point to the Dutch system as a model for the United States, claiming that the United States could establish guidelines not unlike those in the Netherlands. However, Richard M. Doerflinger, in Life at Risk (Washington, DC: National Conference of Catholic Bishops, April 1998), reported that the 1994 Dutch law that regulates euthanasia now allows euthanasia of severely handicapped newborns. Doerflinger felt that the Dutch court's reasoning invalidly equates euthanasia with discontinuing the use of life support and providing relief for pain.

The New York State Task Force on Life and the Law, a commission comprised of persons from various disciplines, studied the feasibility of legalizing physician-assisted suicide. In its comprehensive 1994 report, When Death Is Sought: Assisted Suicide and Euthanasia in the Medical Context, the Task Force concluded that legalizing or legitimizing euthanasia would carry the substantial risk that patients might be assisted in suicide without adequate counseling and exploration of other avenues. The members of the commission feared that for some people the system might even work to encourage euthanasia. Further, they thought that the risk was unacceptably high enough that vulnerable individuals with limited control over their lives, such as the disabled, the elderly, and the poor, might be discriminated against.

Unlike the Netherlands, which provides medical care to all, the United States does not provide health insurance to its citizens. The number of uninsured people continues to increase, rising from 30.5 million in 1979 (13.5 percent of the population) to approximately 43.6 million in 2002 (15.2 percent of the population). Uninsured people are already at risk because they are often unable to obtain needed medical care. Legalized assisted suicide could make them even more vulnerable to potential abuses of resource allocations. Might a hospital be more likely to recommend euthanasia for a nonpaying patient who is draining the hospital resources than for one who is covered by insurance?

Physician-Patient Relationships

Current American medical practice does not differ much from that in the 1980s, when the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research investigated the relationship between patients and doctors. In Making Health Care Decisions: The Ethical and Legal Implications of Informed Consent in the Patient-Practitioner Relationship (Washington, DC: U.S. Government Printing Office, 1982), the President's Commission observed:

In addition to making a recommendation, the doctor's self-perceived role is to get the patient to go along with this recommendation if there is any hesitancy on the patient's part. This is done by some explanation about the need for the recommended treatment and the consequences of not heeding the recommendation. But in the doctor's view there is no decision for the patient to make, except whether to get proper medical care.

If assisted suicide is legalized, it becomes a treatment option that may be recommended by physicians. As the President's Commission noted, physicians often believe that they know the best treatment for their patients. Yet, as the New York State Task Force pointed out, physicians' judgments may not always be impartial. Their professional judgment is shaped by their own attitudes toward illness and euthanasia in general, and toward each patient in particular.

In April 1997 the New York State Task Force on Life and the Law issued a supplement to When Death Is Sought: Assisted Suicide and Euthanasia in the Medical Context. The Task Force, in this most recent report on the topic of assisted suicide and euthanasia, reiterated its initial 1994 finding that physician-assisted suicide would be seriously harmful to a large number of people. The Task Force claimed that the widespread interest in physician-assisted suicide is a symptom of a bigger problem—our failure as a nation to alleviate the pain and suffering of terminally ill patients. The Task Force recommended that even if physician-assisted suicide were legalized, the national priority should be the improvement of end-of-life medical care for everyone.

In 2001 the American College of Physicians–American Society of Internal Medicine (ACP–ASIM) released its position on physician-assisted suicide in "Physician-Assisted Suicide" (Annals of Internal Medicine, vol. 135, no. 3, August 7, 2001). The organization stated that it does not support the legalization of physician-assisted suicide, noting that not only would the routine practice of physician-assisted suicide raise serious ethical concerns, it "would undermine the patient-physician relationship and the trust necessary to sustain it.…"