By Sara Denk
Death is an inevitable fact of life, but it is often hard to talk about. In over 63 countries across the globe, people gather at Death Cafes to discuss the subject of dying over coffee and cake. Welcome to the first virtual Death Cafe, where our guests reflect on the controversial end of life practices of euthanasia and assisted suicide.
I traveled to the Netherlands, a country known for being open-minded about life, even when it comes to death. Euthanasia and assisted suicide have been practiced legally since 2002 and illegally for decades prior. I spoke to individuals who are impacted by this practice both personally and professionally. These are their stories.
Where in the World Do Humans Have a Right to Die?
There are currently nine countries where at least one form of euthanasia or assisted suicide is legal:
In 2017 euthanasia accounted for 4% of total deaths in the Netherlands, where the laws are among the least restricted. Doctors must follow a set of due care criteria:
- There should be a voluntary and well-considered request
- The patient's suffering should be unbearable and hopeless
- The patient should be informed about their situation
- There are no reasonable alternatives
- An independent physician should be consulted
- The method should be medically and technically appropriate
The law allows for those suffering mental illness to be eligible for euthanasia, as long as the due care criteria are met. This goes beyond the more restrictive laws seen in the U.S. where patients must be terminally ill and have less than six months to live.
From Family Doctor to End-of-Life Activist
Rob Jonquiere spoke about Dutch euthanasia law when he first became a doctor in the 1970s. "It was explicitly illegal, so you weren't allowed to do it," he said. "Still, I knew that some doctors did help patients. So when I first got a request in my practice, I complied."
Jonquiere had been practicing euthanasia long before it was legalized. Dutch prosecutors turned a blind eye to the many family doctors who actively helped their patients die for many years. It wasn't until 1999 when the number of cases rose to over 2,000 per year that lawmakers and politicians decided to address the issue with an official piece of legislation.
He was directly involved in getting the Dutch euthanasia bill passed and helping doctors apply it when it came into effect in 2002. By then he was working as the CEO of the Dutch Association for a Voluntary End of Life, known in the Netherlands as the NVVE.
Jonqueire retired as CEO in 2008, but his work did not end. Over the years he became so involved with the topic that he now works as a volunteer for NVVE. He supports the board and looks after the website with the goal of keeping the conversation going at an international level. Because as he says, “a problem is not a problem as long as you can talk about it."
Ex-doctor Designs a 3D-Printed Killing Machine
The Sarco is a 3D-printed capsule that will allow people to kill themselves with the push of a button.
After the button is pressed, the oxygen levels inside the capsule are reduced from the normal 20 percent to only one percent. The person inside dies from hypoxia, which is known to be a painless and even pleasant death. The capsule can then be lifted away and used as a coffin.
There are two main criteria that must be met in order to use the Sarco: you must be an adult and you must prove that you have "mental capacity," essentially meaning you are able to understand and make your own decisions. Right now, the only way to prove mental capacity is through a psychiatrist's evaluation. Nitschke is working on developing a computerized test that can determine a person's mental capacity that will eventually be a part of the Sarco experience.
When the design is completed, Nitschke envisions that anyone with the access and funds will be able to have their own Sarco printed by a local print shop. The cost and accessibility will vary greatly as 3D-printing is still in its infancy and is expected to become cheaper over time. Currently the Sarco is estimated to cost around $7500 USD.
The Sarco is being 3D printed by Nitschke with the help of Dutch designer Alexander Bannink. They hope to have it done by the end of 2018, and when finished, basic plans will be made available online for free. More detailed specifications will be published in an update of The Peaceful Pill Handbook, written by Philip Nitschke and his partner Fiona Stewart.
Suicide Handbook Gets Doctor Deregistered
The Peaceful Pill Handbook contains detailed information about various suicide methods. It also covers other end-of-life topics such as how to write a will and what to do after a loved one's suicide.
The first version of The Peaceful Pill Handbook was published in the U.S. in 2006. It is updated each year by Nitschke and Stewart and is available in six languages: English, German, Dutch, Italian, French and Spanish.
Nitschke's view is that death is a human right for any adult with sound mental capacity, whether they are terminally ill, suffering mentally or even to avoid a prison sentence. He believes that if a person truly wants to end their own life, they will do it with or without this book.
“I don’t want to have people jumping off high buildings or hanging themselves," Nitschke said. "That’s a grim and horrible death. A lot of what drives that is most people don’t have access to information.”
Writing a book about suicide methods has not come without consequence. In 2014, a man named Nigel Brayley killed himself after speaking with Nitschke and purchasing his book, which was and still is banned in Australia. When the medical board of Australia learned of this, they declared him a danger to the Australian public and took away his medical license.
Nitschke fought the decision in court and won. Still, the medical board was not happy with his work and gave him an ultimatum: if he wanted to continue to be a doctor in Australia, he had to stop publishing The Peaceful Pill Handbook. That's when Nitschke left his life as a doctor behind in Australia, symbolically burned his medical license and moved to the Netherlands where he continues to work on what he believes in.
"Society has no right to stop people who want to die,” Nitschke said. "Life’s a precious gift, we all accept that idea. But you can't give life away. A gift you can’t give away is not a gift at all.”
Critics say Euthanasia and Assisted Suicide Go Against the Principles of Healthcare
"We are made to believe that there is nothing we can do but kill these people, but in fact we can care for these people without killing them," Alex Schadenberg, Executive Director of the Euthanasia Prevention Coalition said. "Caring and not killing should be the focus of healthcare."
Both the American Medical Association and the American College of Physicians formally oppose all forms of doctor-assisted dying. They say that it undermines doctor-patient trust and contradicts the core values of the medical profession. Instead, they push for improved access to adequate disability end-of-life healthcare.
The disability rights group Not Dead Yet says that assisted suicide and euthanasia are "deadly forms of discrimination against old, ill and disabled people."
Photo by Not Dead Yet UK.
A study that looked at two decades of research on euthanasia in the Netherlands suggests that disabled people and other minority groups have not been targeted so far:
"There is no evidence for a higher frequency of euthanasia among the elderly, people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations," according to the study.
Oregon was the first U.S. state to legalize assisted suicide in 1997. Robert Joondeph, Executive Director of Disability Rights Oregon said that he has yet to receive any complaints of exploitation or coercion of an individual with disabilities in the use of Oregon’s Death with Dignity Act.
Jonquiere sees this argument is as a social tool rather than a practical problem. He believes that doctors know how to ask the proper questions to avoid performing euthanasia on a person who does not truly want to die, and that euthanasia is always used as a last resort, when end-of-life care and pain management are not sufficient.
"I am rather convinced that this kind of thing is not happening, but it is a kind of public worry," he said. "I am afraid this is just being used by opponents. When a patient asked for euthanasia, I thought, oh no, not again," he said, "I did not want to do it. And I would ask, why? What is wrong? And we would try to fix it."