Faced with an increasingly open practice of euthanasia, Dutch leaders have reached an agonizing new frontier in government, trying to decide democratically when doctors should perform mercy killings.
The controversial effort, which Dutch officials and experts say is unprecedented in the world, is likely to result in legislation or government regulations by this fall spelling out legally when mercy killings are authorized, according to supporters and opponents of the measures.
The heated political debate in large part represents an effort for government to catch up with public opinion and jurisprudence in a country known for liberal attitudes on a variety of social issues. In the last decade the Netherlands already has moved toward widespread and perhaps unmatched acceptance of voluntary euthanasia, often known here as "mild death."
Favored in Polls
Although nobody knows for sure, advocates of mercy killing estimate that doctors in the Netherlands administer fatal injections to 6,000 to 10,000 hopeless patients a year. Opinion polls show that two-thirds of the population favor this active euthanasia, and most Dutch courts have stopped jailing doctors who do it carefully.
The practice has become so open over the last decade that the Royal Dutch Pharmacists' Assn., after a two-year study, last month drew up a list of the most efficient drugs for doctors seeking to administer a quick and painless death to patients beyond hope.
Under Dutch law, active euthanasia in theory has remained illegal, with a maximum penalty of 12 years in prison. But most doctors who perform euthanasia enter a natural cause on the death certificate, and prosecutors have brought few cases in recent years.
Since the mid-1970s, judges have developed a jurisprudence that provides largely symbolic penalties for doctors who do end up in court, provided that they have followed increasingly explicit court guidelines.
These require the doctor to have a persistent and carefully considered request from the patient and his family, to determine carefully whether the patient is suffering unbearably from an irreversible illness and to get a second doctor's opinion in the decision.
The jurisprudence has been applied only to mercy killing, or active euthanasia, such as administering fatal injections. Passive euthanasia, such as halting life support systems to allow natural death, has long been considered acceptable medical practice in the Netherlands and many other places.
Citing the gap between law and what actually goes on in Dutch hospitals and courtrooms, the minority D66 party has introduced in Parliament proposed legislation making mercy killing legal according to specific conditions. The proposed conditions, although slightly more stringent, generally were patterned after the last decade's jurisprudence.
"It is a horrible sort of question to deal with," said Jacob Kohnstamm, a D66 parliament member who has championed the proposal. "But I think it is so dangerous a question that you should be able to control it."
Three nurses at the Free University Hospital in Amsterdam, for instance, were arrested last month on suspicion of murder after telling authorities they ended the lives of three comatose patients.
The proposed law also would bar such deaths, requiring two doctors to decide and an express request from a conscious patient. Advocates of the law argue, however, that it would help prevent such abuses by spelling out clearly what is legal and what is not.
"I cannot accept in my thinking that there is a law that says no-go, and that there is a practice that says OK," Kohnstamm said.
The governing coalition, led by Prime Minister Ruud Lubbers' Christian Democratic party, has opposed the proposal strenuously. Lubbers vowed not to sign such a law if it were voted by Parliament.
"There is no place in the world where they are talking about euthanasia like we are," said Fred Borgman, a Christian Democratic Parliament member leading efforts to prevent legalization of the practice. "It is crazy. When you cross that frontier, where do you stop? Now it is only people who ask for it, but what about comatose patients? You start here, but what about 10 years from now?"
Borgman said he was told that some elderly rest-home patients, reacting exaggeratedly to the debate, are afraid to drink their orange juice.
The Roman Catholic Church and some Protestant denominations also have strongly opposed the idea on moral grounds. The country is about equally divided between Catholics, about 40%, and Protestants, with the remaining 20% having no religious affiliation.
Because Christian Democrats dominate the ruling coalition, Kohnstamm acknowledged, there is little chance that his party's law will pass in the near future as it stands. But the government, responding to mounting pressure, announced in February for the first time its willingness to set legal guidelines under which euthanasia will be allowable.
It is unclear whether the guidelines will take the form of legislation or regulations. A prestigious government commission recommended such guidelines in 1985 and said the Dutch Parliament should pass judgment on the issue. In addition, the Royal Dutch Medical Assn. urged in 1984 that the legal uncertainty on mercy killings be resolved as soon as possible, without saying specifically how.
Legislation This Year
In any case, government legal and medical commissions recently began new studies and are expected to report by this summer, which officials have said will open the way for the regulations or legislation by fall.
With regulations or legislation, the government approach will leave the prohibitive law intact, spelling out exceptions instead. Borgman said he opposes this middle way, pointing out it provides for legal mercy killing sanctioned by the government even if the law remains on the books.
But he and Kohnstamm agreed in separate interviews that the government appears headed in that direction as a compromise that both sides in the debate consider temporary. The relative strengths of Dutch political parties in future elections will determine final arrangements, they predicted.
"The regulations we are about to get are a very important first step," said Jeane Tromp Meesters, an official of the Dutch Assn. for Voluntary Euthanasia.