Legalized Killing : A Dutch Doctor Carries Out a Death Wish

It was a Tuesday this past January. Dr. Anton Burghard had slept well the night before, even though he had an appointment to go to a quiet apartment here to kill one of his patients about 10 o’clock in the morning.

He would roll the man--a 63-year-old retired farmer who had terminal, heavily metastasized lung cancer--over on his side, swab his right buttock with rubbing alcohol and inject a lethal dose of 200 milligrams of morphine. The patient, drowsy as the drug began to take effect, would look up at Burghard as the physician gently maneuvered him so he was lying on his back again and mutter, several times, “Thank you.”

Six hours later, the farmer would be dead, succumbing to the gradual slowing of respiration and vital functions characteristic of massive narcotic overdose. Burghard would get this news by telephone from the farmer’s son and sign a death certificate citing “natural” causes.

Sitting in his office late one afternoon a few days ago, Burghard--a young general practitioner whose waiting room is generally occupied by youthful patients with comparatively minor complaints--reflected on the farmer and his death.

A Casual Killing

For a visitor from the United States, it’s a discussion that, on some levels, defies belief. The physician talks about killing the farmer and says he has terminated the lives of eight patients since 1983. He says these things casually, largely emotionlessly and without fear of arrest.

Under Dutch law as it’s now applied in such cases, Burghard probably can never be prosecuted. Burghard says the farmer’s situation was not unlike the previous occasions on which he has participated in euthanasia--a practice legal here in a de facto sense since about 1973 but an issue always near the surface of emotional controversy in Dutch society.

The debate is usually dominated by policemen, politicians, prosecutors and a long list of blue-ribbon study committees. Indeed, Burghard faced prosecution for a while after he played a minor role in a patient death in which the physician in charge, Dr. Piet Schoonheim, was eventually cleared along with Burghard and another assistant, setting a precedent that widened the grounds on which euthanasia can be performed here.

The Schoonheim case, attorneys familiar with it say, established that it is legal in the Netherlands for a physician to take the life of a patient who is not terminal in the literal sense but who nevertheless suffers from the ravages of old age and wants to die.

But this tie to precedent and minor celebrity doesn’t seem to affect Burghard. He sits in a pleasant, high-ceilinged chamber that doubles as his private office and examining room in the back of an old converted row house. He hesitates only to divulge the farmer’s name. To him, it’s just one case, involving one patient and the man’s 35-year-old son--his only surviving relative.

Burghard has found the adjustment to the process of killing difficult but manageable. He remembers his first euthanasia as a case that haunted him emotionally. “After the first time, I would think about it daily for a month after it happened,” he said in a soft, unemotional monotone. “But now, I am very grateful I am in a position to help somebody.

“It’s taken some time. It still is difficult . . . to accept that you are helping people sometimes by performing euthanasia. What I like about this work is that you become very close to people.”

Burghard first met the farmer last fall. The old man had retired and moved to Amsterdam to be with his son. Another doctor diagnosed his lung cancer. It had spread and was inoperable; radiation did little good. The other physician referred the farmer to Burghard.

When the farmer first got to Amsterdam, his son often stayed home from work to care for him because the farmer didn’t want to be alone with a nurse. “He really didn’t want help from strangers,” Burghard recalled. There was never any doubt that the farmer would die, Burghard said, and after a hospital stay last November, the farmer, who had asked earlier about euthanasia, became somewhat preoccupied with it.

Son Opposed Death

“We (Burghard and another physician with whom he practices) always told him we were not against it and it would be something to be discussed between him and us,” Burghard said. “It wasn’t necessarily for the son.” In fact, the farmer’s death wish was delayed, Burghard said, because the son was adamantly opposed.

“He (the son) had great difficulty accepting the fact that his father had lung cancer and he didn’t want to miss him yet,” Burghard said. But the November hospitalization hardened the farmer’s attitudes and forced the son to finally accept the decision to die. The old man was exhausted, in pain, wasting away.

“He was tired,” Burghard recalled. “He couldn’t wash himself. He said, ‘Well, I never want to go back to the hospital again. I would like to die at home and I would like you to help me.’ ”

So on the Friday before that Tuesday morning in January, Burghard called on the farmer and his son again, telling them to think about the situation over the weekend. Monday morning, he visited the quiet apartment again, finding a decision had been made. Death was requested the following morning.

So Tuesday about 10, Burghard arrived. The son had not slept the entire night. The farmer, on the other hand, had slept soundly, Burghard said the son told him. “The son said it was strange to know, more or less exactly, when his father would die,” Burghard said. “It was not difficult to accept that he was going to die--the sooner the better. But the son found it difficult to accept that he knew when.”

Alone in a bedroom with his patient, Burghard carefully swabbed the injection site, falling back on basic medical training that teaches respect for the human body so complete that even an injection intended to kill must be preceded by the normal preparations. Burghard also has some experience answering questions of the police in such matters. He recalls instances--when the death certificate disclosed that the patient died by euthanasia--in which homicide investigators have asked him suspiciously about swabbing the injection site.

“He (the farmer) said, ‘Thanks,’ ” Burghard recalled. “I’ll never forget this. And then he laughed. He was very weak so it was very difficult to communicate. But he laughed and he pinched my hand.

“I thanked him for the help he had given me in taking this decision with him and I said goodby.”

Burghard stayed with the farmer for another hour, watching his patient fall into the deep narcotic sleep from which he would never awaken. The look on the farmer’s face, Burghard said, was one of “tranquility.”

“I think that would be a good word,” the doctor said. “He had been tense in almost every conversation. But this time, he was really at peace.”