Dutch Treatment

A Eureka Moment for Holland's Medical Ethics

There seems to be no end to the creativity of the right-to-die movement in the Netherlands. How about a euthanasia delivery service? The lobby group Right To Die wants mobile euthanasia teams to buzz around the streets in vans so that patients can die at home, not in a hospital.¹

At the moment, this is no more than a proposal, but proposals have a way of becoming policy in the first country in the world to legalize euthanasia.

Unlike most other countries, where euthanasia is still taboo, in the Netherlands doctors are constantly expanding the circle of eligibility for a lethal injection. A recent position paper² from the Royal Dutch Medical Association (KNMG) reminded its members that they are obliged to take seriously all requests for euthanasia, even if patients are demented, mentally ill, suicidal, or merely tired of living.

Perhaps in response to this encouragement, registered euthanasia deaths³ rose from 2,636 in 2009 to 3,136 in 2010, an increase of 19 percent—and this figure does not include the numerous deaths for which harried doctors did not do the paperwork or deaths from terminal sedation—slow euthanasia brought about by withdrawing food and water from heavily sedated patients.

It is commonly thought that euthanasia is just for the elderly. Not so. If Dutch babies are seriously ill, doctors are permitted to euthanize them. This practice has even been codified in an agreement between pediatricians and the government called the Groningen Protocol.⁴ Since a baby cannot consent to his own death, his parents are allowed to consent for him. Such involuntary euthanasia is regarded as a caring response to patients with severe disabilities.

A Line Is Drawn

Not everyone is happy about these developments, however. Some opponents have even accused Dutch doctors of abandoning all ethics.

But the utter falsity of this accusation is clearly demonstrated by another position paper that the KNMG put out in May 2010. According to this paper,⁵there is a line beyond which no Dutch doctor must step, a medical procedure so barbarous and morally repugnant that the KNMG has condemned it as completely unethical. This is the ancient practice of circumcising male babies.

So you see, Dutch doctors do have ethics. They're just a bit different from traditional ethics.

The KNMG insists that its stand is highly principled. In its paper, it asserts that "minors may only be exposed to medical treatments if illness or abnormalities are present, or if it can be convincingly demonstrated that the medical intervention is in the interest of the child, as in the case of vaccinations." It also claims that "non-therapeutic circumcision of male minors conflicts with the child's right to autonomy and physical integrity."

The KNMG even argues that there is a good case for outlawing circumcision despite its "deep religious, symbolic and cultural meaning" for many people, but that a ban would drive the practice underground and might therefore do more harm than good. About 15,000 boys are circumcised in the Netherlands every year, most of them Muslim or Jewish.

A KNMG medical ethicist, Gert van Dijk, explains:

We feel circumcision is a medically unnecessary form of surgery. The patient has to give consent, but children can't give consent and we feel that is wrong and a violation of the child's rights. . . . In our code of medical ethics, it states that you must not do harm to the patient, but with this procedure this is exactly what you're doing.⁶

Straining Out the Gnat

Does anyone else detect something dark, dangerous, and loopy about these explanations? Male circumcision is the world's most common surgical procedure. There is a low incidence of gruesome complications—but death is not one of them. How can it be unethical to circumcise babies but ethical to kill them? How can parents offer surrogate consent to euthanize their children but not to ­circumcise them? Aren't Dutch medical ethicists straining out the gnat and swallowing the camel?

The inconsistencies in the KNMG's ethical positions demonstrate the deadly absurdities that doctors fall into once their ethics are no longer anchored in the conviction that they have an obligation to preserve life as a sacred trust. If life is no longer the primary value in medicine, what is? In the Netherlands, the purported answer is "choice" or "whatever I want." But it is becoming increasingly apparent that, ultimately, it is not what the patient wants that the medical establishment holds sacred, but what his doctors and caregivers find expedient. •

Endnotes
1. www.cbsnews.com/8301-501714_162-57325933/dutch-group-proposes-mobile-euthanasia-teams.
2. http://knmg.artsennet.nl/Publicaties/KNMGpublicatie/Position-paper-The-role-of-the-physician-in-the-voluntary-termination-of-life-2011.htm
3. www.worldrtd.net/news/dutch-annual-report-2010-euthanasia-review-commissions-published-4-languages
4. www.nejm.org/doi/full/10.1056/NEJMp058026
5. An English version of "The non-therapeutic circumcision of male minors, KNMG" can be downloaded from: http://knmg.artsennet.nl/Over-KNMG/English.htm.
6. www.bbc.co.uk/news/world-europe-15486834.

From Salvo 20 (Spring 2012)
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