A License to Kill?

By John Cloud

French writer Emile Durkheim noticed a century ago that such intensely regulated environments as religious sects and military bases had higher suicide rates. Which makes you wonder what he would say about a society that decides to regulate suicide--that actually allows you to apply for it like a driver's license. Would that society experience a spate of "contagious" suicides, as Durkheim might theorize today?

We will find out. Soon it will be possible in the Netherlands for doctors to inject lethal drugs into chronically ill people who want to die. No other nation has formally legalized euthanasia. And though mercy killings have not been criminally punished for years in the Netherlands and a few other places--Colombia and Switzerland among them--there's something creepy about how far the Dutch have gone with the law. When it takes effect in the fall, doctors will be able to euthanize sick children as young as 12, as long as the kids ask and Mom and Dad agree.

To be sure, the Netherlands hasn't completely become Hemlockland. Two physicians must agree that a euthanasia applicant suffers an unbearable, hopeless condition. Subsequently, each case of mercy killing will be reviewed by a lawyer. Something like the Dutch law exists in only one U.S. state, Oregon, but its Death with Dignity Act is less sweeping (see chart). Under its strict rules, doctors there signed only 96 prescriptions for lethal doses of medication from 1998 through 2000. By comparison, physicians already euthanize roughly 4,000 Dutch each year--and it's not even technically legal yet.

Not surprisingly, the regulation of a decision as wrenching as suicide creates many gray areas. In the Netherlands, cancer patient Lenie Lemckert, 68, says the Dutch requirement that the patient experience unbearable suffering is inhumane. "Is the fact that your situation is hopeless not enough?" Lemckert asks. In Oregon, because patients must be able to swallow pills in order to kill themselves, many worry about waiting past the point they can ingest substances. State officials wonder whether the law violates the Americans with Disabilities Act by excluding those who can't swallow. "And can a family member lift the cup to their lips? I don't know," says Dr. Katrina Hedberg of the Oregon health division. "Those things need to play out in court."

Mercy-killing foes feel emboldened by the legal uncertainties. A psychologist must agree that Oregon applicants don't suffer "depression causing impaired judgment," but critics say that standard is vague. Dutch opponents also focus on the emotionally impaired. "Vulnerable patients who consider themselves to be a burden might opt for euthanasia while in fact they would be happier with improved care," says Henk Jochemsen of the Dutch Center for Medical Ethics.

Polls show that the euthanasia law is popular in Europe, and other countries may follow. South Korean doctors asked for a similar law last week. But in the U.S., opponents hope Attorney General John Ashcroft will rescind his predecessor's ruling that the federal Controlled Substances Act doesn't bar Oregon's use of drugs for mercy killing. If he does, the case will go to court. During his campaign, President Bush said he would sign a proposed law preventing doctors from using drugs to intentionally kill, which would effectively overturn the Oregon law.

Whatever the law, informal doctor-assisted suicide will occur, as it has for years. "[Doctors] give a bunch of drugs in combination with a coded message: Go home and do what you want," says Dr. Lauren Shaiova, an end-of-life expert at Manhattan's Beth Israel hospital. She says that is sometimes the only solution for dying people crushed by fatigue and darkness. Says Shaiova: "What are you going to do, just give them Prozac? That can fail for people who have everything to live for." Can bureaucrats really settle such issues? The Dutch will point the way.

--With reporting by Abi Daruvalla/Amsterdam

With reporting by Abi Daruvalla/Amsterdam