by Jeremy Beer

Seduced by Death: Doctors, Patients, and the Dutch Cure

Herbert Hendin, M.D.

256 pp., Norton, $27.50 Hardcover

In the reigning Whig theory of history the latest stage of society is always perceived as best, for it is man's essential nature to progress to a point of societal justice beyond that reached by his ancestors. The history of civilized man is his sometimes gradual, sometimes sporadic, emancipation from the yokes of tradition, religion, and custom toward a more full realization of his natural rights.

Incessant clamoring for this or that right reminds us daily that, to those who subscribe to this philosophy of history, many frontiers of oppression remain. Among that vast array of rights which they currently claim are unjustly withheld, perhaps the most beguiling has been the so-called "right to die." Supporters of this movement wish us to believe that each and every one of us has, in principle, the right to be killed by a physician (euthanasia), or at least the right to have a physician that will help us kill ourselves (assisted suicide). This right, it is argued, is simply one special case of the general right of self-determination, the right to do as we wish with our own bodies.

In the morally depleted political and philosophical vocabulary of the age, this is an argument which is quite difficult to resist. The right-to-die movement strikes all the right chords (e.g., personal rights, freedom, privacy, choice, sentimentality) while strenuously avoiding all the wrong ones (e.g., personal duties, the limits of freedom, the common good, humility, the sanctity of life). Oregon voters' recent approval of a state law legalizing assisted suicide bears witness to the issue's comfortable position within the zeitgeist. The general feeling is that the right to die is just the latest cause in modern man's righteous march toward the end of history, when all persons shall be afforded their full allotment of rights and peace and justice shall reign.

This is all very good in theory, but what happens in practice when euthanasia and assisted suicide are recognized by state and society as acceptable, if not heroic, ways to die? This is the question posed by Dr. Herbert Hendin, a New York psychiatrist and suicide expert, in Seduced by Death: Doctors, Patients, and the Dutch Cure. It is one of the book's strengths that Hendin is, so far as I can tell, a secular liberal and an implicit believer in the Whig theory of history; this makes his forthright observations on the practice of euthanasia and assisted suicide in the Netherlands all the more useful (and remarkable).

Hendin's study of the Netherlands followed a 1991 report of a Dutch governmental committee, called the Remmelink Commission, on the practice of euthanasia and assisted suicide there. That report made clear that euthanasia in practice had become something quite different than the Dutch had envisioned it in theory. Plain statistics are horrifying enough: 11.3% of the annual deaths in the Netherlands are the result of involuntary euthanasia; in 56.5% of all non-sudden deaths physicians took steps that may have or definitely did hasten the deaths of their patients; 14% of those killed without their consent were fully competent adults (another 8% were elderly persons in the throes of dementia); and so on.

These statistics suggest that it is impossible to restrict euthanasia or assisted suicide to the mentally competent and terminally ill only, for this is inevitably viewed as a form of discrimination; soon the mentally incompetent and perfectly healthy are graciously admitted to the license. Exhibit A is the Roman Catholic nun involuntarily euthanized by her doctor because her religious beliefs prevented her from asking to be killed herself. I beg your pardon: the Remmelink Report instructs us that the proper term for involuntary euthanasia is "termination of the patient without explicit request." Even the calm and moderate Hendin refers to this as nothing less than "sinister."

That is not a word Hendin uses to describe the Dutch euthanasia advocates whom he interviewed, but in many cases it would be just as applicable. These interviews form the most interesting and original aspect of Hendin's work. The cast of characters (mostly doctors) to whom we are introduced runs the gamut from idealistic liberals to sadistic kooks, but they all hold certain attitudes in common. Writes Hendin:

I found that euthanasia advocates, while willing to admit abuses in general, and even to agree that in a particular case euthanasia should not have been performed, or to concede a wrongful death, did not express anger or indignation that a life had been taken unnecessarily. The common attitude was that the doctor may have been mistaken but that he was entitled to his judgment of the matter. This casualness, or what appears to a foreign observer as callousness, is consistent with...the Dutch lack of moral passion and unwillingness to assign individual responsibility.

Indeed, it is a frequent theme of Seduced by Death that the Dutch legislators and bureaucrats, Dutch courts, and Dutch medical societies are much more concerned about protecting pro-euthanasia doctors than they are patients' rights. They do not scruple to try their hand at censorship either. Doctors who speak out about the regime are vilified, sometimes viciously. Dutch medical journals refuse to publish critical articles. The epithet "religious fundamentalist" is slapped on anyone who publicly denounces the Dutch practice of euthanasia-even though some prominent critics are in fact not believers. And it is actually illegal for any Dutch doctor not to refer a patient who wants to be euthanized to a doctor who will do so.

Another of Hendin's arguments is that the de facto legalization of euthanasia and assisted suicide (for both remain theoretically illegal on the Dutch legal books) means that it is virtually impossible to treat suicidal patients successfully. These patients know that if they hold out long enough, their doctors must agree to either euthanize them, assist them in suicide, or refer them to someone who will. Yet, as Hendin makes clear through the presentation of several anecdotes, most of them are at once anxious and ambivalent about their own deaths; thoroughly alienated from society, many simply want someone to tell them that they are wanted. Unfortunately, their family and friends, encouraged by Dutch society to believe that expressing such a feeling is an unwarranted intrusion upon private liberty, often help push them toward death.

There is much else in Seduced by Death to recommend it, especially the psychological insights offered by Hendin. And I have said that it is a strength of the book that Hendin stays clear of extended forays into philosophical and theological arguments against euthanasia and assisted suicide. But this is true only in the sense that it allows him, and us, to concentrate attention on Hendin's unbiased account of the actual workings of the Dutch system. Hendin's aversion to theological (or if you will, metaphysical) objections to euthanasia lend a certain quality of thinness to the book; it never gets at the deeper questions which lie at the heart of the difficulty. For instance, it is clear that Hendin is a proponent of legalized abortion. But why (as the citizens of Oregon must have asked themselves), if a woman may kill her unborn child, may she not kill herself? The logic is irresistible, and quibbles about inevitable abuses and unwanted extensions only appear as obscurantism to the true liberal believer.

Better understanding of pain control, greater availability of palliative care and hospice-these suggestions of Hendin's are, in the long run, merely stop-gap solutions. What is needed is a grammar that allows us to explain why, precisely, life is worth living; why humility and piety are preferable to pride and vanity; why freedom has natural limits that mustn't be transgressed; why the Whig theory of history is wrong. This is the grammar of theology, detested by our intellectuals and completely foreign to our masses, but essential to a fuller understanding of the crisis.

Jeremy Beer is a graduate student in psychology.