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Why are women in their twenties opting for assisted dying in the Netherlands? LBC went to find out
28 November 2024, 07:09 | Updated: 28 November 2024, 07:13
Assisted Dying: Henry Riley in the Netherlands
Here in the Netherlands there is hardly a debate over the principle of vulnerable people wanting to end their own life.
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My experience from travelling up and down the country is that the subject, considered somewhat uncouth, virtually taboo in the UK, is one which is discussed openly in the Netherlands. It is a topic which affects many, resulting in personal experiences being frequently shared and often overheard in cafes, restaurants and even on street corners.
That is unsurprising, too. Both euthanasia and assisted suicide deaths were in the low thousands per year when the act came in, yet now they account for over 5% of total deaths nationwide. Last year saw 9,038 people choose to end their suffering in this manner.
The wording of the law has not changed. Doctors work to the idea that someone eligible is enduring “unbearable suffering with no sign of improvement”, and the conversation must be initiated by the patient. There must be two doctors who concur, and the case is automatically referred to the coroner and an independent review committee.
Yet, it is the interpretation of the law, passed back in 2002, which some argue has changed.
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The topic of contention is whether physically healthy individuals, including young women in their 20s, should be able to end their lives because of mental health struggles.
Again, this phenomenon has risen exponentially. Back in 2010 there were just two ‘psychiatric’ cases of assisted suicide, compared with last year when 138 people used this justification.
This poses all sorts of challenges for lawmakers and campaigners alike, highlighted by high profile cases in the media.
Milou Verhoof, a physically healthy 17 year old chose to end her own life last year after struggling with borderline personality disorder.
Take Zoraya ter Beek, a 29 year old women who ended her life earlier this year. She opted for physician assisted suicide after a three year wait battling with anxiety, trauma and depression.
On the face of it, of course no one wants to see someone grappling with serious mental health issues opt to take their own life. Instinctively we are uncomfortable with it, and many argue it is evidence of the “slippery slope”.
But that is the essence of the law here: it is the patient's choice. In the case of 29 year old Aurelia Brouwers, she was suffering with depression, anxiety, eating disorders and psychosis. She was killed in a controlled manner clutching her toy pink dinosaur and listening to her favourite music surrounded by friends. Previously she had tried “on at least 20 occasions” to end her life, and was in a “critical condition” on a few of those occasions. The moral argument is tricky and deeply complex.
Indeed, this is not the only debate I have encountered during this trip. Commuters at Utrecht station, rushing to escape the snow, told me about the practice of ‘duo euthanasia’.
This is an increasingly common scenario where two individuals - often couples - choose to end their lives together. The concern here is that one person may be more strident and determined in their wish to terminate their life, at the expense of their spouse who has reluctantly agreed to.
One man warned of a scenario where a healthy individual who is caring for a seriously ill partner becomes sick themselves and concludes that they should both end their existence. The seriously ill partner feels in some way indebted due to the care they have received and agrees without thorough thought, no longer wishing to be a ‘burden’.
Though experts maintain that the strict criteria to qualify for such a death is not compromised in these cases - of which there were 66 in 2023 alone - and it falls to each individual. Similarly, many couples genuinely do not want to live without their soulmate - such as Jan and Els. The couple were married for almost five decades until earlier this year when they made the decision to die. Jan, 70, was suffering serious back pain, whilst Els, 71, had dementia.
The most high profile example of this was Dries van Acht, the Catholic former Dutch Prime Minister who was previously opposed to the law. He and his wife chose earlier this year to die together - they were both 93.
Being an outsider I have to confess I was rather taken aback to learn that 12 years olds are legally eligible for the practice. Naturally there are stricter procedures followed, parental consent required and but there are cases where people of that age are significantly suffering. Understandably and thankfully these cases are rare.
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Experts here are stubbornly unconcerned that there has been an increase in the total number of people choosing to end their life early. Former GP Dr Rob Jonquière, who was until recently president of The World Federation of Right To Die Societies maintains “we shouldn’t be worried about the numbers”. He told me: “Yes it is going up, but it is still relatively small, and it is up to the individual to decide”.
Dr René Héman, who is president of the Royal Dutch Medical Association told me “you are not forced by law to perform euthanasia and the patient has not the right to get euthanasia, that means it is a subject in which there is still a lot of discussion”.
There are regional differences which are worth highlighting. Euthanasia and assisted dying account for over 5% of total deaths but as Theo Boer from the Protestant Theological University points out that doesn’t tell the full picture.
Professor Boer highlights the interesting discrepancy that in some areas of Amsterdam the percentage is as high as 20%, and yet in other rural parts of the country near Rotterdam it is as low as 1%. He has concerns over allowing this practice to become “the default way to die”.
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“Intentionally killing a human person should always be the last resort”, he told me.
Naturally there is also opposition from key religious voices, though their criticism is not universal. I spoke with Rabbi Marianne van Praag at The Hague railway station. The religious leader described the act as “beautiful”. She told me: “People don’t come easily to this decision, but if you’re suffering it’s a gift. It sounds strange but it’s very beautiful”.
The legislation here is watertight and has not formally changed, though how it is interpreted has undoubtedly altered. Public approval ratings have put support for the policy at 95%, it is here to stay and has proved to be an example of the policy working effectively in practice.
Naturally there are disagreements surrounding how the law is applied, and how far it should go. High profile individual cases highlight a healthy, ongoing debate into the parameters of the acceptability of euthanasia and assisted suicide.
The UK could learn a thing or two surrounding the discourse present in Dutch society. Debates are polite, viewpoints respected and the culture of speaking openly about death is one which is largely refreshing (if not a little alien to my experience of obstinate British etiquette).
