“Going Dutch”: Euthanasia and the Beautiful Game
John Kleinsman
My accent is Kiwi but the name gives it away. I'm a first generation New Zealander of Dutch descent and it is something I'm proud of. I'm also a football fan – I love watching 'the beautiful game' and once enjoyed playing it!
The Dutch are known for many things including the quality and technique of their football. It was the Dutch who, in the 1970's, invented what is now known as 'total football', a tactical style in which players' positions are interchangeable as part of a general method of attack – difficult to defend against. It's very much a team oriented approach and around the world football coaches have learnt much from this Dutch innovation.
Ironically, while they have over the years continued to produce players of exquisite talent and ability who perform exceptionally as individuals, the Dutch football teams have also gathered a reputation for self-destructing at the highest level of competition and they now carry the tag of being the best team never to win the World Cup; three finals and three defeats! Commentators agree that this is largely the result of internal divisions brought on by the inability of their talented and strong (some would say stubborn) individuals to create a team culture; total football on the field is not compatible with an individualistic approach off it.
The Dutch are also well known for being the first country in the world to legalise euthanasia; something that evolved from turning a blind eye to euthanasia to openly tolerating its practice and eventually to legalising it in 2002. It has occurred to me that there is a commonality between this fact and their struggles on the football pitch.
I have always been intrigued by the fact that the debate about euthanasia (and physician assisted suicide) is prominent only in certain societies, namely affluent white western societies. Why is that? It's a question that is rarely explored. My own hunch is that it is a feature of those largely secular societies where certain assumptions prevail; where the dominant notion of personhood is individualistic and the dominant 'virtue' is the individual's right to make his or her own choices. This emphasis on autonomy and rights shapes us to see the world as belonging to those who are independent, strong and productive. It also shapes us to see moral issues and dilemmas in a certain and very narrow way.
The liberal case in favour of euthanasia is not without its own logic. The argument is made by proponents of change that legalising euthanasia will not adversely affect the freedom of those who do not want to die in this way. On the other hand, the ongoing prohibition of euthanasia unfairly prevents some (albeit a very small minority) from exercising their freedom of choice; the personal beliefs of one group are then effectively being forced onto others, or so the argument goes. In this way, those in favour of euthanasia frame the issue in terms of the protection of rights; specifically the right to choose. The current law in New Zealand is seen as bad law because it unfairly prevents people from making their own end-of-life decisions. Good law, it is stated, upholds individual choice above all.
At this point in the debate I suddenly find myself agreeing with those proposing a change in the euthanasia laws. And I say to them: 'You are right. This debate is about choice!' They look surprised and quizzical while I continue: 'What you don't realise is that it is the legalisation of euthanasia that will ultimately take away people's choice.'
A law change that allowed for people in certain circumstances to dispose of themselves (physician assisted suicide) or be legally 'disposed of' would inevitably start to reshape the way we looked at sickness, old age, disability and death. In particular there would exist the temptation for relatives, as well as over stretched and under resourced care institutions, to see those who are disabled and sick as a burden to be shed rather than as persons to be cared for. Furthermore, and perhaps even more seriously, legalising euthanasia has the real potential to change the way in which those who are disabled, sick and elderly see themselves. These people are already vulnerable because of disability, sickness or infirmity. In a world in which they feel undervalued and isolated they will more easily come to see themselves as a burden and will want to do the right thing if euthanasia is legalised. The so called 'right to die' all too easily becomes a 'duty to die'. On-going debates about the costs of caring for people in the last six months of life fuelled by greater pressure on health-care resources and growing numbers of elderly persons living in institutions will only further exacerbate this pressure.
In other words, the net result of legalising euthanasia would be that those who are most vulnerable will become subject to various forms of physical and psychological coercion. Upholding the choice of a few to be euthanised will effectively take away the choice of large numbers of others to live. What is initially presented as a matter of freedom and choice now comes to look more and more like the imposition of a burden. In the words of one who knows and for whom the desire to live is at times already tenuous in the face of the burden his chronic illness places on others: "If euthanasia were a legitimate option ... then life for the chronically seriously ill would become contingent upon maintaining a desire to continue in the face of being classified as a burden to others ... The mere existence of the [euthanasia] option will affect attitudes to our care, and hence our own willingness to continue."
Furthermore, it is both impossible and contrary to reason to limit euthanasia to a particular group of persons, such as adults or those with a physical terminal illness. Recent developments in Belgium, Holland's closest neighbours, which have extended euthanasia to children, are the most recent testament to this. In the words of one commentator: "The right approach to life and death cannot be restricted to adults. It stands to reason that if euthanasia is a virtuous and compassionate act and a right given by law, then restricting it to only the aged and excluding children is illogical." If euthanasia is permitted as a 'treatment' for pain and suffering then it has to be made accessible to all people.
That inevitably includes people incapable of making a competent choice? While the Belgian law regarding children stresses that the child must repeatedly request euthanasia and be proven to have the capacity to understand what they are asking for, it is, ultimately, just as illogical to restrict euthanasia to those who are competent. No other medical treatments are given or withheld on the basis of a person's competence.
The experiences of the Dutch are, once again, instructive in this regard. Euthanasia of neonates has long been tolerated under what is known as the Groningen Protocol. More recently a public referendum has been initiated in the Netherlands that would allow those over 70 to access euthanasia for no other reason than that they were 'fed up' with life. This would include people who felt isolated, who were demoralised or who felt themselves to be of no use and a burden. As one commentator notes: "Euthanasia in the Netherlands has gone from requiring terminal illness to no physical illness at all, from physical suffering to depression only, from conscious patients to unconscious, from those who can consent to those who cannot, and from being a measure of last resort to one of early intervention."
Thus, legalising voluntary euthanasia is tantamount to permitting all forms of euthanasia – voluntary and non-voluntary and, as international evidence shows, will invariably lead to cases where people are euthanised against their explicit wishes (involuntary euthanasia). It is, therefore, inevitable that choice will be undermined.
To reiterate; the choice to allow euthanasia to remain illegal is a choice in favour of the rights of people rather than the opposite as proponents claim. However, it is now readily apparent that we are talking about a particular kind of choice. It is a choice that recognises the needs of the most vulnerable. It is a choice to promote and uphold the common good. It is a choice that locates individual decisions within a community perspective. It is a choice to care. It is more of a 'total football' approach to life which recognises that strong minded individuals do not always bring back the winners medal.
It is evident to me that Maori and Pacific Island cultural perspectives have been largely absent from New Zealand discussions on attitudes to dying. It is their voices we need to bring a fresh perspective. The Western approach considers respect for human life almost exclusively at the level of respect for the individual while ignoring the effects such a law change would have on society and at the institutional level, in particular its effect on the institutions of law and medicine. It is an approach which too easily neglects the fact that, when all is said and done, we are all interconnected persons whose identity and well-being is tied up with being part of a caring and inclusive community.
'Going Dutch.' In the colloquial sense it's all about individuality; paying one's own way, going it alone, not wanting to be beholden or a burden, being independent. 'Going Dutch?' No thanks.
I will, of course, keep on barracking for the Dutch football team as they travel to Brazil for another go at that elusive World Cup just as I will continue to be vociferous and staunch in my opposition to euthanasia. Come to think of it, I am even grateful to the Dutch for demonstrating so clearly the dangers of euthanasia ... if only they would go back to a 'total football' philosophy.
John Kleinsman is the director of the New Zealand Catholic Bioethics Centre – The Nathaniel Centre