POLICY/ETHICS: Follow up to the Dutch euthanasia issue

Well I’ve spent some time emailing with Sydney at Medpundit about her original article and she’s also received support from Enoch at Medmusings and Dr Bob at The Doctor Is In. All three are coming at this (I presume) from a Christian "faith-based" perspective and so there may be no possibility of them agreeing with a secular humanist like me. But let me detail my correspondence with Sydney and make one more attempt.

Last Friday after she had said that the Dutch doctors were the moral equivalent of those committing genocide in Bosnia, the Sudan and Nazi Germany, I called in this post for Sydney to retract her words. My argument was that this was a profound disagreement among well-meaning people, and that equating the Dutch with totally malevolent people was a) incorrect and b) insulting. I also argued that there was no specifically rational or moral difference between ending care and feeding of a terminally ill child causing its death, and actively causing the child’s death by, say, overdosing it with morphine. You could quite reasonably argue that this was kinder for the child as it reduced its suffering. And, as I showed using recent poll data, the former activity is accepted medical practice amongst pediatric specialists in this nation–just as highly regulated euthanasia appears to be becoming in the Netherlands. (As opposed to the unregulated, unstated euthanasia that’s been practiced by many physicians in many countries forever).

Note that I am not trying to convince Syd (or Enoch or Dr Bob for that matter) to change their views. What I am objecting to is anyone saying that  someone who disagrees with them (and acts accordingly) on this type of highly-charged issue is as evil as a human can be–there is no worse crime than genocide. Syd responded:

I disagree. You’re assuming some innate goodness on the part of the Dutch that would prevent them from killing others that they find too much of a burden, and/or some innate evil on the part of the Sudanese and Bosnian Serbs that allows them to kill normal adults they find burdensome. We are equally human and equally subject to moral failings. Once a society has decided it’s acceptable to kill those that are a burden, then any troublesome group is fair game. The only distinction between the Dutch, the Bosnians, and the Sudanese is who they define as a burden. And history has shown us more than enough that that definition belongs to whoever holds political power.

I responded to Syd by saying that "there is one absolute difference. The Dutch physicians believe rightly or wrongly that they are doing what they are doing purely because they are preventing the children from further suffering. They do not believe they are doing it for their own advantage–that’s your (mis)interpretation of their actions. The Sudanese/Serbs/Germans who commit genocide are doing it for their own perceived advantage and have no consideration of any kind for their victims.

There is also one relative difference. If you withdraw care and feeding from a terminally ill child with no prospect of recovery, it will die sooner than if you don’t. If you euthanize a terminally ill child the same is true. It’s a reasonable position to equate these positions morally, and if you do that then many, many physicians (as shown in the poll on my blog) are guilty of the same act. According to your logic, they’re all the same as those committing genocide.

If you cannot logically defend these points you should withdraw your remarks."

Sydney replied:

Active killing is active killing, regardless. The Dutch doctors may tell themselves they’re doing it to end the suffering of the children, but truthfully, there’s no indication that children with neural tube defects have pain just from the defects. They do have long, complicated roads ahead of them, however. The Dutch are making the decision for the children that those are roads best not taken. (According to press reports the physicians make the decision without even taking into consideration the parent’s wishes.) Take it from someone in the profession – doctors make those kinds of decisions most often based on how much of a hassle factor it will be for them, rather than the patient.

Here’s another example. In Germany, before the Holocaust, it became acceptable practice to euthanize mentally handicapped children. The doctors convinced themselves it was OK to do so because the children were too restless and unmanageable. They would put them down to put the "poor idiots" out of their misery. In truth, it was the doctors’ and nurses’ misery that was being eliminated. It wasn’t so much the patient’s condition that was the real problem, as it was the medical profession’s inability to manage their conditions properly.

It was not so long ago that people with even mild physical handicaps were treated as non-entities, even in this country. They were often locked away in their homes by their families. That’s still better than being euthanized out of pity, I suppose.

I guess that’s the difference between the two of us. I’m unconvinced that the Dutch doctors kill infants for completely altruistic motives. You are too willing to take them at their word.

I certainly won’t withdraw my remarks.

On a somewhat trite level it’s easy to refute Syd in this particular case. The Dutch hospital has set up a special protocol, consulted parents, judges and lawyers, and invited controversy including attacks like Syd’s from far and wide on the personal morals of those involved and their national character, all allegedly in her view to save themselves from the "hassle factor" of letting, so far, four children die by withdrawing care and feeding. I know in which course lies the "hassle" and it’s not in the withdrawing of care and feeding. Furthermore, Syd has convinced herself that because she’s seen doctors take those type of decisions for reasons of their own comfort–you see it happens here too–that the Dutch doctors must be doing it for that reason. She also hasn’t bothered to try to logically untangle the relative difference between causing death by action and causing death by deliberate inaction. She just says "active killing is active killing". Similarly Enoch says:

I think there’s a huge difference between allowing a person to die off of life support, and actively ending the life of the person. It’s true that it’s an action to take a person off of support, but that’s morally acceptable to me, to remove life support from a terminal incurable process that will inexorably lead to death soon. Removal of life support is completely different from an action promoting and accelerating death and altering the natural course of disease.

None of them come up with a "why" as to there is a difference. In their view it just is (based presumably on their interpretation of their theology), and that’s that.

Sorry guys, but that’s not good enough. You are all supposed to be scientists and scientists are supposed to bring reason and logic to bear on problems. You may well be right, but you have to at least attempt to prove your case.

But it’s accusing the Dutch physicians of moral equivalence of genocide that is not acceptable. Let me give an analogy. A while back there was a huge brouhaha when two of some 1200 amateur made videos commercials submitted in a contest to Moveon compared Bush to Hitler. As soon as Moveon realized this, they took them out of the contest, and they were rebuked (rightfully so in my view) by both the Republicans and the Democrats for not weeding the commercials out earlier (even if hardly anyone saw them). Now, if you really wanted to, you could draw a parallel between Bush and, say, Stalin. Bush has ordered the indeterminate detention without trial of at least two American citizens. Is he as bad as Stalin, who had thousands detained without trial and tortured and killed? The ACLU (of which I’m a member) has vigorously opposed these detentions (and those of several hundred more non-citizens) as being opposed to fundamental human principles of due process (not to mention the Bill of Rights). However, no reasonable person would suggest that what Bush is doing equates him with Stalin, even though indeterminate detention without trial was a hallmark of Stalin-ist totalitarianism. Whether you agree with him or not, Bush (and his administration) seriously and sincerely believe that the relatively limited numbers of detentions carried out are essential to protect the United States and its citizens. No serious historian believed that Stalin’s use of those tactics (and much worse) was anything other than a means of crushing any possible opposition.

By equating the Dutch physicians with the genocide seen in Rwanda, Sudan, Bosnia and Nazi Germany, Syd and the others are doing the equivalent of saying that Bush is the same as Stalin. That’s what’s so offensive.

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  1. Hi,
    I’m a dutch woman and I am amazed by the american (or international) press when they write on our euthanasia policy. They are inaccurate in their facts and the critics manage to present them in such a way that even I would agree with them. Fortunately everybody can come to holland without a risk of being killed, even when you have a handicap or if you are pregnant!
    I think your story illustrates a lot of the misconseptions in the international press. For instance, the parents consent is a must (a lot of critics say it isn’t, but no docter would end the life of a suffering child without the consent of a parent and if they do, it’s against the law here as well!), but it can never be on their request alone (another misconception). An independent second docter needs to asess the case, and there has to be extreme suffering and no long-term perspective. These are “and” criteria, not “or” (which is a clever way to misrepresent the facts as well). On top of it all, critics use percentages from dutch research to back up their story’s, but what they forget is that we have those percentages because we investigate and regulate the cases of euthanasia. Similar cases can be found all over the world, but you won’t find percentages, because it’s not regulated and instead it’s done in secret. Instead of leaving dilemma’s like that in a grey unregulated area, I think that regulating it in such a way can even prevent the unjust killing of infants. Anyway, this became a longer story then I wanted, but thanks for your clear story, it’s refreshing!

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