Issues in Law & Medicine Dutch Euthanasia, Health Care Rationing, Assisted Suicide, and the Remarkable Potential of Adult Stem Cell Research.(Brief Article)

Editor's note. Issues in Law & Medicine is a peer reviewed professional journal published three times a year by the National Legal Center for the Medically Dependent & Disabled, Inc. and the Horatio R. Storer Foundation, Inc. Published since 1985, Issues is devoted to providing useful information on recent legal and medical developments to assist attorneys, health care professionals, educators, and administrators on legal, medical, and ethical issues arising from health care decisions.

The featured article in the spring 2002 edition of Issues in Law & Medicine evaluates the legalization of euthanasia and physician-assisted suicide in the Netherlands, practices that had long been legally sanctioned as a result of court decisions since the early 1970s. In Holland, euthanasia has even become a "cure" for those with clinical depression. In other words, depressed people with suicidal tendencies are sometimes encouraged to consider euthanasia.

The author, Herbert Hendin, M.D., medical director of the American Foundation for Suicide Prevention, notes (1) that according to official reports the euthanasia guidelines have failed due to widespread disregard by physicians practicing euthanasia, and (2) that there is a significant pattern where incompetent patients were "terminated" without their consent, or when competent patients were not consulted before they were euthanized.

Dr. Hendin concludes that Dutch tolerance of euthanasia is really a mask for indifference toward people with chronic mental or physical problems. The casualness with which Dutch physicians recommend euthanasia to their patients, he argues, is really a sign of ambivalence toward patients and disinterest in developing patient care alternatives such as treatment of depression and anxiety, pain relief, and hospice.

The second article, by Professor Raphael Cohen-Almagor, University of Haifa, Israel, focuses on the influential writings of Daniel Callahan, founder and president of the Hastings Center in New York. He argues that Callahan's approach is too cold and detached, and that age alone should not serve as the decisive criterion for limiting medical care. His criticism of Callahan's views on older patients stems from two different lines of reasoning: the medical and the moral-contractual.

From the medical perspective, while age is an important variable in determining a patient's medical condition, there are other no less important factors that influence one's health care decisions, such as accurate diagnosis, prognosis, life expectancy, and the belief system of the patient. Age may affect these determinations, but should not be determinative of whether medical treatment should be limited.

From the moral-contractual line of reasoning, Cohen-Almagor contends, a liberal society should not desert its citizens at the time they need its help most. It is the older patient who has contributed most through a lifetime of paying taxes and rendering personal service to the community in which he or she has lived. The age criterion is too simple, too general, too sweeping, and too convenient.