Ultimately, it’s about compassion
In 2016 the Rutte Cabinet proposed that assisted suicide be legalised for older people who feel they have led a full life. The proposal is, according to Maarten Verkerk, endowed professor of Christian Philosophy, a “neoliberal” brainchild that prioritises individual autonomy over morality. There is no such thing as pure self-determination, says David Townend, endowed professor of Law and Legal Philosophy in Health, Medicine and Life Sciences. “What kind of society are we if this is the only way out we can offer to elderly people who have lost hope?”
Verkerk was a member of the Schnabel Commission, which early last year advised against greater self-determination in assisted suicide cases. Far from heeding this advice, the government is instead proposing to expand the existing euthanasia law. Under the new law, relatively healthy older people who consider their lives to be “completed” would be eligible to have their lives terminated by a professional. The bill places autonomy centre-stage, virtually making euthanasia and assisted suicide a right.
It is a polarising prospect – and one that is not helped by the fact that public debate is all too often characterised by fierce and dogmatic rhetoric. What is lacking, say the two philosophers, is calm, serious dialogue focusing on the issues at hand.
The professors share the same objections to the proposed law. For starters, the bill does not do justice to the diverse motives of elderly people who wish to end their lives. Verkerk refers to the recent PhD research ‘Ready to give up on life’ by Els van Wijngaarden, who interviewed elderly people who had grown tired of life for non-medical reasons. The results revealed a broad spectrum of motives. Some old people fear becoming dependent. Others suffer from a deep sense of loneliness; while still more feel they simply no longer matter. “For all these different ‘completed lives’,” Verkerk explains, “one diagnosis and one solution is offered: suicide.”
Townend suggests elderly people may feel under pressure to make use of the new law. “Often it’s not a free choice. People’s motives are the result of the social situation in which they find themselves. What kind of society are we if this is the way out we offer to elderly people who have lost hope?” The failure of the government to live up to its moral responsibility to protect particularly vulnerable old people may, Verkerk fears, ultimately lead to a less safe society.
The unpredictable consequences of the new law may be the most concerning. Townend emphasises the current importance of “anchoring” any assisted suicide law in a medical setting to guard against stretching it too far. In Verkerk’s view, the present Termination of Life Act is broad enough to accommodate “completed life” cases. The act hinges on two criteria: unbearable suffering and no prospect of improvement. “But the interpretation of these criteria may gradually broaden on the basis of new verdicts. That happens all the time.”
Yet the present euthanasia law does not provide a solution for everyone. Based on Van Wijngaarden’s study, Verkerk identifies two groups of elderly people who are “without hope”: those who are afraid of being dependent, and those who are existentially lonely. The first group can be helped through proper home care, nursing homes and more support from children and volunteers. But the deeply lonely cannot be fixed with bingo nights and outings, Verkerk acknowledges. “We can only listen to them attentively and talk about it.”
And so we arrive at the key question surrounding the euthanasia debate. What kind of society do we want to be? The problem of unlimited self-determination is mainly found, Verkerk explains, in individualistic societies. “The sociologist Norbert Elias once said ‘if you live alone you die alone’. In our type of society loneliness is much more common than it used to be. Euthanasia is a solution, but is it a good solution? I don’t see it that way. Personally I find relationships, including those with fragile elderly people, very important.”
The professors’ main objection to the bill is its lack of moral foundation. “It’s only about autonomy, autonomy, autonomy”, Verkerk says, banging the table for emphasis. “Proponents just say ‘die, if you want to die’. They don’t see autonomy as constructed in a social environment.” Townend: “Doing something for people who have lost hope is a moral challenge. If this new law is the answer, that’s a terrible indictment of our society.”
Their own answer is one that involves more social warmth and responsibility. It’s about compassion, Townend emphasises. “It’s about how we as a society help suffering elderly people cope with their fear of dependence, loneliness and dementia.” Which brings us, ultimately, to the question: what kind of people do we ourselves want to be? “Medical care should be merciful”, says Verkerk. “That involves taking better care of vulnerable citizens who have had enough of life, and training compassionate, trustworthy doctors.”
But there is no trace of this in the government’s position. Verkerk criticises the simplistic approach of what he calls neoliberal and populist politicians. “They just parrot what the people want without reflecting on it.” Townend adds:. “We, as citizens, have allowed this issue to become exclusively debated by politicians. Yet it’s a topic we should all be talking about openly and everywhere in society – in schools, cafes, universities.”
David Townend (1966) is endowed professor of Law and Legal Philosophy in Health, Medicine and Life Sciences at Maastricht University. His PhD focused on the regulation of data protection in medical research. He is interested in human rights and healthcare, including such themes as patient rights in European health law.
Maarten Verkerk (1953) is endowed professor of Christian Philosophy at Maastricht University. His second PhD focused on responsible behaviour in industrial organisations. He is a board member of the healthcare innovation network VitaValley and served on the Schnabel Commission, which advised the government on extending the euthanasia law.
By: Hans van Vinkeveen (text) and Paul van der Veer (photography)