If this should seem fanciful and alarmist, then consider the Netherlands, which has had over a quarter of a century's worth of experience of trying to design a suitably stringent legal framework for regulating assisted suicide and voluntary euthanasia. Since 1984, Dutch law has in effect permitted doctors to assist patients to die or to be killed upon request under certain conditions. These conditions do not stipulate terminal illness. They do not clearly stipulate physical illness. They only require that the candidate's suffering be unbearable and without hope of improvement. Accordingly, in the Chabot case of 1994 the Dutch Supreme Court ruled that a 50-year-old woman who was physically healthy but in persistent grief over the death of her two sons, was subject to "unbearable suffering" and legally eligible for assisted suicide. Six years later in the Sutorius case, a trial court in Haarlem judged it legal to give assistance in suicide to an elderly patient who felt his life to be "empty and pointless".
Now it is true that an Amsterdam appeal court later overruled the trial court's judgment, arguing that doctors have no competence to judge "existential" suffering resulting from loneliness, emptiness and fear of further decline. It is also true that the Supreme Court denied Dr Sutorius's subsequent appeal to have his conviction quashed, holding that a patient must have "a classifiable physical or mental condition" to be eligible for medical killing.
These judgments have settled nothing, however, and the debate rumbles on. In 2004, the Royal Dutch Medical Association published the Dijkhuis report, which argued that someone who is no longer able to bear living any longer and had a hopeless outlook on their future could be said to be "suffering from life" and should therefore be eligible for assisted suicide or voluntary euthanasia. This view has not yet won the support of a majority of the association's members, but it is being championed by the Dutch Right to Die Society, which is often taken by public bodies to be the representative of patients' interests. If the society gets what it wants, then the Netherlands would be well on its way to enshrining in law the principle of arbitrary autonomy. "Suffering from life" is not a medical condition and there are no medical grounds on which doctors would have the authority to contradict an individual's claim that he feels such suffering to be unbearable and hopeless.
Britain is not the Netherlands, of course. We could adopt stricter arrangements here. We could permit only assisted suicide and not voluntary euthanasia and we could limit eligibility to the terminally ill-as they do in Oregon. Indeed, that is exactly what Dignity in Dying is currently campaigning for. However, there are two reasons to think that if we start with the Oregon model, we won't stop there. The first is cultural. Oregonians, being American, are typically allergic to the state and analogous institutions and zealously protective of individual liberty. So whereas they are willing to grant individuals medical assistance in killing themselves, they refuse doctors the authority to kill their patients under any conditions. Britons, however, are not American. They have a more benign, European view of the state, of state-run healthcare and of those who provide it — just like the Dutch.
The second ground for doubting that thiswould rest with the Oregon model is logical. The reasons for restricting the right to die to those terminally ill who are capable of suicide are not at all strong. Indeed, one of the liberalising campaign's leading lights, Lord Joffe, has stated in public on several occasions that the rationale for the proposed restrictions in his Bill is simply political: currently, a more cautious Bill has a greater chance of winning sufficient support to become law than a less cautious one. He fully hopes and expects that sooner rather than later the restrictions would be lifted. That he would not long be disappointed is suggested by the fact that, of the recent cases that have been seized upon by much of the British press to promote a change in the law, several already fall outside the tactically cautious arrangements proposed by Dignity in Dying. Neither Daniel James nor Sir Edward Downes was terminally ill. Nor were they suffering unbearable physical pain. They were simply "tired of life".
But why shouldn't we go the whole libertarian hog and grant all rational adults the right to die or be killed on demand, as the director of Dignitas, Dr Ludwig Minelli, enthusiastically recommends? As long as the decision for assisted suicide or euthanasia is made freely by the individual concerned, what reasonable objection could there be?
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