English review - Debating a Deathly Wish

A surprisingly carefree vibe surrounded the Culture Café this Monday, considering the topic of the evening: euthanasia. Little did the audience know about the clash of titans that awaited them. It all started, when the audience had to stand up. ‘Tonight you will all be members of the jury,’ Liesbeth Jansen, moderator, judge and programme director, announced. The titans? Defending the choice of the individual was Suzanne van de Vathorst, professor by special appointment at the University of Amsterdam. On the other side, trying to guide the audience to a communal perspective, stood theologian and writer Annemarieke van der Woude. This night revolved around the question of euthanasia in all its facets. When is suffering insufferable? Are mental suffering or dementia also good reasons to ask for euthanasia? What does euthanasia mean for relatives and society as a whole?

Insufferable suffering

First up, was Suzanne van de Vathorst and her opening statement started off with some statistics. In 2018, the euthanasia procedure was performed on 6126 people by a general practitioner. Van de Vathorst stressed that for euthanasia to be granted, the suffering of the patient must be insufferable. Insufferable pain is often associated with lethal diseases. However, when is a disease lethal? Is a disease lethal when it is certain you will die from it? Then dementia is a good contender, but only a small portion of these 6126 had dementia, namely 400. Most people that request euthanasia have cancer, over 4000 of all applicants. However, in general only a small portion of all cancer patients opt for euthanasia, as a lot of them eventually get better.

Since it is difficult to connect euthanasia requests to a certain disease, lethal or non-lethal, Van de Vathorst focussed on what it means to suffer insufferably. According to her, people who suffer insufferably are people who experience their suffering as needless and hopeless; there is no possibility for improvement. As a comparison, she took the case of giving birth: no one will deny that a woman in labour suffers. She is able to live through this suffering, since she knows she will get something beautiful as a result, namely a baby. Thus, the suffering is not needless. Her suffering is also not hopeless, because she knows that once the baby is born, the pain will be over. There is the outlook of improvement. However, suffering that is needless and hopeless, becomes unbearable. In this case, the patient must be allowed euthanasia, according to Van de Vathorst. And this, she argued, is more often the case for people who do not have a lethal disease, since their pain can drag on for many years without the relief of death in sight. So, for Van de Vathorst, euthanasia may be  especially applicable to people with non-lethal diseases.

Euthanasia or Suicide

Annemarieke van der Woude disagreed with Van de Vathorst specifically on this point. Van der Woude claimed that people with non-lethal diseases are not granted euthanasia; they are facilitated with suicide. For her, patients are terminally ill when they would have inevitably died from the consequences of their disease in due time, with the important side-note that, in her eyes, mental illnesses could also be lethal. People who are not terminally ill simply chose their own day of going, and therefore commit a form of suicide.

Van der Woude emphasized this difference, because suicide and euthanasia have different meanings. Euthanasia is helping someone to die, who would soon have died anyway. It is the shortening of their suffering by the soon inevitable. Suicide is taking away one’s own life, while there still was a lot of life to live, and this has a very different meaning for the relatives of the deceased. Why did my partner leave me? Could he not have hold on a little bit longer? These questions can spiral into ‘complicated grieving’, as Van der Woude called it, which puts a strain on human relationships.

Individual or society

This brought the evening to its second major disagreement. In distinguishing euthanasia from suicide, Van der Woude took up a different perspective, namely the perspective of relatives and society as a whole. Of course, on an individual level, anyone can understand why someone who is suffering needlessly and hopelessly wants to die. However, in the case of people who are not terminally ill,   euthanasia might simply be the wrong answer to the problem. Society is losing its ability to help these people make their suffering bearable. That should be the task, not ‘pointing to the exit sign’. In contrast, Van de Vathorst pleaded for the individual’s own choice in this matter. The reactions of loved ones can be taken into account, but only by the patient himself. ‘The ultimate question of death can only be answered by patients themselves,’ she stated, ‘and if family members do not agree, then that’s tough luck for them’.

Judge Liesbeth Jansen poked the bear of this matter when she asked whether the demand for euthanasia increased through societal pressure. Van der Woude reacted that this pressure becomes internalised and that the question of death will come to mind more easily. A bad thing, according to her. Van de Vathorst questioned this and held that the demand for euthanasia already existed long before it became a real possibility. Therefore, she saw euthanasia as an attainment for those who have no other way out.

Who wins?

An evening filled with a lot of disagreement about a sensitive topic ended with a verdict of the jury. The members of the audience could choose between the individual standpoint of Van de Vathorst and the communal standpoint from Van der Woude. In her final plea, Van de Vathorst repeated her claim that especially people with non-lethal diseases should have the opportunity to undergo euthanasia. They are the ones who are truly suffering needlessly and without hope on recovery. Van der Woude rebutted that especially in these situations, euthanasia is not the right answer. What will become of a society that is not able to care for those who are suffering the most? The night ended with the jury voting in favour of Van de Vathorst, but most importantly everyone went home with a lot of food for thought on this deathly wish.

This report was written by Carlijne Vos, as part of the Research Master Philosophy of the Radboud University.