In 2017, a member of the Dutch House of Representatives – Ms Pia Dijkstra – published a legislative proposal under the right of initiative. The proposed act carries the name ‘Wet toetsing levenseindebegeleiding van ouderen op verzoek’ (‘Termination of Life on Request by the Elderly [Review Procedures] Act), and is popularly referred to as the ‘completed life act’.
Pia Dijkstra is a member of parliament on behalf of D66: a party that identifies with the social-liberal philosophy.
The Netherlands has had the Wet toetsing levensbeëindiging op verzoek en hulp bij zelfdoding (‘Termination of Life on Request and Assisted Suicide [Review Procedures] Act’) since 2002. This act is referred to as the ‘euthanasia act’, and it permits euthanasia and assisted suicide under very strict conditions (the requirements of ‘due diligence’). The ‘completed life act’ was conceived in response to the euthanasia act; the political motive is that the euthanasia act may not in all cases offer a solution for people who consider their life ‘completed’ and wish to end their life in a dignified manner. The proposed act aims to offer these people a government-sanctioned form of diligent and professional assistance to end their life.
As one of several medical-ethical issues currently under debate, the legislative proposal played an important role in the 2017 negotiations to form a new government, with both D66 and the religiously inspired ChristenUnie party, which is firmly opposed to the proposal, participating. A coalition agreement was subsequently reached which includes the agreement to conduct more research into the current law on euthanasia, and to pursue a broad public debate on the issue of ‘completed life’.
As a care ethicist I wish to respond to the legislative proposal from a care-ethical perspective. Since I consider myself explicitly ‘humanist’, my vision resists the framing of objections to the proposal as something ‘typically Christian’ – a framing often used to dismiss counter-arguments as ‘outdated’.
The proposed ‘completed life act’ compels us to think very carefully about assisted suicide. The scope is limited (for now) to elderly people who consider their life ‘completed’ and whose only wish is for assistance in ending their life. This calls for a public debate without any misunderstandings; while there are in fact several misunderstandings at play.
First, the act is formally titled ‘Wet toetsing levenseindebegeleiding van ouderen op verzoek’ (‘Termination of Life on Request by the Elderly [Review Procedures] Act); so there is no mention of the concept of ‘completed life’.
Second, the concept of ‘completed life’ is presented as a natural phenomenon that can simply happen to people, comparable to how a party must end sooner or later: life is over. However, we need to think about the decision a person makes to consider his or her life as ‘completed’.
Third, the notion of ‘a completed life’ has a positive ring to it; as if life had been basically satisfactory up to that point, like a successful party. I could continue to embrace this life, but seeing what life has in store for me I choose not to. I want to be able to quit this life in a satisfactory manner, which requires neither an age limit nor third-party assistance, but simply ‘Drion’s pill’ (a hypothetical lethal pill that Supreme Court judge Huib Drion proposed should be made available to elderly people, in 1991).
This suggests that it’s about having a happy conclusion to an autonomous life, as a further form of personal ‘art of life’ which many modern people apparently find appealing. However, the explanation attached to the legislative proposal refers to people for who (without medical reasons) life has become something to suffer. One may wonder how autonomous people are when each day is a torment: is the experience of suffering not (partly) a matter of being unable to continue to embrace life?
Fourth, people will not suffer ‘purely’ from life itself. Life happens to us as a succession of experiences. These experiences can be fulfilling, but not necessarily so. People can suffer severely from a sense of loneliness (the core of much suffering), social redundancy, fatigue (mental or spiritual), anxiety (say, for the impending indignity of dementia), humiliation (for example, they may experience care dependency as humiliating due to the loss of autonomy), and so on. These are some of the phenomena that may cause people to feel that their life is ‘completed’.
Fifth, a longing for death without medical reasons is not limited to people aged 75 and over. Not everyone is lucky enough to experience life like a party! Countless people (which then includes their nearest and dearest) are exposed to drastic experiences of loss at some point in their life. And there are many who struggle and even fail to regain a sense of control afterwards. Vulnerability is inherent to life, after all.
Sixth, vulnerability is not devoid of value. After all, as the Dutch poet Lucebert once wrote: ‘everything of value is vulnerable’.
Seventh, in our ‘can-do’ culture, professional care has come to mean the effective repair (medically or psycho-socially) of situations of loss. This is a misinterpretation of what professional care ought to be, however. Perhaps partly due to the immense success of our (social) technologies, care is no longer seen as a moral matter in which a sense of powerlessness and the capacity to offer comfort also have their place. If we were to think differently about professional care – also in terms of inevitable tragedy and hence of solidarity – and we were to translate this into relationally designed care practices, then this would contribute significantly to building a humane society.
Eighth, people can completely lose their desire to live, despite all the good care they receive; so they may have understandable reasons to wish to end their life. This certainly calls for a caring and careful response, but the current interpretation of the euthanasia act already offers the option of invoking existential suffering, due to the absence of perspective in life. This is not attached to any age limit. However, this procedure does demand the involvement of a medical doctor and a very specific assessment procedure. In such a situation, ending life does not mean the crowning of an autonomous life, but is a fitting course of action in a case of severe need.
Ninth, objections to the legislative proposal are easily dismissed as religiously motivated, and hence as conservative. The suggestion is that the time for such ‘grand narratives’ – read, religious belief – is definitively a thing of the past. Yet at the same time, a new liberation ideology seems to be foisted upon us. From the whirlpool of secularisation, depillarisation and especially individualisation, the Grand Narrative of Self-determination has emerged. Powered by neo-liberalism, (positive) psychology, the illusion that life can be engineered and the perception of vulnerability as of no value, this narrative can only propagate the value of self-determination (or autonomy), geared entirely to the condition of individual well-being.
Personally, I fear that the proposed new act will not enhance the caring nature of today’s society, but will make it more inhospitable instead. In my view, the notion of ‘completed life’ is a clever lobbying concept, to replace the stark and chilling concept of ‘suicide’. Even people who do not suffer at all, or not grievously, or only temporarily (just two months need to pass between the first and second request for support for the request to be classified as ‘enduring’) ought to become eligible for publicly organised forms of assisted suicide.
My objections are grounded in a humanist, hence secular spirituality. Humanism can be understood as the will to contribute to human dignity. I mainly have in mind the philosophy that motivated the establishment of the Humanist League in the Netherlands (right after the Second World War). The pioneers at that time referred to a lesser struggle (for equal rights for non-religious and non-churchgoing people) and a greater and more important struggle: the struggle for the spirit of humanity – or, the struggle against nihilism. How should we view the current legislative proposal from that perspective? If the illusion of self-determination becomes dominant in our life and society, then I fear that we have indeed ended up on the slippery slope that the opponents of the euthanasia act already cautioned against – and it’s a slippery slope in the direction of nihilism.
This text was first published in the journal De linker wang (a journal published by the religion working group of the GroenLinks political party). It has been redacted slightly to make it more accessible for non-Dutch readers of ethicsofcare.org.
Translation: Beter Engels Vertaalbureau