The euthanasia law, approved in The Netherlands on April 10 2001, has been definitely enforced these days. Active euthanasia and assisted suicide thus become part of Dutch medical procedures, though controlled by regulations and limitations.
In theory, this law extolls individual autonomy, the freedom of choice when faced with the prospective of a life marked by suffering and deprived of hope. In fact, this law consolidates and confirms the existential solitude of the sick, who feel they are a burden to a society that will not put up with suffering and sufferers anymore, and wishes to remove one aspect of the human condition.
This decision is also the result of a great theoretical void concerning the definition of the moral boundaries which current medicine must set itself when treating human beings. We cannot ignore a fact - people today are obsessed by the fear of not succeeding to die rather than of death itself; hence the myth of the so-called “peaceful death”.
Surveys describe this century’s anguish - being kept alive without being aware you are alive.
This technological terror, the same as being buried alive, the fear on which imagination focussed in past centuries, is behind most of the approval given to euthanasia.
But there are other reasons too, both social and cultural, orientated in this direction: the gradual disintegration of family ties leaves the dying exposed to the care of “strangers”, while hospitalization in the last stages of life removes man from an environment that can give him peace.
This is the triumph of patterns created by health fanatics who assess man’s worth according to parameters of efficiency and self-sufficiency; these are contradicted by the experience of pain, suffering and the awareness of being about to die, which create a deep state of depression.
I do not think it right to underestimate the anguish of one who is close to death or of one who knows that a painful death awaits him. I do not even think that every death request can be interpreted only in terms of a cry for help and assistance - the depth of human existence does not justify easy assessments or interpretations. And I do not believe that the course to be taken should lead to a committee which assesses the legitimacy of the request and decides on the matter. This new manner of administering death, this new death sentence given to the consenting and suffering innocent has no human side to it.
As concerns medical procedures in a democratic society, human existence remains and must remain a possession that cannot be disposed of.
There is, in fact, no authentic right to die because death is the very denial of that same right, it is the end of man’s identity and freedom.
There exists, instead, the right to an all comprehensive assistance. There exists the duty to do everything that is morally legitimate to enable a person to end his days and last hours in the least painful and most human manner possible: pain-relief, human assistance, and when requested, religious assistance of the dying are the only weapons which enable man, the mortals, not to violate man’s dignity. Yes, it is true that our hands are once again tied by death and sickness - in other words they prevent us from going beyond the human condition, but they also lead us to understand the meaning of reciprocity and solidarity.
The theoretical models which refer to the sacredness or quality of life cannot alone identify the criteria with which the terminal stage of human existence should be faced in this historic juncture. Before defining the value of human life, we must consider the concrete situation of the sick in the western technological and cultural context. There exists a great social pressure which heavily influences both the “freedom” of choice of the suffering person and the “freedom” of the medical staff.
The absence of serious and articulate reasoning on the limits to be set to medical intervention, in the name of respect for the human being, has opened the way to subjective assessments of the “quality” of one’s existence. As a matter of fact the paradox lies in legitimizing, in name of the patient’s request, both heroic treatment and active euthanasia - two facets of the same moral error.
No consent can, in fact, make what is morally wrong legitimate. Turning the therapeutic allegiance between doctor and patient into a kind of death orientated complicity means distorting the very meaning of the medical task; equally misleading is the vitalist prospective which overlooks the complexity of human existence, considering death only as a defeat, and not as an event typical of the human condition. In commenting the recent Dutch law, some media went to the extent of stating that in fact euthanasia is practiced in Italy too, though unofficially.
According to the reasoning already followed in regards to abortion, we can even declare that it is better to regulate and control the standard procedure of euthanasia, rather than leave it to the discretion of each doctor. On the one hand, these extremely serious statements lead us to question the credibility of the medical class which is confessedly a complice in actions which are really offences, till the contrary can be proved, or makes gratuitous statements for rhetoric purposes. On the other hand, it is striking to note a certain degree of approximation in the moral assessment of acts which are generally called “euthanasian”.
Many doctors prove themselves refined and well informed in technical and scientific fields, but when it comes to morals they enlarge on argumentations and distinctions which do not cross the threshold of “common sense”, considered a historical and social set of “clichés”. There is no hypocrisy in distinguishing between heroic treatment, withdrawal of life-sustaining treatment and real euthanasia. Death still has natural causes and there is a difference in letting death occur where it is unreasonable to oppose it, and in causing it directly.
The staunch supporters of active euthanasia are the very people who do not accept these distinctions which are instead necessary - they help understand the degree of responsibility and freedom at stake in medical procedures. The topics of pain and suffering too deserve careful and detailed attention, as these terms cover very different situations and experiences, which cannot be interpreted univocally.
This Dutch law opens a new social and cultural issue which, intentions apart, risks striking the existence of those who have learnt to live with crippling diseases which are serious but not terminal. When, in fact, we repeatedly maintain that man’s dignity is assessed by parameters of physical efficiency and good health, thus presenting death as a rational choice to the seriously crippled, we create a dangerous atmosphere of discrimination among men, and medicine borders on eugenics.
All this may not take place, but we cannot underestimate the consequences when our idea of the quality of life expresses the expectations and intolerance of the healthy rather than a simple medical criterion which on the other hand cannot alone establish the value of man as such.
It is paradoxical that the euthanasia season is inaugurated today, when western medicine gives new hope to those who, in poor countries, are still fighting against epidemics and death caused by diseases eradicated in our nations.
Considering medicine today, and its future progress which can be figured to a certain point, we must learn to gauge our ability to intervene in life, in order to balance the technically possible and the morally legitimate.

( translated by Interpres sas)

Adriano Pessina
Cattedra di Bioetica Università Cattolica - Milano