Catherine Pepinster: 'We can have a choice about dying - but not the Dutch way'

I watched my grandmother die some years ago; a lingering death caused by cancer which first attacked her throat and then her brain

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Seeing a once vivacious woman become first an angry, then a paranoid and later a mute and passive creature was almost unbearable. Would it not have been more merciful if a doctor had filled a syringe and injected her with a lethal drug, quietly letting her slip away from us when she was not yet in the darkest days of her disease?

Seeing a once vivacious woman become first an angry, then a paranoid and later a mute and passive creature was almost unbearable. Would it not have been more merciful if a doctor had filled a syringe and injected her with a lethal drug, quietly letting her slip away from us when she was not yet in the darkest days of her disease?

Such an end will soon be possible in the Netherlands. Last week it became the first country in the world to legalise euthanasia. Dutch doctors already perform euthanasia on 3,000 patients a year, but this latest Bill is supposed to bring the practice into the open; once it is approved by the Dutch Senate in the spring (which is highly likely) a doctor will be required to ensure that the patient's request is voluntary, based on full information, and is carefully considered. The patient's condition must be unbearable and untreatable, and a second medical opinion must corroborate the first physician's.

No other country has such a law, yet there is a growing acceptance of euthanasia across the world. It is tolerated in Belgium, Switzerland and Colombia, as it has been in the Netherlands for years. In the US, Oregon allows doctor-assisted suicide for the terminally ill. Australia's Northern Territory legalised it in 1996 but repealed it a year later. An idea once taboo - that killing people deliberately is acceptable, desirable even - is becoming tolerated. Of course, we have always had exceptions: we kill people in wars, in self-defence. But ever since Hippocrates, doctors have been supposed to save lives, not cause deaths.

Medical advances have changed that. Doctors today are often not so much saving lives as prolonging them. What made the condition of my grandmother so dreadful was not that she was suffering from a fatal illness but that she became a victim of scientific and medical progress. The treatment that was available kept her alive long after the quality of her life had been destroyed. Is it any wonder that people seek drastic solutions, if the very professionals whom we want to ease suffering instead extend it.

That solution can make a patient feel in control again. We don't expect others to decide whom we marry, when or whether we have children, where we live. Why should it be down to the whim of nature to decide when we die? Isn't death the most significant moment of our life, and should we not have the right to decide when it comes? It should not be down to the bogus notion of letting nature takes it course. What is natural is what we're used to. It seems perfectly natural for us to have somebody else's blood transfused into our veins, for example, because that has been possible for generations. We don't say to the elderly person who has difficulty walking that that's nature taking its course; we expect them to be able to get an artificial hip.

In this way, deciding about one's dying seems a matter of private morality; it is part of our "moral sense" about how we ought to live. It is as much a part of the way I perceive the world as whether I think I should lie when it suits me, or whether it is shaming to deceive somebody. But euthanasia is not just a private issue. Deciding to legalise it is a public statement about the kind of society we are. It would certainly make us more honest: for years doctors in this country have carried out a form of passive euthanasia, by treating patients with drugs that provide pain relief. If a dose is high enough, there is a risk that the patient will die, and often does.

But intentional killing is a very different matter. The Netherlands' change in the law is supposed to protect doctors, yet making euthanasia legal may well place an enormous burden on them to provide this service. Patients too may be placed under undue pressure from relatives to choose death as a way out, a solution to their ills.

When I waited for my grandmother to die, the way she was dealt with by the health service was the most distressing experience of all. She was moved from one hospital to another. Sometimes she was placed in a ward with patients who were not suffering from a terminal illness, as she was, but were suffering from acute dementia. What my grandmother needed was not a grim hospital where the emphasis was on treatment, but a place where the priority was care; a place where people accepted that she would die but did all that was possible to make her final days as comfortable and pain-free as possible. She needed a hospice. In the Netherlands, where hospices are almost unknown, that would not even have been an option.

However much we talk about mercy and dignity, euthanasia is still a form of killing. But what matters when people kill - and our acceptance of killing in war and in self-defence makes this clear - is motive. The doctor's aim in killing his patient should be carefully examined. The House of Lords select committee on medical ethics unanimously agreed that there should be no change in the law on euthanasia. It was right. But to impose a mandatory life sentence on a doctor is too harsh. We should not go down the Dutch road; but if such a case of deliberate killing came to court, a judge should consider whether the doctor did indeed act in the best interests of the patient and on a persistent request. Then it should be open to the judge to offer a lenient sentence - or none at all.

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