Mobile clinic to administer the right to die

The Dutch euthanasia organisation has launched a mobile Right to Die clinic. JOEP DERKSEN uncovers how the initiative will serve those whose end of life choice goes unheard by physicians.

In the Netherlands, a country known worldwide for its liberal view of euthanasia, many people seeking an end to life are denied the opportunity to execute their wishes desire. With no legal medical option available to them, some of these individuals cross the Belgian border to buy suicide pills, available in the neighbouring country in pharmacies and without prescription.

“When a person finds his or her situation hopeless, but doesn’t get support from doctors, getting the suicide pills in Belgium may be an alternative,” says Walburg de Jong, spokesperson for the Nederlandse Vereniging voor een Vrijwillig Levenseinde (Right to Die NL, NVVE). The NVVE promotes these cross-border pick-ups, however, only “in some cases.”

According to De Jong, this illegal means of enacting the right to die, can save a person from a worse fate, such as an unsuccessful suicide attempt. “Currently, people who want to end their lives can’t go anywhere for assistance. Often, they resort to horrific suicide attempts. We feel an institution should be set up where people can obtain a suicide pill.”

And that is exactly what the NVVE has done. From March, the organisation will oversee a Levenseindekliniek or euthanasia clinic. With its headquarter located in The Hague, the mobile unit offering assistance to those whose right to die choice has been disregarded. Additionally, six specialised euthanasia teams consisting of one doctor and one nurse will make house calls across the country. “Many people want to die in their own house; therefore we come to visit them. But, only after a thorough screening process and intense conversations on the reason why the person wants to end his or her life,” says De Jong.

In the Netherlands, those who meet certain criteria are legally eligible for euthanasia. However, support from physicians can sometimes be lacking, as some fear over legal back-lash and oppose the unclear rules. “We want to help the people who don’t get any support from their physician, but do have the right to choose to end their lives,” says De Jong. According to her, the NVVE does not want to change Dutch laws regarding euthanasia. They instead want to draw attention to the inadequate approach of physicians toward genuine suicide requests. “The physician fulfils all criteria of the law, but can’t or won’t execute the euthanasia. Doctors have an obligation to refer a patient to a colleague, if they can’t provide the best care possible. Too often, this does not happen when a patient indicates the wish to die.”

The start-up capital to establish the Levenseindekliniek has been gathered thanks to the donations of NVVE members. Also, the organisation is negotiating with two health insurance organisations for additional financial contributions. However, not everybody is pleased with this initiative. “Physicians should not separate euthanasia from other requests for care. An insight into all problems and help requests is necessary before euthanasia can be executed. We seriously doubt that these requirements can be met through contacts that are aimed at euthanasia. We have to prevent people being euthanised, when they could be helped in other ways,” says the Dutch medical association KNMG, the professional organisation for physicians in the Netherlands.

De Jong insists that the NVVE conducts thorough evaluations of their patients to ensure their end of life decision is voluntary and well-considered and that their situation is hopeless and unbearable. “First we have extensive screening and conversations, after which amongst others an independent doctor is contacted. Only then euthanasia can be executed,” she says.

More than 300 people contact the NVVE each year with end of life requests from patients whose doctors have refused their decision. The organisation expects their mobile unit to see up to 1,000 patients a year. Their services are only available to Dutch nationals. As awareness over the right to die grows in the Benelux, attention to the physicians' dilemma is sure to grow. Indeed, the newly released documentary Medeleven (Compassion) does just that. Following the plight of a 90-year-old Dutch man to five pharmacists in Belgium, the film tells the story of an old man pretending to be a long way from home who has forgotten his medication. The man succeeds in obtaining 350 suicide pills; more than seven times the required dose. Only one of these pharmacists refused to help the man.

It is a story of controversy as much as sympathy, according to Jan Depoorter from the Apothekersbond in Belgium. Acknowledging that pharmacists in the film broke the law, he says he understands their decision. ‘Many pharmacists would choose to help a 90-year-old man with such a story.” It is not yet known whether the pharmacies will face official reprimand.

(Verschenen in The Holland Times March edition)