Dutch treat

in Amsterdam - Joop Stolk's mind is in the halls of Dutch academia, but his heart meditates on severely mentally handicapped children: "Every time I am with them, I am distressed for a while. Then it is like a miracle. They open your heart and force you not to pretend." Combining heart and mind, Mr. Stolk has spent countless hours interviewing and observing mentally disabled children and their parents. He has written several books and more than 100 articles in widely regarded European medical journals on his specialty, the ethics of treating the mentally disabled, which he teaches at Amsterdam's Free University. His field of study, along with deep-seated Christian convictions, has put him on the front line at the latest battle over social issues in the land heading nether: euthanasia of children. Are children and newborns now being put to death? "Yes," Mr. Stolk replies simply. How can he be sure? "Doctors are very open about it because of the liberal climate here in the Netherlands," he told WORLD. In fact, scientific journals in this country matter-of-factly report on doctors who have "successfully" put children to death. In one case involving a baby with spina bifida who was killed by injection, it was the attending nurse who was reprimanded. She violated professional ethics, authorities said, by discussing the case with her husband. The couple had sought to adopt the child. As many as six cases have been well documented, but experts on both sides of the issue agree that they are only the best-known ones. Every year at least 50 newborn handicapped babies go without medical care-deliberate but passive euthanasia. Even so, "most doctors in this field are calling it more humane to actively end the lives of these babies," said Mr. Stolk. That is done by injection, the same method used with thousands of adults here who are deliberately put to death each year. Estimates vary widely, but experts say that 5,000-20,000 of the 130,000 annual deaths in the Netherlands are the result of euthanasia. A government-sponsored survey of doctors in 1991 found that 49,000 yearly deaths involve a "medical decision at the end of life," with over 50 percent of Dutch physicians admitting to practicing some form of euthanasia. Dutch policy on euthanasia is not simply permissive; it is deviously so. Terminating life at the explicit request of a patient (euthanasia) or providing the patient with medication to do it himself (physician-assisted suicide) is still, technically, a criminal offense. But those practices have been widely tolerated for nearly 20 years, and in 1993 lawmakers moved to "regulate" them. Now doctors receive immunity from prosecution if certain "guidelines" are followed: The request for euthanasia must be voluntary and long-standing; it must be accompanied by unbearable suffering with no prospect for improvement; a physician must consult with a colleague and document the entire "procedure" to the municipal pathologist's satisfaction. Furthering the de facto legalization in the guidelines is the loophole for force majeure, or euthanasia "without the explicit request of the patient." Under that rubric, euthanasia is allowed "if the person concerned was compelled to commit a criminal act by circumstances." Doctors can be exempted from prosecution in even forcible euthanasia cases where their two duties "conflict": the choice between the duty to preserve life and the duty to relieve unbearable suffering when there is no prospect of improvement. Herbert Hendin, an American physician who last year authored Seduced by Death: Doctors, Patients, and the Dutch Cure notes that "the Netherlands has moved from assisted suicide to euthanasia; from euthanasia for those who are terminally ill to euthanasia for those who are chronically ill; from euthanasia for physical illness to euthanasia for psychological distress; and from voluntary euthanasia to involuntary euthanasia." There is no regulation on euthanasia, Mr. Hendin states, that has not been violated with impunity. Still, the growing approval among Dutch doctors for putting some children to death is fueling a political move to decriminalize it further, and the socialist party D66, whose leader Els Borst is Dutch minister of health, is proposing to give children over the age of 12 the right to request euthanasia. Even though the socialist D66 party took heavy losses in the elections two weeks ago (see p. 16), it will get support from the new coalition government for shifting the regulatory burden in euthanasia cases from physicians to local committees. They would be composed of doctors, municipal officials, and plain citizens, "so long as they are not hard-line Christians," one D66 parliamentarian is reported to have said. Christian Democrats and three orthodox Christian parties will oppose the plan. What is more difficult to oppose is the peaceful aura the pro-euthanasia establishment wraps around the practice. Doctors performing euthanasia are required to follow a lengthy procedure by hospital protocols existing in most of Holland's 150 hospitals, where a simple overdose of morphine would more unceremoniously do the trick. Patients are brought into a coma with an anesthetizing drug, usually Versed (midazolam), administered at nearly 20 times the strength of a therapeutic dosage used in the United States. It is accompanied by a paralyzing drug like Pavulon (pancuronium)-used normally to sedate patients about to undergo intubation or other uncomfortable procedures. The sedative, together with phenobarbital, is administered in sufficient dosage (16-20 mg.) eventually to cause respiratory failure. Prior to the procedure, which usually takes about an hour, patients are given anti-nausea drugs so there will be no vomiting from the deadly drug dosages. "The situation in Holland is really different from what we have in the United States with [suicide practitioner Jack] Kevorkian. He is the best thing we have going for us because he is so freaky," said a Dutch-American whose father was euthanized earlier this year. He spoke to WORLD on condition of anonymity because of ongoing difficulties in his family over the killing. "In Holland the care that these patients are given is excellent," he emphasized. "They see euthanasia as an extension of that kind of care. Even if you are a Christian, it can be hard to know what's right." Ill with cancer, the father was given round-the-clock care at Holland's top teaching hospital, he said, until the time of his father's death by lethal injection. Family members in Holland supported the decision to end his life, even though doctors predicted he could live several more months. A second doctor was consulted, as required, and government paperwork completed before his father was put to death on a January morning. "My mom is hurt," said the Dutch-American son, now back in the United States. "She wants me to validate their decision and thinks it is an act of utter unkindness that I am against it.... It is a great evil that is coming our way. It is very seductive and sounds so compassionate, like it is perfect and so peaceful-almost a religious experience." The doctrine of euthanasia is already gospel among Holland's medical professionals. Over 50,000 physicians who belong to the Royal Dutch Medical Association-the Netherlands' equivalent to the AMA-endorse statements permitting abortion and euthanasia. The association was heavily involved in drafting the 1993 regulations and the current proposals to do away with restrictions. The Dutch Physicians League is a pro-life association founded in 1972 to counterbalance growing support for euthanasia among physicians. It now warns doctors in residency to keep silent about their anti-euthanasia view until they have finished their studies and secured jobs. "As a doctor, formerly you were an exception if you favored euthanasia. Now you are an exception if you do not," said Krijn Hasnoot, vice president of the League and a general practitioner near Utrecht. Ironically, academician Mr. Stolk says he is not able to speak freely about euthanasia on campus, even at a university founded by Reformed thinker Abraham Kuyper. "This is a Christian university in name, but even my colleagues are very opposed to my ideas," says Mr. Stolk, who is a member of the Christian Reformed Church. "If I motivate my views from my Christian belief, I burst out in anger. I learn to live with that, two separate lives. I make many publications from my Christian point of view so everybody can know what I think. In my lectures, I try to make students sensitive about these matters and leave the motivation to them." Research by Mr. Stolk and several Dutch colleagues has centered on the meaning of life and "meaningful care" for handicapped children, issues he says are at the heart of the battle against euthanasia. "You want to protect the value of that life, but you cannot say it is easy. You should never forget that when you are fighting for their life, it is also a burden. It is emotionally overwhelming." Four parent organizations function as both support groups and lobbying organizations, and they have become sources for Mr. Stolk's research while he, in turn, has functioned as a kind of spokesman for them. All oppose government euthanasia policies. The groups are divided, according to Mr. Stolk, along "confessional" lines. "Even the humanist organization is opposed to the marginalization of handicapped children," he said. "The idea that these children are a burden is imposed by a hedonistic worldview with heavy emphasis on personal development and the right to choose for yourself. Parents are frightened and they will look for a doctor who will give them a way out. The right to choose is very, very popular. "'Why shouldn't you prevent the birth of a handicapped baby?' I am asked repeatedly. That's why the parent groups are so important-to show their experience and love for a handicapped child." One of the frequent speakers for these parent support groups is Beth van Breukelen, a Dutch-American with a severely mentally handicapped, 31-year-old son. Mrs. van Breukelen is a native of Holland, where she is known as "Bep." She returned from living 20 years in the United States when her son, Jeff, was 8 years old. At that time, he required full-time, institutionalized care. In the Netherlands, that kind of care is taxpayer-supported, free to the recipient. It is not free from danger, however. "With great consideration and great care," Bep says sarcastically, "doctors may kill a person." Mobilized by the kind of people who ask her, Do you have any real children? Bep speaks at every opportunity to parent groups about the value of rearing a handicapped child. Once a year she lectures Mr. Stolk's students on her experiences with Jeff. Her son does not speak, but, among other talents acquired in three decades' experience, she has become a recognized expert on discerning body language in the severely handicapped. Year by year, Bep says, the task of convincing parents by her experience grows harder, when the options of abortion and euthanasia are so pleasingly presented. More frequently, she has encountered parents who refused surgery to remove a stomach blockage for a Down syndrome newborn, and she has learned of other cases where babies with problems are being passively euthanized. "The cruel thing in it is, no one knows the ceiling on the development of a child," she said. Case in point: Two weeks ago, during a visit with Jeff, he brought to her a broken radio, carrying the pieces in both fists and passing them off to her purposefully and together. The two-handed gesture was something he'd never in his life accomplished. She handed it back so she could watch him do it again. "This was a present," she beamed, "a kind of graduation." "You are too proud of him," Mr. Stolk teased. "Yes," she said, "I am."