Europe's growing euthanasia debate

BRUSSELS — Amid the already emotional debate over assisted suicide, one of the world’s leading advocates for legalized suicide has an additional concern: that potential practitioners of suicide might not get an effective dose when they buy drugs to kill themselves.

So beginning this month, British residents will be the first to be able to order a kit designed by Dr. Philip Nitschke — an Australian who shares the nickname “Dr. Death” with American assisted-suicide advocate Dr. Jack Kevorkian — to test the potency of their on-hand supply of deadly drugs, usually the barbiturate pentobarbital. Nitschke, who founded the organization Exit International, says the kit will help people make “end-of-life choices,” and hopes that his new product will reduce anxiety for those contemplating suicide.

It may all sound morbid, but debate over decriminalizing euthanasia and assisted suicide is growing, along with — in some countries — the pressure on governments to change their laws to allow some forms of the practices.

Nothing illustrates that more starkly than recent events in Luxembourg. The country’s ruler, Grand Duke Henri, indicated in December he would not support the assisted-suicide decriminalization bill his parliament had just passed, citing his conscience and his Catholic faith. The Luxembourg constitution vested executive power in the monarch and bills required his signature to become law.

So the parliament changed the constitution.

The Grand Duke was stripped of his power to reject laws and the vote went ahead, with the legislation coming into force in March. It allows people who are teminally ill to commit suicide if they make repeated requests to do so and get the consent of two doctors and a panel of experts.

Thus, Luxembourg became the third European Union country to allow euthanasia. The Netherlands was the first in 2002, under similarly strict conditions as Luxembourg, followed by Belgium. Outside the EU, Switzerland allows people to assist in suicide, but not to actually administer the deadly drugs. It is also legal in Albania, the U.S. states of Oregon and Washington, and in various forms in a handful of other countries around the world.

But is the situation with Luxembourg the way of the future when it comes to this question? In Europe, at least, governments may be getting closer to the answer to this question.

Public debate about the practice spiked in 2008, both in countries that allow and those that ban the practice. When Belgian author Hugo Claus, suffering from Alzheimer’s, chose to end his life March 19, it ignited controversy about the right to euthanasia, which has been legal since 2002.

The same day, coincidentally, Chantal Sebire was found dead in her home in Dijon, France, after having unsuccessfully begged French President Nicolas Sarkozy to grant her the right to have doctors end her suffering from the rare disease esthesioneuroblastoma, which had painfully disfigured her face with tumors. French law only allows families the right to refuse life-support equipment for the terminally ill — it doesn't allow active euthanasia, and a court rejected Sebire’s request. Forty-eight hours later, she was found dead in her home. An autopsy revealed that she had gone ahead with the deadly cocktail. French Foreign Minister Bernard Kouchner — a medical doctor himself — is among those who argue that euthanasia should be allowed in some cases.

And in July, Italy was under the spotlight. Euthanasia is illegal there but patients do have the right to refuse life-extending measures. In a dramatic series of events that went all the way up to Prime Minister Silvio Berlusconi, the family of comatose 38-year-old Eluana Englaro sought to discontinue life support after 16 years. Doctors had proven Englaro would never wake from the vegetative state she’d been in since a 1992 car crash and her father had testified that she would not have wanted to be kept alive solely by machines. A court eventually ruled that the feeding tubes could be removed, and despite Berlusconi's attempts to restart the feeding, Englaro died after three days.

The government dropped threats to prosecute doctors who helped the family, but promised clarification in Italian laws. Lawmakers and the public remain deeply divided over the issue.

But despite temporary wall-to-wall coverage of some of these cases, perhaps none was more graphic or elicited more response than the 2006 death of American Craig Ewert, which was captured live in a documentary and shown in December by Sky Television. Although it had already been seen in Canada and Switzerland, it was in the U.K. that it generated controversy.

Ewert had been diagnosed with a degenerative nerve disease while living in Britain, and gradually became unable to care for himself. In the United Kingdom, there are legal distinctions made between passive euthanasia — the removal of life support, which is allowed — and active euthanasia, which means that anyone assisting a suicide could be prosecuted for murder. Wanting to ward off legal trouble for his wife, Ewert traveled to Switzerland to take the barbiturate cocktail at the premises of Dignitas, one of the best-known advocacy groups.

Ewert had said his only other choice would be to suffer and make his family suffer before he died of the disease anyway. But statements like this are exactly what concern anti-euthanasia activists like Dr. Jacqueline Laing of London Metropolitan University. She warns that “what starts as a right ends up as a duty,” suggesting that people with various forms and in various stages of disability may be made to feel as if they must kill themselves to avoid being a burden.

Laing argues that legalizing assisted suicide — which she describes as “allowing people to intentionally kill others” — is an unacceptable overstretch of the concept of personal autonomy and also creates a basic dilemma in the identity of a medical provider, who is turned to for healing, but also has the power to end a life.

As the debate proceeds, Nitschke's May visit to Britain provides tangible examples of just how touchy the issue remains. He’ll be touring several cities in the next few days, offering “tutorials” for his new drug-testing kit to groups wanting more information about how to commit suicide effectively.

However, he has been disinvited from a planned event May 14 at Oxford University because other panelists who’d been asked to appear with him to speak in favor of assisted suicide reportedly considered him too controversial.

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