Jos van Wijk has never made any bones about it: the seventy-year-old believes that his own death is a private matter. No one else needs to interfere with that.
Van Wijk turned his conviction into work; Until 2023 he was chairman of Coöperatie Laatste Wil (CLW), founded in 2013 with the aim of legally providing a humane means of suicide. That has not yet happened: this year several CLW members were in court for allegedly providing the ‘remedy X’ recommended by the cooperative. Some of them were convicted of assisted suicide – which carries a maximum prison sentence of three years.
“Let me start by saying that I am a baby boomer,” Van Wijk said in court in April – from the generation that was “spoon-fed” with “responsibility and self-determination”. “You can decide for yourself about smoking, drinking, gender reassignment and getting your driver’s license, but not about the end of your life.” He was given a suspended prison sentence of four months for participating in an organization aimed at assisted suicide.
Van Wijk expressed a sentiment that is widely supported. The group that wanted to be “boss in their own stomach” in the late 1960s has grown old and also wants to decide for themselves when and how to die. A representative survey by the Dutch Association for a Voluntary End of Life (NVVE) recently showed that 65 percent of the population believes that people should be able to decide for themselves to end their lives if they consider this to be ‘completed’. In 2017, the last time a similar study was conducted, this was still 57 percent.
After the lawsuits over drug X, the next controversial development occurred this fall. In Switzerland, where the rules on assisted suicide are more flexible, someone died for the first time in a Sarco, a suicide capsule developed by Dutch-based doctor Philip Nitschke that works with nitrogen. Cooperative Last Wil called on politicians in the Netherlands to “allow the use of the Sarco in a safe environment.”
Never before has there been “so much public attention” for self-determination around death, writes the Einder Foundation in its end-of-year newsletter. She should know: the Einder was founded in 1995 with the aim of enshrining the ‘right to die’ in law. This summer, psychiatrists discussed euthanasia for psychological suffering, which is increasingly being granted. Isn’t this stretching the boundaries of the euthanasia law too much? In 2025, a working group will consider new guidelines.
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No one held her hand in the Sarco
Completed Life Act
In politics, at the initiative of D66, work has been going on for years on a Completed Life Act, which should give older people the opportunity to die if they feel they have lived their lives – including people who do not qualify for euthanasia according to the legal criteria. . The call for more control over dying dates back to the 1980s. In 1991, professor of civil law Huib Drion published in NRC An op-ed in which he advocated that the elderly should be allowed to decide for themselves how and when they die – that option was known for years as the ‘Drion pill’. “If there are so many people who want that,” Drion wrote, “why shouldn’t they?”
There was no euthanasia law at the time, but the practice was in line with what was stated in the law that came into effect in 2002. Doctors must determine whether patients’ suffering is unbearable and without hope, the law states. If that is the case, only they may provide euthanasia. In the years that followed, further context was given to the law through lawsuits and legal procedures: there must be suffering with a medical cause.
Even when the law came into effect, there was a movement “of people who found the law too restrictive for all kinds of reasons,” says Johan Legemaate, emeritus professor of health law at the Amsterdam UMC and the University of Amsterdam, and involved in recent evaluations of the euthanasia law. . For example, he says, they felt that you should not be dependent on your doctor when choosing to end your life and that ‘medical suffering’ should not be the only criterion. According to Legemaate, there were already people who believed that requests for euthanasia due to a ‘completed life’ should be honored.
Because of that sentiment, the subject has been prominently on the political agenda since 2016. D66 finally submitted a bill in 2023. If someone aged 75 or older feels that their life is complete, they can go to a so-called end-of-life counselor, the bill states. Three conversations should be held over a period of at least six months, after which the end-of-life counselor – who does not have to be a doctor – can provide assistance in dying. At the beginning of December, experts answered questions from MPs about the bill in a round table discussion. This showed that there are still many hurdles to overcome. For example, experts criticized the strict age limit of 75 years. Isn’t it discriminatory? Aren’t you actually saying: at 75 you have lived long enough?
Els van Wijngaarden took part in the round table discussion. She is a care ethicist and associate professor at Radboud University Medical Center in Nijmegen, where she leads a research group that focuses, among other things, on aging and autonomy surrounding dying. Van Wijngaarden is critical of the completed life law, especially because in conversations with the elderly and their loved ones she repeatedly sees that a death wish is ambivalent. “People are often in two minds – the wish to die and the wish to live often coexist. As an argument for more self-determination, you often hear that people do not want to suffer, and also that they do not want to become victims of poor care. Should we then set up a scheme whereby you might put pressure on people in a vulnerable situation to die earlier?” A completed life law, pill or more self-determination may reassure people, she says, “but death will never be something simple.”
Lawyer Tim Vis, who represents various suspects in X cases and other cases involving assisted suicide, is pleased that the Completed Life Act has been “awakened”, but believes that the proposal does not go far enough. He advocates that people who want to die do not have to rely on doctors or other practitioners. “As a lawyer, I have difficulty with the current situation. We ask doctors or end-of-life counselors to solve something that is an existential human choice. And moreover: a human right.”
Together with Coöperatie Laatste Wil, Tim Vis has been conducting a lawsuit against the state for years to decriminalize assisted suicide. In 2022, CLW lost in the first instance. The state is obliged to protect the lives of citizens, the court emphasized at the time. According to the court, this means, among other things, that the state must try to prevent vulnerable people from ending their lives on a whim. CLW and Tim Vis have appealed, the case will be continued in 2025.
Johan Legemaate sees legal possibilities for broader legislation on assisted suicide. “The European Court of Human Rights has made quite a few rulings on the end of life, and they indicate that as a national legislator you should go a little further than the current euthanasia law.” You may wonder, says Legemaate, whether it is necessary to add something to the current system. “Is there a large group of people out in the cold? Maybe not.” It is unclear how many older people have the wish to die but are not eligible for euthanasia. However, it may be that the government wants to offer more room for self-determination in principle. “That could be a reason for additional regulations.”
Stop eating and drinking
Fransien van ter Beek, chairman of the Dutch Association for a Voluntary End of Life (NVVW), does not think it is important in this discussion how large the group is. “Do you need to know how many believers there are to be in favor of freedom of religion?” Because the medical world is getting better at eradicating diseases, we are getting older. “And there is a category that does not want to grow that old and is also not eligible for euthanasia.”
She sees the demand for more self-determination as a driver of medical progress. “You also see that views in maternity care have changed in recent decades. We no longer believe suffering is necessary: pain relief is being used more and more.”
Cathelijne Verboeket-Crul published this year Letting go of lifea book about dying. At the hospice where she works, she also guides people who consciously stop eating and drinking in order to die that way. She wets their lips to reduce the feeling of thirst and ensures that the end of life is as comfortable as possible. It is an intensive, but legal method for patients and practitioners. This year, a new ‘guide’ came into effect at this practice, which for the first time no longer contains an age limit (previously it was sixty years).
Verboeket-Crul thinks that society benefits from an honest conversation about dying. “About the fear of death, fear of suffering, about our negative image of old age.” There are no ready-made solutions, she says. “We are in a fix culture in which everything has to be done as quickly as possible and exactly the way people want it.” Is death the solution or should we as a society work on greater community spirit, she wonders. “We have organized our society very individualistically and our care is becoming increasingly stripped down – and it is not getting better as it looks now. Death is sometimes a good alternative to admission to a nursing home. If we lived in a community where you mattered in old age, we would treat the elderly differently.”
You can talk about suicide on the national helpline 113 Suicide Prevention. Telephone: 113, 0800-0113 or www.113.nl.