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The "Bespreekbarheid" of End of Life

In July of 1998, Dr. James Kennedy was offered a contract by the Dutch commercial publisher Bert Bakker to write a history of euthanasia in the Netherlands. During the spring 2000 semester and the following summer, he pursued research on this topic in the Netherlands, funded by the Van Raalte Institute and supported by Hope College. This is his report on the project, which is expected to result in a finished manuscript in 2001.

The Dutch are known for their social experimentation on a number of fronts: drugs policy, homosexual marriage, and, last but not least, euthanasia. Yet the history of euthanasia in the Netherlands is neither well known nor extensively researched. As an American, my question is: What has prompted the Dutch to openly tolerate that doctors kill their patients at the patient's request, while other nations have held back? And why did they arrive at this conclusion relatively quickly?

Although a handful of places have either liberalized, or are considering liberalization of, physician-assisted suicide or euthanasia, the present modus vivendi in the Netherlands is already about fifteen years old. My research had to consider a range of cultural factors: political, social, medical, legal, and religious. The last category of analysis, religion, has been most lacking in current analyses, and yet a look at religion yielded one of the most surprising results of my research. More than any other group (for example, the unchurched), Protestants played a dominant role in making euthanasia acceptable in the Netherlands, while other Protestants (and this is better known) played the most central role in opposing euthanasia. Nor does it seem wise to leave gender out of the discussion. It is striking to discover how many women were at the forefront of the fight for the liberalization of euthanasia: the doctor who euthanized her own mother, prompting the first high-profile euthanasia trial; the youthful chairwoman of the powerful Voluntary Euthanasia Society; the first parliamentarian to put forth euthanasia legislation; and the colorfully non-conformist "Jack Kevorkian" of the Netherlands, Klazien Sybrandy, who took on the medical establishment in her own way.

The theme of my work centers, however, on how much a Dutch partiality to bespreekbaarheid (translated as "discussability") created a culture where euthanasia became a possibility. Rather than relying on iron rules or zealous consistency, the Dutch thought that wisdom and justice would prevail on the issue of euthanasia as long as it was sufficiently discussed, by the doctor and her patient, but also (in a more general way) by all of Dutch society. In some ways this bespreekbaarheid became a substitute for a coherent policy, making it possible for the Dutch to sail more easily around some perennial conundrums of end-of-life decisions, such as patient autonomy, that have confounded other nations' attempts to sanction euthanasia. Whether this is a path that was worth treading I leave (mostly) for the future reader to evaluate.

My research entailed some interviews with persons central to the euthanasia debate in the Netherlands, but mostly focused on newspaper reports, journal articles, and books from the period between 1970 and 1985, when Dutch attitudes toward euthanasia were largely shaped. Perhaps in the end the book is more about the 1970s in the Netherlands than it is about euthanasia. And maybe that is not all bad; after all, even the gravitas of death may be helped by some comedy.

In summary, what one could say about the Sixties in the United States is that it did not bring about a clear-cut defeat of the forces committed to traditional morality, whatever such conservatives have meant by the concept. To be sure, one can make a strong case...that behind the self-deluding legal and political rhetoric of traditionalism American institutions and structures are anything but traditional and stable. But whatever the social realities-and they are complicated realities-it is clear that many Americans, including many self-styled progressives, continue to look to pre-1960s moral sensibilities as absolutely essential for ethically undergirding the nation. Partly through nostalgia, partly by principle, usually selectively, many Americans continue to "look back" for a moral landscape they find more amenable than what "the Sixties" seems to have afforded.

But in the Netherlands, no "right-wing populism" really got off the ground after the 1960....Dutch politics, always less populistic and more carefully channeled than American politics, did not offer the space for such a movement. Perhaps, too, the elimination of poverty and the relative absence of economic insecurity removed some of the social conditions that drove this populism. Perhaps the Dutch showed, like other Europeans, a kind of ideological exhaustion after two world wars, making them unwilling to impose a political or moral agenda on others. Finally, a potential constituency for right-wing resentment, Holland's Catholic and orthodox Protestant subcultures had expended much of their energy....Through all of these developments, there was remarkably little nostalgia among the Dutch for the past. As a result, the Netherlands became, after a period of ideological unrest in the late 1960s and 1970s, a rather ideologically homogenous society, much more so than the United States. Just as the Dutch had created a stalwart consensus of traditional morality through the 1950s, they created a "progressive" and "pragmatic" moral consensus by the early 1980s.

From "The Moral State: How Much Do the Americans and the Dutch Differ?" by James C. Kennedy in Regulating Morality: The United States and the Netherlands in Comparison.