The Netherlands?! A Good Bad Example

Original Article

President Obama’s drive to remake the entire American health care system—dubbed “Obamacare” by friends and critics alike—has been seriously hobbled by fears of “death panels” and worries Grandma will be denied life-saving care by rationing boards or pushed by end-of-life counselors into “taking the pain pill” (to quote the president) rather than accepting life-extending treatment.

With the Administration struggling to assure millions of worried Americans that Obamacare will not unleash such a culture of death, it seems exceedingly odd that at a recent town meeting in Grand Junction, Colorado, the president would tout the Netherlands’ health care system as a “good example” for America to emulate.

The president mentioned Dutch health care while defending his “public option,” claiming that its “government is involved [in health care] but you still have a thriving private insurance market.” Talk about an understatement: The Dutch have what is known as a two-tiered system of financing care. Everyone must purchase insurance from heavy regulated private insurance companies that offer plans with benefits set by the government. While the plans compete with each other on price, each company’s plans must be sold at the same price to everyone regardless of their age and state of health. It is illegal to refuse to sell anyone insurance, to create deductibles, or to refuse to fund treatments that a doctor has determined to be medically necessary. Employers pay 50% of the premiums and citizens 45%, and the government subsidizes people who can’t afford premiums. Long term care is paid by the government, as is chronic mental health treatment and end of life care, services that are financed through taxation. Insurance companies that have heavy payouts are compensated by the government and a competition regulator ensures that the companies don’t act against the consumer’s interests.

That’s a lot more than just being “involved.” In a country the size of the USA, instituting such a heavily regulated, universally mandated two-tiered system would, to say the least, be an administrative challenge.

That matter aside, given the widespread public fear that Obamacare will destroy Hippocratic medical values, it is very odd that the president would pick that particular country as a template for emulation. You see, Dutch doctors are not just healers; many are also active killers. Since 1973 when a Dutch trial judge effectively decriminalized active euthanasia under supposedly “strict” guidelines (later legalized by the Parliament), doctors there have lethally injected or assisted the suicides of tens of thousands of their sick, disabled, elderly, and even physically fit but depressed patients.

Usually, euthanasia is voluntary. But according to several Dutch studies, physicians also engage in non voluntarily euthanasia, illegally lethally injecting hundreds of patients each year who never asked to die—a practice known as “termination without request or consent.” Even though such killings are technically murder under Dutch law, doctors who euthanize people who never asked to be killed are almost never prosecuted, and the few that are rarely receive any meaningful punishment.

Mercy killing has even entered Dutch pediatric wards, with doctors euthanizing scores of seriously disabled or terminally ill babies each year. Indeed, according to two studies published in the Lancet, Dutch doctors lethally inject about eight percent of all babies who die in the Netherlands annually, about 80 children. Chillingly, the journal reported that 45% of Dutch neonatologists and 31% of pediatricians responding to the Lancet study questionnaires admitted committing infanticide. Not only are these crimes—also technically murder—only rarely punished, but infant-killing doctors from the Groningen University Medical Center boldly published the “Groningen Protocol” describing the guidelines they use in determining which babies to euthanize. And even though they admitted to killing about fifteen babies under the protocol, they were never prosecuted.

Of course, none of this means that if Obamacare passes, we too will fall off Euthanasia Cliff. But it is worth noting that in Oregon—where assisted suicide is legal and Medicaid (the government funded insurance fund for the poor) is rationed— two terminally ill cancer patients were denied life-extending chemotherapy by bean-counting bureaucrats and then offered assisted suicide instead.

Moreover, given that the system’s overhaul has been primarily sold to the public as a way of cutting costs, and given that the drugs to end life cost under $100, it is worth noting that Derek Humphry, founder of the Hemlock Society, called cost savings the “unspoken argument” in favor of legalization. In his book Freedom to Die, Humphry wrote:

There will likely come a time when PAS [physician-assisted suicide] becomes a commonplace occurrence for individuals who want to die and feel it is the right thing to do by their loved ones. There is no contradicting the fact that since the largest medical expenses are incurred in the final days and weeks of life, the hastened demise of people with only a short time left would free resources for others. Hundreds of billions of dollars could benefit those patients who not only can be cured but who want to live.

Don’t get me wrong: There is no evidence that Obama plans for assisted suicide/euthanasia to become a means of easing our strained health care budget. But his proposal would mark a major change in American law and morality. Thus, if Obamacare breaks down Hippocratic medical ethics—as I think it would—if its proposed centralized cost control board imposes health care rationing and a concomitant duty to die—which, given the views of his closest health care advisers, it very well might—and if assisted suicide/euthanasia ever becomes merely another medical treatment choice—it is now legal in three states—the Netherlands may turn out to be more of a model for American health care than even the president may now suppose.

Wesley J. Smith

Chair and Senior Fellow, Center on Human Exceptionalism
Wesley J. Smith is Chair and Senior Fellow at the Discovery Institute’s Center on Human Exceptionalism. Wesley is a contributor to National Review and is the author of 14 books, in recent years focusing on human dignity, liberty, and equality. Wesley has been recognized as one of America’s premier public intellectuals on bioethics by National Journal and has been honored by the Human Life Foundation as a “Great Defender of Life” for his work against suicide and euthanasia. Wesley’s most recent book is Culture of Death: The Age of “Do Harm” Medicine, a warning about the dangers to patients of the modern bioethics movement.