English Translation of Borst Interview

On April 14, 2001, the daily newspaper, NRC Handelsblad, published an interview with Dutch health minister Els Borst in which Borst discussed the passage of Holland’s law legalizing euthanasia and assisted suicide.

In the article, Borst also declared that she is not against “Drion’s pill.” (“Drion’s pill” is named after Hulb Drion, the former vice-president of the Dutch High Court. Ten years ago, Drion proposed that a suicide pill be made available to elderly people upon request.)

A link to the Dutch language article appears after the following English translation.

Minister Els Borst on the deficiencies of the new euthanasia law

“I can well imagine that doctors don’t report mercy killings.”

The senate approved Tuesday the world’s first euthanasia law. Thanks be to the efforts of the D66 political party says answerable minister Borst, who is also a member of D66. “It is finished!” But is that so? “I am not against Drion’s pill.”

By Margriet Oostveen

The floor of the department of Health, Welfare and Sport where minister Els Borst-Eilers(69) resides, looks like a chic hospital. The lights are bright, the walls no-nonsense white, the trusty little trolley with coffee and tea rattles along the corridors. Voices are hushed near the office of the fragile woman who, according to former D66 leader Hans van Mierlo, can command silence by “merely raising her eyebrows.”

That works as follows: First she pulls down the corners of her mouth a little and then her eyebrows simultaneously shoot upward. A brief glance follows, too brief to be truly scornful. Promptly she lowers the eyes again and then she waits for the effect. For example, when it concerns the Christian segment of the population that one day earlier demonstrated about 10,000 strong around the Dutch Houses of Parliament against ‘The Law Governing the Ending of Life on Request and with Aid of Suicide,’ as the world’s first euthanasia law is actually called, which had been passed in the First Chamber with a majority of 46 against 28: “There, alas, I have lost all contact with people who can think like that.” Her D66 political party gloried in their triumph. Although she refrained from saying so explicitly, yet, as an aside, she summed up what was essential:

“I phoned Elida Wessel-Tuinstra yesterday evening, who took the initiative in submitting the first euthanasia law proposal in 1984 on behalf of the D66 party.”

“Roger van Boxtel, likewise D66, also presented an initiative bill during the ‘Paars I’ cabinet.”

“We have always sat behind the back of the bus. It is fantastic that we have achieved this.” She clenched her fists.

Then I may fittingly ask whether you have celebrated it.

Alertly: “I again do not find it something to celebrate about.”

Modestly adding: “Yesterday evening we sat together satisfied.”

Then she laughed in spite of all that: “It is finished!”

We had one hour, so we limited ourselves to the last ten years. Ten years, ago as vice-chairman of the Health Council, she was a member of the Remmelink commission which investigates the euthanasia practices in the Netherlands. Due to the findings of this commission, which concluded in 1991 that the active ending of life was not reported in at least a thousand cases per year, there the cabinet, after years of postponement, could no longer avoid the issue: Whoever wanted to persuade doctors to report, had to be able to exclude them from prosecution with a euthanasia law.

Even so, important recommendations by the commission, which Borst always stood behind, were not be far completely adopted in the present law. Is her task then indeed actually “finished”?

She begins carefully. “The discussion about life and death never ends.” The time in which the discussion politically comes to the top of the agenda again, as concerns her period as a minister, lies safely distant. First, the next report by professors Van der Maas and Van der Wall must appear, she says. They will evaluate for the third time the frequency with which doctors report euthanasia. From that it must become apparent whether the law settles anything. And then it is 2003. ‘After me the flood?’ Borst would never take it so. Of ‘slippery slopes’ she does not want to hear anything; that is the rhetoric of the Christian Unity party which drew comparisons with Nazi practices in the Senate. And why should it be a sin?

“Why should you think that this is against God’s will? I find that then you go around formalistically with the interpretation of what people may do and not do, of God. People can be permitted to endlessly prolong life and develop all sorts of medicine. It is difficult to believe anyhow in a God who says: ‘You must leave him alone to die next week.’ and not: ‘You may help him die this week.’ That I cannot understand.”

Are you yourself religious? Or have you been?

“I am not a member of any church community, but I do not regard myself as a-religious. I do not think that I really need to answer such questions. But never mind.” With that response the subject was closed as far as she was concerned.

Els Borst has been a member of the Netherlands Association for Voluntary Euthanasia for years. Her own involvement with euthanasia began in 1983 when she was medical director of the Utrecht Academic Hospital. Nurses reported that two doctors had carried out euthanasia. “My first reaction was: ‘That cannot be so, that in the dead of night patients were helped to their end.’”

Did it really happen like that? At night?

“It occurred quite secretly. I went immediately to the management and said that I wanted to have a transparent euthanasia policy. That was frightening; in the management sat respectable notables, but by then I was converted.”

Who or what converted you?

“I was never against it, I only had not thought much about it. Until I experienced it in the case of my own grandmother who was 95 and longed for the end. But she was healthy. And in my stepmother’s case who died from cancer after much suffering and who never asked for euthanasia.”

Your hospital had to be open about euthanasia. How did you tackle it?

“I went to the public prosecutor and said: ‘I want to set up a protocol for euthanasia.’ That became a pleasant conversation. He could not guarantee that he would refrain from prosecution on every occasion if we reported each and every case, but he indicated that the consequences of prosecution would be acceptable.”

Did you report to him that your doctors had already carried out euthanasia?

“I reported nothing.”

Doctors who carry out euthanasia or provide aid in suicide, reported five years ago at most 40% of the cases. Figures over the last two years show a decrease in the number reports. The security from prosecution the euthanasia law wants to offer must definitely change that. No prosecution if a doctor has acted in accordance with the criteria of due care. The most important being a ‘consistent request’ for ending life by a patient who must be suffering unbearably and without hope of recovery. Like minister Korthals of Justice, Els Borst strives for “100%” reporting. “Also a doctor who by force of circumstance has not been able to adhere to any of the criteria when carrying out euthanasia, must from now on have the courage to report that.”

Now we come to the ‘Remmelink thousand.’ The task of the Remmelink Commission was to study the frequency of euthanasia on request; but the commission extended its brief to cover all decisions doctors take concerning the end of life. “This resulted in approximately one thousand unreported instances coming to light where the patient had not explicitly requested euthanasia.”

Were you shocked by that number?

“We had a vigorous discussion about the whole question of whether we had to find that deleterious.” For in the largest unreported category of life-ending actions the patient was usually already so seriously ill that he simply could no longer make the crucial request for euthanasia. The Remmelink Commission wanted to see such cases as ‘aid-in-dying’. That was defined as ‘the act of ending life at the moment that vital functions begin to fail.’ Borst: “So if someone has difficulty breathing, is in a battle with death, if his heart or kidney function deteriorates, then you help that person over the threshold. We wanted that that be reckoned as normal medical practice.”

That did not succeed.

“No, Hirsch-Ballin (CDA and then Minister of Justice) did not adopt it.”

Thus there is no judicial alternatives between murder and euthanasia. Doctors who give ‘aid-in-dying’ still continually risk prosecution of the patient has been unable to properly request it.

Have you, since you became minister, yet ever had the inclination to change that state of affairs?

“No, because we also let it rest in the legislation proposed by Van Boxtel. And that was adopted by the ‘Paars-I’ two-party coalition. But I can imagine that the subject will reappear on the agenda after the subsequent report by Van der Maas and Van der Wal.”

Thus if the number of reports still appears to lag behind, will you yet recognize ‘aid-in-dying’?

“It would be good if doctors dealt openly with these matters. But I can well imagine that they might say: I can’t report this as euthanasia with a clear conscience, so I will say nothing. For my part it may well one day be established that we respectably reckon ‘aid-in-dying’ to normal medical care the same way as the discontinuation of treatment.”

She began to speak on her own about Wilfred van Oyen: “He thought that he gave ‘aid-in-dying’.” This Amsterdam house doctor was sentenced in February by the courts for murder because he administered a deadly muscle relaxant to a patient who, under pitiful circumstances, lay several hours before she would die a natural death in a coma. She had not asked for that and he had not reported that. The euthanasia rules were thus broken, judged the bench, which nevertheless struggled with the decision: Because Van Oyen had acted conscientiously no penalty was exacted of him for the ‘murder.’. Because Van Oyen has appealed, and the case is still under judicial consideration, Borst does not want to go into specifics. Yet indeed in general terms: “Also with ‘aid-in-dying’ the criteria of due care apply in that there must be a question of intolerable and hopeless suffering. For someone in a coma, intolerable suffering does not apply. However difficult it may be to observe – one lies there peacefully. The whole euthanasia discussion concerns only releasing someone from their suffering – and if someone does not suffer, then you must let him remain there.”

May a doctor who has been convicted of murder continue to practice?

“A doctor who does not fulfill one or more euthanasia criteria must make an appeal to grounds of necessity. If he stood next to a death-bed where someone suffered so much that he felt compelled to help? That is an act of God force majeur and has nothing to do with euthanasia.’

The judge properly says: ‘I convict you nevertheless, it was no act of God.’

“I have yet to meet such a judge.”

The judge said that against Van Oyen.

“I refer to the ideal situation.”

But I am talking about what happens in reality. May such a person still remain a doctor?

“That is a matter for the inspector.”

I have asked your chief inspector for healthcare. He says that there still was no occasion to investigate the Van Oyen case.

“For a Doctor intentions remains critically important. Also a doctor who makes a stupid medical mistake with fatal consequences, can thereafter still be a very good doctor.”

For years the legal system has gone ahead of legislation in euthanasia affairs. In 1994 the High Court determined already that suffering includes psychic suffering. Here it concerned euthanasia of a depressed patient by psychiatrist B. Chabot. Precisely when the euthanasia law was being dealt with in the Lower-House last autumn, the Haarlem High Court reached a yet more far reaching judgment. In the case against P. Sutorius, who aided ex-senator E. Brongersma (86) in suicide because he was tired of life, the bench found that also that was justified. The ‘intolerability’ of suffering is subjective; only the patient himself can judge its severity, was the finding. Only ‘hopelessness’ remains objectively testable. And that was seen applicable in this case, according to the judgment, because of Brongersma’s advanced age.

In the Lower-House following on from the Brongersma-case you have voiced your understanding of very old people who are done with life. You said: “From that I don’t want to run away and say: never help.”

“I have personal experience of someone, and later have also spoken to another such one. Both were 95 and both had simply already had enough. They were bored sick – and alas were not bored to death. For that was actually what they most dearly wanted: ‘Every day that I wake, I think – damn – again I haven’t died in my sleep’.”

In the senate Korthals did not exclude that ‘being tired of life’ could become grounds for euthanasia, but he wants to first await the Brongersma appeal.

“I would rather say: that ‘being tired of life’ has nothing to do with euthanasia law, with medicine and doctors. You indeed free someone then from their suffering, but it is a suffering unrelated to sickness or handicap. But then you come out with Drion’s pill, and that is again dangerous.”

She refers to the plea of the High-Court’s ex vice-president Huib Drion in 1991, who wanted to provide suicide pills free of charge to old people who themselves wanted to put an end to their lives. “They do not want to be killed by a doctor; they want to do it themselves, as a last expression of the will.”

That is no question for a Minister of Health, she says. “but it can very well be that a Minister of Justice says: I want to permit people there to manufacture their end.”

You would be for that?

“If people can do it themselves and there is a test to see whether someone is really such a case. The old lady of 95 whom I knew had also lost her children. That one really had neither child nor crow any more! Yes, a few great grand-children who also no longer interested her. If she had said: ‘I have here a pill and I am taking it’, then I surely would have been at peace with that.”

You are for Drion’s pill.

“I am not against it if it can be carefully regulated so that it only concerns those people of advanced age who are done with life. Concerning this subject we need an extensive social discussion.”

Seven years ago you said in this paper that you yourself had not made a euthanasia declaration. You found the printed draft of the Netherlands Association for Voluntary Euthanasia too rigid. Have you found a solution for that?

She laughed. “That is true. You don’t often find yourself in a form. In the meantime, I have myself conveyed something in somewhat different words.”

The April 14, 2001 Dutch language article translated above is  “Ik kan me goed voorstellen dat artsen stervenshulp niet melden.”from the NRC Handelsblad.

Holland’s euthanasia law
Text of Dutch law.