She Didn't Want To Be Dependent

April 22, 1997|By Ellen Goodman

HAARLEM, Netherlands -- Annalies van het Nederend still finds it hard. There are signs of mourning in the lines around her eyes, in the tension of her mouth when she talks warmly about "my mother, my best friend, my tennis partner."

The auburn-haired woman, who lives with her husband along a canal not far from Amsterdam, half-expects to see her mother come through the door, bustling, carrying packages and good cheer. Yet it's been months since the 75-year-old died of cancer and euthanasia.

Elizabeth Myer, nicknamed Dop, had nursed her husband through Alzheimer's and had seen her son die of a brain tumor. When she was stricken with cancer of the esophagus, Dop was fiercely determined "not to die like a plant."

So when treatment failed to arrest her cancer and it began to spread to the brain, this woman began a series of long talks that now occur openly in Holland, where doctors are allowed to discuss and even to fulfill a patient's death wish.

Anna, as she is called, still remembers those conversations among doctors, daughter and mother. She remembers the final chill of knowing on a Friday that her mother would die on Monday. She remembers holding her mother after the doctor's lethal injection and hearing her say first, "take care of each other," and then, "dying is not so terrible."

On this April evening, she struggles to explain to a visiting American the roots of her mother's decision. "She was independent, you see. She didn't want to be dependent."

This is a sentiment that has become familiar to me as I crisscross the country at the forefront of a debate about dying. Here, 2.4 percent of deaths occur with a doctor's assistance. These are mostly terminally ill patients who cut short their lives -- and suffering -- by days or weeks. But they are repeatedly portrayed with understanding and respect as a cohort of the strong . . . the independent.

East of here, Eugene Sutorius, the energetic lawyer who tried nearly all the cases that led to the acceptance of doctor-assisted death, said it another way. "Euthanasia rests on two prongs. One is mercy. The other is autonomy."

On television recently, a prominent Dutch businessman known as "Mr. Fokker," after the airplane business he managed, echoed this sentiment in a posthumous broadcast. This master of industry, ill with cancer, announced his plan to "die like a gentleman," master of his own fate.

Elsewhere, Dutch doctors described those who ask for euthanasia as verbal, outspoken people who put a strong value on their dignity and control. And the minister of health, Else Borst-Eilers, said that she wouldn't want to live if she no longer recognized her grandchildren.

Independence has become a trademark value of postwar culture in many countries. But in Holland, it interacts with decisions about the end-of-life in ways that leave many wary.

"We have rapidly moved to an individualistic culture," warns Henk Ten Have, an ethicist and opponent of euthanasia at the Catholic University in Nijmegen. "What does it do to a society if this becomes the rational and ideal way to die? If one behavior is rational, another becomes irrational."

Similar arguments are reflected in the American debate as well. In the case now before the Supreme Court, six philosophers filed a brief favoring assisted suicide on the grounds of autonomy.

"Most of us see death as the final act of life's drama," they wrote, "and we want that last act to reflect our own convictions, those we have tried to live by."

A subtle social pressure

But others like Harvard's Michael Sandel wonder whether "changes in law can bring changes in the way we understand ourselves." Is there a subtle social pressure to end life rather than become a burden?

This debate about the value of autonomy has echoes even in Holland, a country with universal health care. And it has echoes as well in this Haarlem family.

Sitting at the dining room table, Anna's husband voices the discomfort he still feels with his mother-in-law's decision. He earnestly describes his attempts to get the ailing woman to come into their home. "I can't understand that she was afraid to give us trouble," he says shaking his head.

Anna, however, does understand. Dop had told her daughter, "I don't want to end life a fool, an idiot. I am a thinking person and I want to stay that way."

In the end, moral questions surrounding life and death are no easier to sort out under the liberal Dutch laws. The changing mores may just present more and more complex choices.

But this daughter believes that "the way my mother died was good, if you can think of good in those circumstances. For her to have become dependent . . . well, it was just not her."

Then Anna adds, "I am the same way. I would do the same thing."

Ellen Goodman is a syndicated columnist.

Pub Date: 4/22/97

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