Euthanasia as a Dutch neoliberal success story

I’ve seen things you people wouldn’t believe. Attack ships on fire off the shoulder of Orion. I watched C-beams glitter in the dark near the Tannhäuser Gate. All those moments will be lost in time, like tears…in…rain. Time to die. — Roy Batty, Blade Runner

In Blade Runner, the Tyrell Corporation created its replicants with a built in expiration date, a post human planned obsolescence where the replicants had a pre-set life expectancy. Dutch actor Rutger Hauer, who improvised the monologue for one of the most moving death scenes in film history, knows his life is completed, utters the words “Time to die” and quietly expires. At the time, the film was quite reviled by critics. It had a short run in theaters and its dystopian plot confused most viewers. Thirty four years later, Blade Runner is generally considered a cult classic and one of the best sci-fi films ever made. Roy Batty’s death scene is one of the most quoted and revered in pop culture history. It was through the eyes of a dying replicant, an artificial entity’s “completed life” that we shed tears for our own ephemeral humanity: we, too, have seen things; we, too, have unachieved dreams and a will to thrive.

A completed life in The Netherlands

In 2014, the phrase “completed life” was introduced to the Dutch mainstream through quite extensive reports and subsequent discussions. The phrase was used in relation to a healthy 63 year old man who was euthanized the year before due to “fear of pension”. These, “fear of pension”, were the words used by the psychiatrist who approved the procedure for the man. When describing his patient’s state of mind, the psychiatrist said “People told him it was a shame he had to go. Is this really necessary was also something I heard people saying. They thought he had a good job. But he was so close to retirement. Many people knew how lonely he was and that he spent all his time working.” The man had never been on holidays. He had never built a life outside his work. Now, with retirement upon him, his life was “completed”.

Around the time of this man’s death, the ruling Party of The Netherlands, the right wing People’s Party for Freedom and Democracy, initiated a study on the feasibility of adjusting the current euthanasia law to include aging or elderly patients with no physical or psychiatric symptoms who simply wished to die due to considerations that their lives were “completed”. The study, “Completed Life. About assisted suicide for people who deem their lives completed” was released earlier this year. It included input from ethicists, academics from the medical establishment and interest groups.

The report offered a series of conclusions and recommendations, the most important one being that they did not see the need to change the current law which already contemplates “complains and illnesses related to old age” as reasons to opt for assisted suicide. This conclusion, however, did not deter the proponents of “completed life” as an ethical framework from bringing the discussion to mainstream media. They continue to argue that, after a certain age, when a person no longer leads a productive life, they can see themselves as having done their share for society and might wish to opt for euthanasia. “Time to die”, indeed.

Fear of the mentally ill

In 2015 media reported widely on the statement from the parents of a 25 year old woman who chose euthanasia. She was a comedian who had gotten national attention when she auditioned (and got through the semi finals) at the TV show “Holland Got Talent”. She suffered from psychiatric as well as physical problems. Her family released a message upon her death which media amplified accordingly, always stressing on how this was “her freedom day”.

In May of this year, international media reported with a sense of horror on the case of a 26 year old sex abuse victim who was euthanized because she found her life unbearable. Her case was exemplary of the widespread belief that victims of sexual abuse are “broken beyond repair”; people whose lives are unlivable to the point that death might be a better option than enduring the ongoing trauma.

In Dutch media, with some notable exceptions, these cases of psychiatric patients, which have been on a steady rise in the past couple of years, are presented under a very positive light. Almost always there are statements from the family about how relieved they are, how “happy” the patient was to finally be able to end their lives and how it was a “sad but positive” moment for all involved. Every couple of months, there is a new documentary or article about a family member telling the story of their loved one who chose assisted suicide for psychiatric reasons. Always stressing how important it was for their family member to make such choice.

Absent from these reports and discussions are the roles of the State and the community in the care of the infirm, the elderly or those with severe disabilities. Notably absent as well are discussions about the responsibilities of mental health institutions providing treatment, care and solutions for patients. We simply hear “we did everything but the patient did not get better” or “the patient made a choice”.

The success story of the “soft death”

“A soft or gentle death” is an euphemism commonly used to refer to euthanasia in the Dutch language. “Soft” because the patient avoids the violence inherent in the suffering from ongoing physical or psychiatric torments and because this “soft death” is foreseen, expected rather than in an uncertain future. In this rhetoric, “a soft death” is presented as a success story, the result of a carefully planned procedure that might even include drinking champagne prior to being administered the lethal drugs. The softness and gentleness evoke a sense of innocence, a pastel colored narrative of reassured family members who are ready to let go of their loved ones, to mercifully relieve them of their pain.

There are a few words in the Dutch language that cannot be accurately translated into English. The impossibility stems from the fact that these words denote some cultural belief or quality that doesn’t necessarily exist, in its exact incarnation, in other languages. One such word is “gidsland”. A literal translation, “guiding country” would be quite nonsensical since such a concept does not exist in English. Yet, this is a word that describes a deeply held belief in The Netherlands: the country seen as a “guiding force”, leading by example, setting the path to push the boundaries of what later on becomes acceptable across the Western world (and eventually everywhere else). When Dutch political analysts refer to The Netherlands as a “guiding country”, they use the examples of same sex marriage, attitudes towards soft drugs and euthanasia. This, they believe, is what defines the culture.

It is in this context of seeing itself at the forefront of what is acceptable, that The Netherlands insists on narratives of the “soft death” as the ultimate success story in self determination. The suffering patient, an individual in full use of his or her faculties, drinks champagne for one last time and predetermines his or her own “time to die”. Both Dutch media and government officials insist on these success stories, always completely removed from the bigger sociopolitical context. The patient as an island.

Individual choice in the age of collective loss

In February 2013, the same year a healthy 63 year old man terminated his life on the brink of retirement, all pension funds in The Netherlands issued a joint announcement: for the first time in their history, pensions would be reduced up to 7%. Suddenly, “fear of pension” meant the elderly could find themselves unable to make ends meet.

Since 2010, almost all elderly homes and assisted living facilities have been closed down in The Netherlands. The elderly, facing further budget cuts that have removed almost all alternatives of home care, are left to fend for themselves with the help of family or neighbors. Community centers and recreation facilities where the elderly used to build a social life have been defunded. Aging migrants who moved to The Netherlands as adults, even after 30+ years of work, are not entitled to full pension benefits and, in some cases, are unable to afford even basic 2 euro meals offered by NGOs. Elderly people from the colonial territories in the Caribbean, classified as “foreign” under Dutch pension law find themselves in a colonial limbo, unable to access the full set of pension benefits afforded to native Dutch. Migrants from Morocco or Turkey, who moved here during the post war reconstruction efforts are denied the full scope of their pension if they choose to move back to their countries of origin.

Mental health care, like all healthcare, fully privatized in The Netherlands, has been reduced to the most basic infrastructure, imbued with a laissez faire mentality where nobody is held accountable for the care and well being of patients who sometimes suffer for years with little in the form of solutions or treatments. Access to mental health care is heavily restricted with family doctors discouraging or directly refusing referrals for therapists. The waiting lists for psychiatric care are measured in months and that is for the lucky few who are referred to a specialist to begin with even though the suicide rates are at an all time high and suicide is the number one cause of death for people between the ages of 20 and 40.

For those that suffer from chronic conditions, pain management is scarce and frowned upon by healthcare professionals under the widespread belief that “pain makes one stronger”. Due to a mixture of for profit insurance corporations and Calvinist belief in predestination for suffering, medications are scarcely offered, rarely followed up with therapy and complains are mostly shrugged off with recommendations to “spend more time outside” or “find a nice hobby”.

The current right leaning coalition government is engaged in an ongoing campaign to make the care of the elderly, the sick and people with disabilities the duty of their families and, for those without family, their neighbors. They use words like “own responsibility” and “neighbor assistance” while they steadily remove all State provided care through systematic austerity measures that are increased every year. Recently, a document by the Finance Ministry was leaked to the press. In this document, Ministry officials made a list of possible further cuts for the next government which would represent savings of 50 billion Euros from the budget. The list was distributed as a confidential document to officials of all major political parties in view of next year’s general elections. It further recommended that all political parties start analyzing on which areas they would be willing to compromise.

It is in this context of never ending austerity that euthanasia is presented as the ultimate individual success story. A matter of personal choice where the State has eschewed all sense of obligation towards aging or chronically ill persons and where the ruling Party, with ongoing support from opposition neoliberal Parties such as D66, pushes narratives of “completed lives”. The underlying message, one where a life outside the capitalist system of production, a life that requires care (and a budget allocation) is a life that has outgrown its usefulness. The “soft death”, in its pastel colored rhetoric, presented as the lesser form of suffering, the individual triumph over the inevitable. However when all options of care and support are removed, is there really any choice left? When the State insists that the care for those in need should be left in the hands of unpaid neighbors and strangers, the “soft death” for a “completed life” is obliquely presented as the best viable alternative. The supposedly non violent “soft death” as a mask for the violence brought upon by endless budget cuts.

In 2012, speaking at a public interview celebrating the 30th anniversary of the release of Blade Runner, Rutger Hauer said that when he improvised Roy Batty’s death monologue he felt he had seen the future, even though he couldn’t quite put into words what he had seen. Perhaps the future was a capitalist dystopia where humans who have outgrown their production cycle face their “completed lives”.