dreamed of becoming a medical missionary in a developing country.
That all changed when the Polish doctor married a Dutch woman and
settled in Holland. It turned out I was needed more here,
he says: Im doing missionary work here, I think.
Dr. Zbigniew Zylicz is a pioneer in pain management for terminally ill patients in the Netherlands. Finally, we are being listened to, he says.
Photo by John Bookser Feister
Zylicz is medical director
of Hospice Rozenheuvel in the Netherlands, one of only three hospice
centers in a nation that has accepted the practice of euthanasia
without ever actually legalizing it. The center is three years old.
An oncologist with
a Ph.D. in pharmacology, he is devoting his career to palliative
care, the practice of pain management.
The soft-spoken physician
sees most of his patients in their homes: He makes about 500 house
calls per year in an area about a 20-km. (12-mile) radius from his
10-bed center. He tells St. Anthony Messenger that Americans
should avoid legalizing physician-assisted suicide: The societal
price you will pay for this is enormous: Its a slippery slope.
was never envisioned when the Dutch government first agreed in 1984
not to prosecute doctors for assisting in suicides, euthanasia is
now common. In fact, says Zylicz, doctors in the Netherlands perform
euthanasia so frequently now that they scarcely know what to do
for a terminally ill patient who does not request it. Dutch doctors
have lost the abilitythe creativity and experienceto
solve difficult pain-management problems, he says. They are
losing the art of medicinethe basis of our profession!
He also warns that
once suicide is allowable, it soon will become expected.
The law [allowing assisted suicide] makes a difference because
it is immediately experienced as a right. Thats a big difference....There
is a pressure on doctors to do euthanasia, even if they dont
A 1991 Dutch government
study confirms Dr. Zyliczs assertions. It found 2,280 cases
of euthanasia each year, two percent of all Dutch deaths. What started
as assisted suicide soon progressed to euthanasiait seems
that those who wish to die voluntarily would rather have the doctor
do the killing. Over half of physicians surveyed admitted to practicing
Often it is the doctor
and not the patient who makes the decision for euthanasia in the
Netherlands. The [Dutch government] report revealed that in
over 1,000 cases, physicians admitted they actively caused or hastened
death without any request from the patient, writes Herbert
Hendin, M.D., in the 1997 book Seduced by Death: Doctors, Patients
and the Dutch Cure. Uncontrollable pain was cited in 30
percent of cases; the remaining 70 percent were killed with a variety
of different justifications ranging from low quality of life
to all treatment was withdrawn but the patient did not die.
The investigation found thousands of other cases where painkilling
medication was given with the primary intention of shortening life
and without the consultation of fully competent patients.
Some people in the Netherlands, out of fear, are carrying cards
that instruct doctors not to euthanize them. Others are carrying
cards asking to be euthanized.
The societal price you will pay for this is enormous: Its a slippery slope.
Treating the Whole Patient
Both Doctors Hendin and
Zylicz were featured speakers at The Catholic University of America
conference on euthanasia (see adjoining article). Dr. Zylicz recounted
from his own experience that many times it is the Dutch family or
physician who requests death for an older person, and often not
for dignified reasons, he says. For example, one family requested
euthanasia for an elderly parent who, though terminally ill, was
to be discharged from the hospital to die at home. With some probing,
Dr. Zylicz learned that the grown children had already removed and
divided up the household furniture and didnt want the old
man to find out.
Time and time again,
it is pain and depression that lead a person to request death, he
reports. When those symptoms are managed, he says, people dont
ask to die. One can use his or her final time to prepare for death.
is a careful approach to medicine, looking to treat the whole patient
instead of merely a set of symptoms. A patients life story,
he says, has a profound effect on the request for death. If
a patient comes to us and says, My husband died three years
ago, its going to be very important to know how he died.
Because how he died influences her idea of how she wants to die
or doesnt want to die.
Most doctors seek
merely a diagnosis, he observes. But whats needed in
this case is more of a spiritual examination. You need to have a
lot of time, a lot of patience. And you need to invest a lot of
energy to developing a good relationship. Then, what he calls
soul woundsoften from the distant pastwill
come forward. He recalls a patient who had experienced a stillbirth
50 years ago and began talking about it as she was dying of cancer.
These wounds tend to open at the end of life. If you recognize
this, you can help these people to cope, he explains.
Dutch in Denial
What Dr. Zylicz finds
most significant about whats happening in the Netherlands
today is that people are pretending nothing is happening, that life
is not becoming less valued and medical care is not diminishing:
People keep denying the slippery slope even as it is more
and more obvious.
Yet there is growing
interest in Dr. Zyliczs ideas: Twenty Dutch hospices are in
the planning stages. He offers a three-month training in palliative
care that now has a waiting list of interested doctors. He sees
it as a dramatic change: Finally we are being listened to!
he says. What was once merely a theoretical discussion about pain
management versus euthanasia in the Netherlands now has solid clinical
evidence, thanks to his and other doctors efforts. Three
or four years ago I would write an article for a medical journal
and wait two years before somebody would print it. Now the journals
are waiting two years before I can write something! There
is also talk of setting up professorships in palliative care at
several universities. That would be a first in the Netherlands.
His dream is to see
palliative care become omnipresent in Dutch medicine. Instead of
a network of hospice centers, which he thinks would drain medical
talent from the hospitals, he hopes to place well-trained doctors
throughout the existing health-care system. My idea for the
coming five years is to start strong education and training programs
at the universities, so that all doctors, nursing-home and general
practitioners would be trained in palliative care. He envisions
50 or 60 pain-management experts, highly specialized in helping
general practitioners to solve difficult pain problems.