Although the Netherlands became the first country to legalize mercy killings, a political debate continues over further relaxing the stringent guidelines for doctors, even allowing them to prescribe suicide pills for the elderly who are not terminally ill.
The law, enacted one year ago, slipped quietly into effect with no fanfare, since Monday was a national holiday and because it hardly changed existing practice. But its passage stirred other countries to re-examine their own laws, and encouraged the worldwide movement advocating the right to die with dignity. Belgium enacted a similar law late last year, but the Swiss parliament rejected a motion to legalize assisted suicides, which are now tolerated.
Last week, an editorial in the Vatican's newspaper, L'Osservatore Romano reiterated the Holy See's opposition to euthanasia, calling it "a crime against life."
The editorial came one day after the British High Court, in a groundbreaking decision, granted the wish of a paralyzed woman to have her doctors switch off a life-supporting ventilator.
Another terminally ill British woman, Diane Pretty, 43, appealed last month to the European Court of Human Rights in Strasbourg, France, to let her husband help her die. Pretty, paralyzed from the neck down by motor neuron disease, was seeking to overturn a British appeals court ruling which said her husband could not be granted immunity from prosecution if he helped her commit suicide.
The conviction reaffirmed the tough rules for conducting euthanasia, but the doctor, Philip Sutorius, was neither fined nor sentenced to jail. The court ruled that the offense was "so minor that any form of punishment would be inappropriate."
Euthanasia remains an issue in the campaign for the May 15 election. Democrats 66, the party of Health Minister Els Borst who guided the bill through parliament last year, says the next government should consider the introduction of a suicide pill for patients who are healthy but simply ready to die.
The Dutch have even invented a name for it, the Drion pill, after the retiring Supreme Court justice who first advocated its use 11 years ago.
The Dutch law formalized and legalized rules that had existed for decades, under which euthanasia was outlawed but widely practiced and rarely prosecuted. An estimated 5,000 mercy killings were conducted annually.
It follows guidelines adopted by parliament in 1993 that require a clear statement from the patient indicating the choice to die is rational and reasoned, that the suffering be unbearable with no prospect of improvement, and that a second medical opinion concurs.
Each case is reviewed by a commission comprised of at least one lawyer, one doctor and one expert on medical ethics. The law presupposes a long doctor-patient relationship and requires patients be legal residents of the Netherlands. It also allows patients to leave a written agreement to an assisted death if they become incapacitated, giving doctors the right to use their own discretion. Doctors who violate the strict code may be jailed for up to 12 years or fined if they fail to meet the law's strict codes.