Review by Joost Visser, Medische Contact (12/2009)

Medisch Contact review Visser 12/2009

How do you measure health?  For Dutch people it means still being able to do your errands by bicycle.  It is always interesting to see how others who have lived here for a short or long time view The Netherlands and the Dutch people.  The above observation originates from American anthropologist, Frances Norwood.  In the summer of 2000, she came to The Netherlands for a 15 month, comprehensive study of euthanasia in general practice.  Not only did she speak with a number of experts, she also followed and did in-depth interviews with 10 general practitioners and 25 of their patients.  The image that she sketches of ‘us’ in The Maintenance of Life is a bit too close to what we traditionally label as typically Dutch (those bikes, for instance), but her book – that is a pure pleasure to read – is extraordinarily relevant.

While many Americans have the tendency to hack through the Dutch euthanasia policy without really coming to know it, Norwood weighs in sketching a recognizable image of the practice, complete with penetratingly subtle reason and a clear take on where the essentials lie.  Euthanasia, according to her thesis, it is the way in which euthanasia talk occurs – among general practitioners, patients and their families – that is more important than the end result.  In this discussion, the patients become aware of how they ultimately want to die, the general practitioner is carried by the importance of assuming a helping role, and the family is allowed an active, supporting role.  Unlike many of her countrymen, she thinks that euthanasia is not indicative of the absence of palliative care.  No, says Norwood, euthanasia talk is even a form of palliative care, giving the dying patient identity and self respect, which often does not end in euthanasia death.  Euthanasia talk fits, according to Norwood, within a culture of ‘overleg’ or consultation, where people – she says and I hope that it’s not always true – don’t consult to necessarily make a decision, but to exchange information.  Moreover, the euthanasia policy rests within the Dutch type of general practice (in which the doctor is a true family physician) and within a broad range of accessible and financially affordable healthcare choices, making free choice in euthanasia possible.

She warns that the Dutch euthanasia policy is not something that can be imported to America.  Not only because ‘overleg’ or consultation is not currently a part of the culture of American individualism, but also because real healthcare and homecare options must first be made available to U.S. citizens.  Obama’s healthcare reform plans are one step in the right direction.  Now we can only hope that Congress read this book quickly, before they vote.

Visser, Joost (2009) “Euthanasia through American Eyes” Book review Medisch Contact 64(49):2040.

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