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Bulletin of the History of Medicine 77.3 (2003) 752-753



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James Kennedy. Een weloverwogen dood: Euthanasie in Nederland. Amsterdam: Uitgeverij Bert Bakker, 2002. 248 pp. E19.95 (paperbound, 90-351-2295-X).

In the spring of 2002 I spent six weeks at the University of Maastricht studying the Dutch system of protections for human subjects of research. Upon my arrival, my host walked me around and introduced me to my new colleagues. In one office a rather serious scholar—a philosopher and ethicist—listened disinterestedly until my host explained the nature of my visit. He suddenly brightened and exclaimed: "At last, an American interested in ethics who is not here to study euthanasia!" Such is the plight of Dutch medical ethicists: they are overwhelmed by a flood of foreign visitors eager for a firsthand look at the regulation of euthanasia in the Netherlands. In A Well-Considered Death, James Kennedy does his best to help stem this tide by providing a sociohistorical explanation of the Dutch approach to the end of life—an approach that criminalizes euthanasia, but protects physicians from prosecution if they follow specified "due care" procedures.

According to Kennedy, the permissive rules governing euthanasia in the Netherlands grew out of the widely shared Dutch belief that controversial issues are best handled by making them "speakable" (bespreekbaar). The Dutch believe that euthanasia will be misused if it is done secretly; but if it is bespreekbaar—if the rules governing its use are subject to public discussion and regulation—misuse will be reduced, if not eliminated.

Kennedy's history, which focuses on the mid-1960s to the mid-1980s—the period in which the current legislation took shape—is a search for the cultural features of Dutch society that support its progressive policy. With bespreekbaarheid as the overarching theme, Kennedy draws on a wealth of data—including media accounts, professional literature, government reports, and documents from organizations active in the societal discussion of euthanasia—to examine five other cultural convictions that underlie and support the Dutch desire to make euthanasia speakable: onttaboeïsering (removal of the taboo), onvermijdelijkheid (inevitability), medemenselijkheid (solidarity), zelfbeschikking (self-determination), and toetsbaarheid (verifiability). He does not give us a straight chronology of events; instead, each chapter describes how these cultural themes played out between the 1960s and the 1980s. [End Page 752]

Kennedy shows each theme to be deeply rooted in Dutch society. In chapter 1, for example, he asserts that the removal of death from the sphere of the taboo—the move from "silence around death" (p. 30) to the "opening of the grave" (p. 35)—reflects a "powerful cultural impulse" (p. 36) of the Dutch to break through social taboos. In chapter 2 he revisits a theme he first developed in his history of the '60s and '70s in the Netherlands (Nieuw Babylon in Aanbouw [New Babylon in construction], 1995): the relationship between the Dutch and the sea, a relationship that creates the tendency to see certain developments as inevitable, powerful forces that must be channeled properly because they cannot be resisted. In the case of euthanasia, he finds the "inevitability" argument surfacing again and again, the result of both new medical powers and increasingly outspoken consumers.

Chapters 4 and 5 take up the seemingly contradictory themes of solidarity and self-determination. Implicit in the Dutch word for solidarity is also a sense of empathy, connectedness, and mercy, features that Kennedy uses to explain the important role of women and the church leaders in this history. He notes that both groups supported euthanasia as an extension of their roles in caring for the dying and their desire to diminish suffering. He also observes that the Dutch health system—based on primary care, and characterized by close relationships between doctors and patients—lent support for euthanasia as an avenue to relieve suffering. He then turns to the idea of self-determination, a move that Americans, with their emphasis on autonomy, will find at odds with the notion of solidarity. Recognizing this, Kennedy (an American himself) explains that self-determination in...

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