Euthanasia talk: Euthanasia discourse, general practice and end-of-life care in the Netherlands.

摘要

In the Netherlands, nearly one-quarter of all people who die initiate a euthanasia request with their doctor, yet 9 in 10 of those who initiate a request, do not die by euthanasia. Nine in 10 die instead of natural causes. The Netherlands legalized euthanasia (killing a person at that person's explicit request) and assisted suicide (giving a person the means to kill themselves at that person's explicit request) by court decision in 1984 and again by legislation in 2001. With nearly a quarter of people who die in Holland (not to mention their family members and health practitioners) participating in this dialogue and so few participating in the act, it begs the questions: what are Dutch people talking about when they talk euthanasia and how does euthanasia talk impact the end of Dutch life?; After a 15-month ethnographic study of euthanasia and end-of-life care in the Netherlands with huisartsen (Dutch general practitioners), their end-of-life patients and their families, I found two things. First, in practice Dutch euthanasia is more often a discourse than it is a life-ending act, a discourse firmly embedded in the cultural and historical contexts that make Dutch people Dutch. Using a Foucauldian concept of discourse, I argue that the Dutch have created a script that teaches citizens how to think and feel about death, and ultimately how to die. Second, I found that euthanasia talk holds a wide array of meanings beyond the immediate, the obvious (planning for death). One of the most important is to affirm social bonds and social life at the end of Dutch life. People choose not to die euthanasia deaths because of the feeling of social connection that engagement in euthanasia discourse fosters. Through engagement in euthanasia talk dying individuals maintain connection to family and society, giving them something they need to remain living. This dissertation is intended to provide ethnographic data not currently available on the modern-day practice of euthanasia and to add to a growing body of literature on death, dying and the role of the state.