A tableau I published on July 7th. this year (1)
Prince Friso of the Dutch royal family has been now for 6 months in what is called PERSISTENT VEGETATIVE STATE (PVS). (2)
The transfer to a UK hospital may pose legal problems, as procedures for ‘ending life’ in cases where there is no more chance of recovery is problematic in the UK – as we know of a recent case of a man that sought help for ending his life that had no future – and the formal refusal of a British court to allow ‘euthanasia’ in his case.
The Netherlands does have a more liberal law in this sense.
There are hardly any examples of people in PVS that regain consciousness, and even less that have any chance to function again as a human. Younger people stand statistically a bit more chance than middle age people like Prince Friso. In most cases ‘economics’ (the extreme high costs of keeping someone in such a permanent vegetative state) form the decisive argument for halting such treatment in a specialised medical ward.
In the case of the Royal House of the Netherlands the financial means are not a problem, but this affluence creates an ethical problem.
Recently a Dutch governmental medical advice commission did propose to scrap certain extreme expensive medications for a small group of special patients. This to cope with the ‘economic crisis’. This caused an uproar as life prolonging medication, even in cases of prolongation of life of weeks or months, should not be denied. Many spoke out in this way. From specialised medical staff to patient organisations and laymen. (2)
Now how does the Dutch Prince who is kept in permanent coma in a British private hospital, fits in this discussion?
Royals are human beings like any other, are they not? They do die after all like anybody else. Those who play their role in keeping monarchies alive, need to reflect also on the limits of prolonging life and the morals and ethics needed, there where we all have to face the sometimes paradoxical consequences of the ingenuity of modern medicine. (3)
We have now witnessed a state of exemption since the avalanche accident in Austria this winter of half a year. However sad it is, also royals should come to a decision, that may be harder to take because of their wealth.
The bereavement process of the family must have been frustrated and one wonders why the wife of Prince Friso has not had the courage to, or has been kept from, ending this ‘high tech’ medical ordeal.
Interview and photographs of Prince Friso and his wife Mabel and they way they enjoy London as the place were they work and live in the M magazine of Dutch daily NRC/Handelsblad May 2006. I did fade the Prince into an image of the brain surgery specialised Wellington Hospital where he is kept in coma now.
One hopes that Dutch Queen Beatrix who is used to control family affairs with an iron hand, will come to see that her hand is not the hand of God when she orders to pull the plugs out. It is time – also for a prince – to die.
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(1) 7/7/2012 News -tableaus by Tjebbe van Tijen: “When is Prince Friso Allowed to Die?”
(2) “Unlike brain death, persistent vegetative state (PVS) is not recognized by statute as death in any legal system. In the US and UK, courts have required petitions before termination of life support that demonstrate that any recovery of cognitive functions above a vegetative state is assessed as impossible by authoritative medical opinion.
This legal grey area has led to vocal advocates that those in PVS should be allowed to die. Others are equally determined that, if recovery is at all possible, care should continue. The existence of a small number of diagnosed PVS cases that have eventually resulted in improvement makes defining recovery as “impossible” particularly difficult in a legal sense.[4] This legal and ethical issue raises questions about autonomy, quality of life, appropriate use of resources, the wishes of family members, and professional responsibilities.” [Wikipedia on PVS]
(3) Radio Netherlands Worldwide; 31/7/2012: “An emotional debate is underway in the Netherlands over the value of a human life. On Sunday, a Dutch health insurance body announced that it was recommending that certain expensive drugs no longer be covered.”
(4) Radio Netherlands Worldwide 24/8/2012: An influential Dutch ethicist (Heleen Dupuis, former professor in medical ethics at the University of Leiden) has said that if Queen Beatrix’s son, Prince Johan Friso, had been hospitalised in the Netherlands after his ski accident, doctors would have already stopped his treatment.
the limping messenger 
I also send most English language Limping Messenger posts to the mailing list Nettime, and I did get this reaction by email (as I do not know exactly the status of this message (private or public) I repost it here as a reaction by Martin H:
“The liberal Dutch laws did result in over two thousand people being killed without their permission in the first two years of its operation according to a Dutch government report. There its another dark side to the right to death debate that many liberals simply ignore. It is not without reason that the nazis passed the first laws on euthanasia. Not everything is about choice and nor should it be.”
Reply to Martin H.
I could not figure out the number of 2.000 Euthanasia cases without consent which you relate to a Dutch government report. Knowing the literature a bit that number makes no sense. Also the denominator “people being killed without their permission” is odd. There is the category “levensbeëindigend handelen zonder verzoek” (live-ending acts without a request), used in the euthanasia statistics. The Dutch State Statistical Bureau (CBS) publishes an overview on its web-site “Overledenen naar medische beslissing rond levenseinde” (Deceased according to medical decisions concerning the way in which their lives have been ended). It ranges from the year 2001 to the year 2010 and the number of (reported) cases where medical professionals have decided without patients being (able to be ) consulted has gone down. The numbers are assembled on a 5 year basis: 2001 = 938; 2005 = 551; 2010 = 310. (1) For a more detailed report there is the report of ZonMw which is based on a evaluation research done in the year 2010. Also this report is on line (in Dutch) (2). The conclusions of this report are also avaialble as an article in The Lancet, published July 11th 2012. The abstract is on-line and to once more oppose your numbers I cite part of its conclusions:
“Findings
In 2010, of all deaths in the Netherlands, 2·8% (95% CI 2·5—3·2; 475 of 6861) were the result of euthanasia. This rate is higher than the 1·7% (1·5—1·8; 294 of 9965) in 2005, but comparable with those in 2001 and 1995. Distribution of sex, age, and diagnosis was stable between 1990 and 2010. In 2010, 77% (3136 of 4050) of all cases of euthanasia or physician-assisted suicide were reported to a review committee (80% [1933 of 2425] in 2005). Ending of life without an explicit patient request in 2010 occurred less often (0·2%; 95% CI 0·1—0·3; 13 of 6861) than in 2005, 2001, 1995, and 1990 (0·8%; 0·6—1·1; 45 of 5197).” (3)
You say there is “another dark side” and proceed without too much explanation of what you try to say, to the short-cut argument of the Nazis and their ‘eugenic’ program. Now that is less than what is needed to start any discussion of the ethics of life and death. I could first of all rebuke that there is “the dark side of suffering without any hope to a betterment.” The agony of a medical prolonged life that has lost all its meaning, apart from the suffering. Yes, indeed there are many big dangers about who is deciding what and when. Law and regulations – however enlightened they may be in their formulation – will certainly be misused in certain cases. No law and no regulation, on the other hand may produce even more mishap.
Ethics are – in the end – not an instrument that can function in “the hands of the state”, they need to function at the personal level. They need intimacy. Intimacy between a person from who live is slipping away and her or his caretakers. Not always is there an opportunity for such a very personal discourse on how far treatment should go.
These cases produce part of the numbers that you have named “killed without their permission.” You may have not had in mind to use such demagoguery, but for me I can not escape to read it as such. “Not everything is about choice. nor should it be” you write and that puzzled me. Is it your conviction of life as ‘god given’, or life as something of a bigger order than our own conscious being? Is there some higher plan that gives meaning to our suffering?
I, for myself think so many things about this. Not always the same. One of them, which has come over the years and with many sad experiences of losing beloved ones in all kind of ways, is that as long as there is even a faint will of life, a refusal to go, life is meaningful.
Of course all this only is meaningful when there is some slow process of decay, a slow way of dying. There are the sudden unexpected accidents, war and other man made violence, natural disasters, name it, that slash away any of this discussion of euthanasia.
One can witness – though – a moment of choice, an acceptance of dying. If you want to see that as god or nature given, please do so. Others may experience it within themselves as the last thing of their own.
(1)
http://statline.cbs.nl/StatWeb/publication/default.aspx?DM=SLNL&PA=71438NED
(2) http://www.zonmw.nl/uploads/tx_vipublicaties/sterfgevallenonderzoek_versie_1-1_web-a4.pdf
(3)
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61034-4/fulltext