Abstract
General practitioner involved in first case to change Dutch law on euthanasia
In 1971 Andries Postma was an unknown Dutch general practitioner working in the quiet village of Noordwolde in rural Friesland. But his support for his wife, also a general practitioner, in what they were convinced was the mercy killing of her mother ensured their name a place in medical history.
Postma and his wife neither sought publicity nor set out to challenge Dutch law banning euthanasia. Still the Postma case was reported around the world and its shock waves continue to shape Dutch medical practice today.
As the first euthanasia test case, it broke social taboos in a country with strong Christian traditions. It also reflected a new wave of concern among many young medical professionals about the limits of medical care and patients' self determination.
Many in Dutch society, including the Postmas' fellow villagers in Noordwolde, shared their belief that they were morally in the right, even though his wife was technically guilty of murder.
Their actions were the spark that launched the Dutch Voluntary Euthanasia Society, and 20 years later resulted in a law protecting doctors carrying out euthanasia within legally defined boundaries.
Postma was born in 1926 in Hardegarijp, near Leeuwarden, in the northerly province of Friesland. He studied medicine in Groningen, where he met his wife, Truus, and together they set up a general practice in Noordwolde in the early 1950s.
Postma was a popular doctor and active in village affairs but also a man of conviction. It is believed he first expressed in public his strong views on the rights of everyone to a good and conscious death in 1965 in a local Friesian language magazine.
Six years later these theoretical views were cast in a sharp personal perspective as he and his wife faced up to the suffering of her severely handicapped mother. She had suffered a brain haemorrhage, was deaf, had difficulty speaking, and had to be tied to her chair in her nursing home to avoid her falling. She repeatedly begged her daughter to end her life. Eventually she agreed, injecting her mother with 200 mg morphine. They informed the nursing home director, who in turn alerted the health inspectorate. His wife was charged under the law forbidding voluntary euthanasia, which theoretically carried a 12 year prison term. However, though the Leeuwarden court in 1973 found her guilty, she was given only a symbolic punishment—a one week suspended prison sentence and 12 months' probation.
Postma was described as the “help and support” of his wife both throughout the events surrounding his mother in law's death and later in court. In June that year they jointly wrote in the Dutch Journal of Medicine in response to the countless articles that the case had provoked.
They explained that at first they absolutely did not want the publicity for the case generated both in the Netherlands and abroad. But now it was in the open they felt it “should be exposed so that everyone can reflect on our experiences.”
Calling for a change in the law, they wrote: “From the many letters we have received it appears clear to us that very many dying people suffer inhumanely and without any prospects. There must be another way.”
This was too much at the time for the Royal Dutch Medical Association, which distanced itself from the judgment, arguing that voluntary euthanasia should remain a crime. It took a further 11 years before it was to accept the need for a change in the law.
Many in Dutch society had fewer qualms. The Dutch Voluntary Euthanasia Society was launched in the same month as Postma's wife was convicted, holding its first meeting at Vinkenga, a small hamlet just a few miles from the Postmas' home.
Though Postma initially played no formal part, he was involved from the start in discussions about the new society. He thought the many reactions to the Postma case were reason to support it. He acted as a voluntary adviser on complex decisions surrounding terminal care. He eventually became its chairman for several years. In the 1980s he and his wife were made honorary members for their “contributions to the debate within society.”
Last month the society described him as a “passionate fighter for the right of a free choice at the end of life.” The society's director, Rob Jonquière, who had met Postma, said that he was a man of mercy and integrity who believed that rights belonged to people, and doctors, unless they had strong objections of principle, should respect them. “He was one of those doctors who saw it as a privilege to be able to relieve patients of their suffering.”
He believes neither of the Postmas had any intention of making a test case, but simply acted in a way “doctors have done for centuries” when confronted with desperate patients.
However, Postma did become a test case, which, together with three others, Schoonheid, Chabot, and Brongersma, has defined current policy. Because the court imposed such a lenient sentence, and for the first time accepted conditions under which euthanasia by doctors might be defendable—the patient is incurably ill, suffering unbearably, and has repeatedly requested euthanasia—it was seen as a signal that euthanasia could be possible.
Director of legal affairs at the Royal Dutch Medical Association, Professor Johan Legemaate, said that the Postma case is important because the judge offered an opening for euthanasia and because it triggered a whole social debate.
“The time was ripe for a broader social discussion, and this case started that. It was in tune with the times, and still is. There is plenty of debate today about the boundaries of euthanasia but the central point of their case still enjoys a lot of social support.”
Postma died aged 80. He leaves a wife, Truus, and five children.
Andries Postma, general practitioner Noordwolde, Friesland, Netherlands (b 1926; q Groningen 1955), d 7 December 2006.