AMSTERDAM -- For Nelleke Jorissen-Dumee, the Netherlands' right-to-die law means death with dignity. She recalls her mother Maria's fight with cancer, and how five years ago the sick woman chose the day to end her life.
The family brought 20 red roses and played Maria's favorite songs, including Fats Domino singing "Blueberry Hill." They lit 64 candles, one for each year of her life. Then, after a final glass of wine, she lay in her daughter's arms while a doctor administered two lethal injections.
"For us, it was quite a beautiful experience," Jorissen-Dumee said.
A year and a half after the Netherlands became the first country to legalize euthanasia and doctor-assisted suicide, an estimated 2,000 to 3,000 lives end that way here each year. The law appears to enjoy support among the Dutch public and doctors, many of whom carried out such procedures in secret for years.
But it doesn't seem right to others. Christian groups condemn euthanasia as contrary to their faith. Other opponents are urging counterparts in the United States to block passage of a similar US law.
Such opponents argue that moral objections aside, euthanasia in practice often isn't a black-and-white decision: The patient may be of unsound mind; relatives may disagree on how to proceed; morphine given to relieve pain may also hasten death without anyone having made a clear decision to end the patient's life.
For euthanasia to be legal, the doctor must determine that the patient's suffering is what the law describes as "unbearable" and "lasting," with no prospect of improvement. The doctor must give all "due care," and determine, with the patient, that "there is no reasonable alternative."
"I'm very pleased that it is in the law, because now you know what you can do and you know what you can't do," said Nico Mensing van Charante, who has been a family doctor for 27 years. When he began, most doctors had a "criminal period," he said.
Opponents say the new law encourages people to end their lives when confronted with suffering, and creates an atmosphere in which doctors can make decisions that in many cases go unreported.
"You should never aim to kill a person. That's the bottom line," said Bert Dorenbos, chairman of the Dutch group Cry For Life.
Dorenbos said he has closely followed the case of Terri Schiavo, a woman in Florida who has been in a persistent vegetative state for 13 years. Schiavo's husband won a court order to have her feeding tubes removed, only to have it overturned by Governor Jeb Bush and the Legislature.
Dorenbos sent e-mail messages to US groups opposing the tubes' removal, warning them that if Schiavo is allowed to die, her case will open the door to legal euthanasia. He cited the 1990 case of a Dutch woman in a coma, Ineke Stinissen, who was allowed to die at her husband's request. Dorenbos said the case "shifted the debate" and led to legalization.
Rob Jonquiere, a physician who runs a pro-euthanasia group, The Right to Die, Netherlands, said the lesson to be learned from the Schiavo case was that if she had filled out a right-to-die request form of the type that is freely available in the Netherlands, her wishes would be known.
There is some dispute about the number of euthanasia killings in the Netherlands, but both sides agree there has been no surge in reported cases since the law took effect in April 2002.
According to Cry For Life, 1,882 euthanasia cases were reported in 2002, compared with 2,054 in 2001 and 2,123 in 2000. The group uses figures first published by the Health Ministry and supplied by euthanasia committees that usually lump together euthanasia and the tiny number of doctor-assisted suicides.
On the opposite side of the debate, The Right To Die, Netherlands, reported 3,800 cases of euthanasia and doctor-assisted suicides in 2001. That figure, it said, compared with 3,600 euthanasia and doctor-aided suicides in 1995. It says anecdotal evidence suggests the numbers have held steady.
Legalizing euthanasia was supposed to encourage doctors to be more honest in reporting it, but even supporters concede it hasn't. A family doctor, Mensing van Charante, estimates that half the physicians conduct euthanasia in secret, because reporting it requires filing extensive paperwork and getting a second opinion.
In any case, the numbers may not be complete because euthanasia is strictly defined as the "active termination of life on request" and does not include what is known here as "terminal sedation," when a terminally ill patient in severe pain receives painkilling morphine in quantities that relieve the pain but that also hasten death. Under Dutch law, that leaves room for ambiguity about whether death was intended.
Henk Reitsema, 34, a former social worker at a Christian service agency, is convinced that his grandfather, 80, died from such an overdose eight years ago in a nursing home. The World War II veteran, partially paralyzed from a stroke, was in pain but mentally fit, Reitsema said.
A doctor in the nursing home, in Groningen, gave the man what Reitsema called a lethal dose of morphine. By Reitsema's account, the doctor said he was acting on a final wish, a cry of "please help me." But for Reitsema, the cry was simply a request for relief. "It's unfathomable that he would have made a determination for his own death," Reitsema said.