Annie did it her way
Holocaust survivor Annie Kalman wins her final battle over right to die. After her euthanasia case sets legal precedent in Europe, her son seeks to change Israeli law. 'A person has the right to end his life with dignity, with grace,' he says
This story almost sounds familiar. A young Jewish girl's serene life in Amsterdam is torn apart by World War II. But unlike Anne Frank, Annie Kalman managed to survive the Holocaust, hiding for three years in an attic in Amsterdam.
Over 60 years later Annie found herself locked up again. A massive stroke left her a virtual prisoner in her own body, turning her from an energetic woman to a cripple.
Several weeks ago, Annie won her final battle. At 86, she was euthanized.
According to her son Dov, it was not the loss of mobility that made his mother seek her death. She fought the stroke-induced paralysis for five years and won, but she was never able to regain her speech, managing only to mutter a resemblance of "yes" and "no"; rendering her unable to say the one sentence required by Dutch law in order to grant euthanasia – "I want to die."
Annie stopped taking her medications. All she could do when someone asked her about her wish to end her life was answer with a broken "ja."
Unprecedented decision
The Dutch authorities could not grant Annie's wish, as unspecific as it was, prompting the Kalman family to launch a lengthy legal battle on her behalf.
Her euthanasia marked a legal precedent in the Netherlands, and likely in Europe and the world: it was the first time the procedure was granted for a patient who was not terminally ill, but is suffering the lingering effects of a stroke – a situation which may last for years; and the first time ever euthanasia was granted without the petitioner's own signature, as Annie was no longer able to sign her name.
Following his mother's battle, Dov Kalman has decided to increase awareness to euthanasia in Israel, and has started a petition calling for a legislative change. "A person has the right to end their life with dignity," he said.
"While sitting shiva in my home in Hod Hasharon, I got an acute sense of exactly how Dutch I am," he told Yedioth Ahronoth. "Euthanasia is acceptable there. I encountered true surprise here, about the possibility of one ending their life by choice.
"Most people said they would have wanted the same thing. Everyone has a story to tell about a grandparent or parent who would have rather died through euthanasia. Holland has a very powerful religious establishment, but a person can still make such decisions and no one can stop him – not the authorities, not the government and not the religious establishment."
Annie Cohen was born in Amsterdam in 1924. She was 16 when the Nazis invaded the Netherlands. Her father was able to bribe their way into hiding and those three years changed young Annie forever. "My mother wasn’t afraid of anything after that. Not God, not the Nazis and not death."
Annie met Heins Kalman, a Holocaust survivors himself, shortly after the war ended. The two married and had four sons and seven grandchildren. Dov, the youngest, is the only one living in Israel.
Eyes wide shut
Annie was an active, vibrant woman who volunteered with dozens of cultural organizations. "She was very, very chatty," Dov remembers with a smile. She fell silent five years ago, after a stroke stripped her of her mobility and speech.
"When we got to the hospital that day, we saw it in her eyes – she didn’t want to go on living. She had so many medications in her house – enough to kill all of Amsterdam. I believe that if she could have taken them all in order to die that day she would have."
'I told her she was my hero.' Dov Kalman (Photo: Zvika Tishler)
What made her miserable more than anything, he explained, was the loss of speech: "She had a clear opinion on everything, including euthanasia. She carried a special DNR ("do not resuscitate") card with her, specifically saying she did not want her life sustained via artificial measures, and she was active in a local euthanasia organization.
"She always made it perfectly clear to us, saying 'if anything happens to me, let me go.'"
Dov said that at every doctor's appointment following the stroke, his mother would sign – as best she could – "help me die," but the doctor treating her insisted otherwise.
"This was when my mother found herself confined again, trapped inside her body, seeing life from the sidelines. Speech was impossible. Other reactions – barely possible. The war left its mark on her, and she ended up taking medications all day. She stopped altogether after the stroke."
Battle of dignity lost
The last few years saw Annie and her family battle the medical establishment. Annie's physician believed her death wish was the result of depression brought on by the stroke and refused to grant it.
"Every time she saw the doctor she reiterated her wish to die. Using her hands, bodily gestures. And over and over, the doctor said no."
That changed three months ago, when the doctor called in Annie's sons and told them she decided to grant their mother's wish. "I burst into tears, but my mother – she got up from her chair and you could see how happy she was."
Next came a session with a psychiatrist and a series of tests meant to determine whether Annie was lucid and mentally capable of making such a crucial, final decision.
Two months later the request was granted, only to be hindered by an external official – a doctor whose job was to oversee the legality of the procedure. He refused to green-light the procedure given Annie's physical inability to sign her name to the euthanasia petition.
"The Netherlands conduct a post-mortem inquest into every euthanasia case, to ensure that the authorization followed protocol, otherwise the doctor who performed it will lose his license," Dov explained. Eventually the request was granted in full.
Tears in heaven
Annie's euthanasia was set for 11 am. Initially, Dov opted not to be there, "But my brother asked me to be there and in hindsight I'm so glad I did. I got to witness my mother's nobility."
How do you spend your last day with your mother? "It was a tough question. We ended up getting her a CD with her favorite song, "I Did It My Way," and all of us went to lunch. She had so much fun, more than we've seen her have in a long, long time."
It was raining that day, an angry, mid-August rain storm. When Annie's sons came to the hospital at 9 am, she was waiting for them, all dolled up and sporting a new hairdo. "She was eating breakfast as usual, and she was very relaxed," Dov recounted. "Then the nurse came, and mom followed her very carefully while she hooked her up to the IV. The nurse asked her if she was having second thought and she said no."
Annie's sons spent their last hours with her going through family albums. "She didn’t cry," he said, until she saw photo of Noya, his daughter. "We both burst into tears. It was the only time she cried with me." The brothers then read to her, goodbye letters written by each of her grandchildren.
Eleven o'clock came too soon. Each of Annie's son said his goodbyes, "and I told her she was my hero," said Dov. The doctor came in at 11 am on the dot, carrying a small wooden case. It was the first euthanasia she ever performed, and Dov said his mother held the doctor's hand while she was administering the injections – starting with saline solution and an anesthetic – encouraging her to go on.
Annie looked at her sons and cried. Consciousness slipped away from her before the final injection. "Her final breath left her in a great whoosh. Air and her soul," said Dov. A minute later – she was gone.
Not a private death
"My mother's heroism lies in her determination to follow through on her convictions and her lack of fear," he said when asked why he chose to share Annie's story.
"The same courage that saw her through hiding, made her fight for her last right. She wasn’t willing to lose her dignity in life. I see this as my mother's last will and testament. Her death was not a private act, she made a statement relevant to all of us – we have the right to die with dignity. With grace."
Dov said he intends to launch a public campaign for euthanasia "to turn Israel's medieval legislation into a progressive one, like in the Netherlands.
"Every person who reaches such a point in life should be allowed to let go. Period. Forcing a person to go on living like that against their will, is much crueler, in my opinion, than the injection that put my mother out of her misery."
The question of ceasing medical treatment is addressed in Israel's Dying Patient Act (2005), which aims to regulate such cases while balancing the sanctity of life, the importance of the quality of life and an individual's autonomy on his person, explains prominent jurist Boaz Okon.
The law also aims to adhere to Israel's Jewish values, and stated that "every man wished to live on unless proven otherwise." The law also minimizes the options of ceasing medical treatment, and applies only to patients defined as terminal – having only six months to live or less.
In such cases, and only if the patient is lucid and has informed his doctors of his wish to cease medical treatment, such a request may be granted. If the patient is not lucid, such directives can be derived only via a living will.
The Israeli law underscores the fact that under no circumstances can a physician assist a patient wishing to end his life, rendering assisted suicide and mercy killings illegal.
The law provides detailed options for anyone wishing to make such end of life arrangements in the form of a living will, and all relevant documents – which Okon said make for a laborious process – are available to the public.
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