Wednesday, December 9, 2009

New Research into Dutch Euthanasia law casts doubt on who actually decides

Anthropologist and lawyer Anne-Marie The recently published a new study on euthanasia in the Netherlands casts doubt on whether people actually choose euthanasia?

Anne-Marie The asks the question - Do the wishes of the patient always trump those of the doctor?

An article published in the NRC Handelsblad explains the concerns of Anne-Marie The by this anecdote.
The doctor and the patient had agreed to meet on a Friday at 2 PM. When the doctor rang the doorbell the patient was watching the Wimbleton tennis tournament on TV. Did the doctor mind if he finished watching the match first?
The researched the 2331 cases of euthanasia in the Netherlands last year by speaking to doctors, medical specialists, lawyers, ethicists and politicians about how the (2001) Dutch euthanasia law came to be and the application of the law.

Remember, that when we refer to the 2331 cases of euthanasia in the Netherlands in 2008, that number does not include the approximately 550 death without consent and the approximately 400 cases of assisted suicide.

The stated:
"There is the euthanasia law and then there is the euthanasia reality. To think that we have neatly arranged everything by adopting the euthanasia law is an illusion. Reality is more complicated than that: every patient, every situation and every doctor is different."
The article in the NRC Handelsblad states:
The Dutch euthanasia law didn't legalise euthanasia, but it allows a medical review board to suspend prosecution of doctors who perform it under certain circumstances.
This means that the law actually gave physicians the right to directly and intentionally cause the death of a patient, it did not give patients the right to euthanasia.

Anne Marie The found that the reality of the law does not always follow procedure. She interviewed one doctor who told her of a case where the patient had requested euthanasia but since it was a Friday afternoon there wasn't another physician who could give a second opinion. The doctor said that he did it anyway.
"He didn't tell anyone."
The stated:
"In the end it all comes down to people, one doctor will bring it up himself, another will avoid the subject as long as he or she can. When it does come up it is up to the doctor to figure out what the patient really wants. In the end he (the doctor) has to 'feel' if euthanasia is the right solution"
The also recognized that other countries are much more advanced in palliative care than the Netherlands. Anne-Marie The stated:
"by adopting the euthanasia law the Netherlands went the other way. Euthanasia came first, palliative care came afterwards."
The article in the NRC Handelsblad states:
Els Borst, the health minister at the time the euthanasia law was adopted and a doctor herself, told Anne-Marie The that she thought it was wrong to put euthanasia before palliative care. She was not alone in thinking so. Among the general practitioners, who are on the front line of euthanasia, a reluctance against the practise has begun to take root. One of them was Amsterdam general practitioner Joke Groen-Evers, a long-time supporter of euthanasia. Groen-Evers changed her mind after 2001 and began to advise patients and colleagues against euthanasia. She hoped good palliative care would make euthanasia obsolete.

Groen-Evers told Anne-Marie The that she offers "a set of alternative tools." When a patient brings up the subject, Groen-Evers enquires what it is he or she is afraid of. Is it fear of dying alone in the middle of the night? If so, she will try to find a solution. Groen-Evers also calls the patient herself and she regularly visits her patients. In most of her cases the request for euthanasia is never made.

Anne-Marie The agreed with the criticism that the United Nations made against the Dutch euthanasia law. The United Nations has stated that checks and balances should be in place before the death and not after the death. The Netherlands mandates that a report be filed after the person has died.

In Oregon and Washington States reports are filed by the physician who prescribed the lethal dose, after the death of the person. I have two questions: how can any vulnerable person be protected by after-the-fact reporting? and - Since the reporting is done by the physician who prescribes the lethal dose, therefore is the physician going to self-report an assisted suicide of a person who does not qualify under the law?

Anne Marie The stated:
"They have a point there. When the independent commission ... reviews a case the patient is already dead. But doing it (the review) before the fact makes the procedure much more complicated. It is time-consuming when time is of the essence. And there is a good chance that doctors will hide complicated cases from the commission. They already do that when there are questions about mental competence, or in the case of children, demented or otherwise handicapped patients. The law is still pretty vague about that."
When asked about how the research has affected her opinion of euthanasia, Anne-Marie The stated:
"I understand why people want euthanasia, but I don't share that wish myself. Perhaps it is because I have seen so many people die, at the hospital and nursing home where I worked, but also my own grandmother, who was a cancer patient. For her, dying was part of life. On her death bed she simply embraced it. I thought it was quite beautiful that as a child I was allowed to sleep next to her and help her get cleaned up. She was unconscious for three days. When she started retching the doctor gave her a bit of morphine. the next morning she had slipped away. That's the way I would wish to go too."
There are a few very important point made by Anne Marie The:
First: Do the wishes of the patient always trump those of the doctor?
Second: There is the euthanasia law and then there is the euthanasia reality.
Third: the reality of the law does not always follow procedure.
Fourth: other countries are much more advanced in palliative care than the Netherlands.
Fifth: Els Borst, the health minister at the time the euthanasia law was adopted thought it was wrong to put euthanasia before palliative care.
Sixth: The United Nations has stated that checks and balances should be in place before the death and not after the death.
Seventh: And there is a good chance that doctors will hide complicated cases from the commission. They already do that when there are questions about mental competence, or in the case of children, demented or otherwise handicapped patients.

Once again, when we uncover the truth about euthanasia in the Netherlands we learn that it is out-of-control. Further, when people suggest that vulnerable people are not threatened by euthanasia in the Netherlands they are not taking the reality that the euthanasia deaths of people who lack mental competency, disabled newborns and other people with disabilities are under-reported in order to avoid scrutiny.

Link to the article in the NRC Handelsblad:
http://www.nrc.nl/international/Features/article2425897.ece/Euthanasia_law_is_no_cure-all_for_Dutch_doctors

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