Thursday, July 26, 2012

Netherlands 2010 euthanasia report - A further analysis.

By Alex Schadenberg

On July 11, the Lancet published the long-awaited 2010 euthanasia statistics based on a meta-analysis by a group of researchers.

I responded to the report by publishing an article titled: Lancet study proves significant increase in euthanasia deaths in the Netherlands.

Most of the media reported that the 2010 euthanasia statistics in the Netherlands are similar to the euthanasia numbers from 2001, before legalization which was based on the following conclusion in the study:
"8 years after the enactment of the Dutch euthanasia law, the incidence of euthanasia and physician-assisted suicide is comparable with that in the period before the law."
Is this a true statement?

Historical facts:
Euthanasia in the Netherlands was originally legalized through court decisions. In 1984, the Supreme Court in the Netherlands established a set-of-criteria that should be followed for a physician to cause the death of a person by euthanasia or assisted suicide without fear of prosecution.

From 1984 to 2002 a series of court decisions in the Netherlands led to a widening application of euthanasia. The courts allowed euthanasia for people living chronic depression (mental pain), to children who were born with disabilities, and other vulnerable groups.

In 2001, the Netherlands parliament official legalized euthanasia along the guidelines that were approved by the successive court decisions. The law officially came into effect in April 2002. Therefore euthanasia and assisted suicide were common before being legalized in the Netherlands.

The 2001 report:
The 2001 report determined that there were approximately 3800 (2.6% of all deaths) deaths by euthanasia with only 2054 of those deaths being reported. This means that only 54% of all euthanasia deaths were reported. The 2001 euthanasia report was the final meta-analysis of the practice of euthanasia and assisted suicide before it was actually legalized in 2002.

Media reports concerning the 2010 report:
The media reports focused on the 2010 euthanasia report stating that 4051 deaths by euthanasia and assisted suicide occurred in 2010 stating that since euthanasia was legalized in the Netherlands in 2002, that there has only been a minor rate of increase in deaths by euthanasia and assisted suicide. 

Are the media reports true?
1. The 2010 euthanasia report made an error in its mathematical calculation. 
There were 136,058 deaths in the Netherlands in 2010 with 4051 being caused by euthanasia and assisted suicide (3859 euthanasia deaths, 192 assisted suicide deaths). That represents 2.98% of all deaths.

2. The 2010 report indicates a continued trend to the use of deep-continuous sedation, also known as terminal sedation, over euthanasia and assisted suicide. 

Deep-continuous sedation is done by sedating the person and usually withdrawing fluids and food. When the person is not otherwise dying, death will often be caused by intentional dehydration, which is also known as "slow euthanasia.

Deep-continuous sedation must be differentiated from palliative sedation, which is a practice of sedating a person who is experiencing intractable pain or uncontrolled distress. Palliative sedation is proportionate to the need to relieve the distress of the person with the intention allowing a natural death to occur.

The 2001 Netherlands euthanasia report indicates that approximately 5.6% of all deaths were related to deep-continuous sedation. The 2005 euthanasia report indicates that approximately 8.2% of all deaths in the were related to deep-continuous sedation. The 2010 euthanasia report indicates that approximately 12.3% of all deaths are related to deep-continuous sedation.

The rate of deep-continuous sedation has more than doubled in the Netherlands since 2001 and has risen by 50% since 2005. How often are deaths by deep-continuous sedation done to intentionally cause the death of a person who was not otherwise dying?

Further to that, the rate of increase of reported euthanasia deaths has accelerated over the past few years with a 19% increase in 2010 and 13% increase in 2009.

The facts:
* After the legalization of euthanasia in 2002, there was an evident shift from death by euthanasia to death by deep-continuous sedation, also known as terminal sedation. 
* The use of deep-continuous sedation has in fact accelerated while the trend towards fewer deaths by lethal injection has reversed whereby the number of euthanasia deaths is greater than the 2001 statistic even thought the number of deaths by deep-continuous sedation has more than doubled in that time.

Euthanasia in the Netherlands:
The rate of euthanasia in the Netherlands has increased by 73% in the last 8 years (1815 reported deaths in 2003, 3136 reported deaths in 2010) and even more important, the rate of euthanasia has increased by almost 35% in the past two years (2331 reported deaths in 2008, 3136 reported deaths in 2010).

Combined with the growth in the use of terminal sedation for people who are not otherwise dying “slow euthanasia” and the slight increase in the number of unreported euthanasia deaths, one must conclude that there are abuses occurring in the Netherlands.

On March 1, a euthanasia clinic in the Netherlands launched six mobile euthanasia teams in the Netherlands. The NVVE euthanasia lobby in the Netherlands announced that they anticipate that the mobile euthanasia teams would complete 1000 euthanasia deaths per year.

The mobile euthanasia teams plan to fill unmet demand for euthanasia for people with chronic depression (mental pain), people with disabilities, people with dementia/Alzheimer, loneliness, and those whose request for euthanasia is declined by their physician. In 2010 45% of all euthanasia requests resulted in death by euthanasia.

Legalizing euthanasia and assisted suicide is not safe and the safeguards that are devised to control euthanasia do not protect the dying, but rather they protect the doctor.

Finally: Have you ever wondered why there are no prosecutions for deaths without request or consent in the Netherlands?

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