Wednesday, October 23, 2013

No Second Chances: International experience shows legal euthanasia is never just for exceptional cases.

By Derek Miedema, researcher IMFC Canada. Published on October 22, 2013.
Derek Miedema
Executive Summary 
“Most people want palliative care, but for the exceptional cases, we need to have an answer.”1 These were the words of Véronique Hivon, Quebec’s Minister for Social Services and Youth Protection on June 12, 2013 as she introduced a bill to legalize euthanasia in Quebec. Though Minister Hivon took great pains to call it “medical aid in dying,” the practice is not part of medicine as Canada has understood it to date, neither does it “aid patients in dying.” Quebec’s proposed legislation allows doctors to kill patients who request death, purportedly only in “exceptional cases.”
The problem with Minister Hivon’s statement is (at least) twofold. Firstly, the proposed law is not in itself limited to cases of exceptional suffering. Secondly, international evidence shows that once assisted suicide or euthanasia are legalized, the once-selective criteria expand to include more and more people. This is as true in the Netherlands, where euthanasia has been legal since 2002, as it is in Oregon and Washington State, where assisted suicide was legalized in 1997 and 2009, respectively.
In Oregon, the number of deaths by assisted suicide has doubled since 2005.2 Prescriptions for a poisonous cocktail to kill patients have grown by 76% over the same time frame.3 The population of Oregon grew by seven percent during this time frame.4
In Washington, between 2009 and 2012, the number of deaths by assisted suicide grew 130%.5 Over the same period, Washington’s population grew only 18%.6
In the Netherlands, the number of deaths by euthanasia has increased by 64% between 2005 and 2010.7 In comparison, the Dutch population grew by less that two percent over the same interval.8
This paper will briefly examine Quebec’s proposal and compare it with the situations in Oregon, Washington State, and the Netherlands.
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  1. CBC News, Montreal. (2013, June 12). Quebec tables bill on medically assisted death. Retrieved from
  2. Oregon Public Health Division. (2012). Oregon’s death with dignity act (1999 to 2012). Retrieved from
    EvaluationResearch/DeathwithDignityAct/Pages/ar-index.aspx.With author’s calculations.
  3. Ibid. With author’s calculations.
  4. Portland State University. (2013). 2012 Annual population report tables. Retrieved from Pop Report Tables2012_
    web97Excel.xls. With author’s calculations.
  5. 2009 to 2012 reports: Washington State Department of Health. (2012). 2009 to 2012
    Death with dignity act reports. Retrieved from
    IllnessandDisease/DeathwithDignityAct.aspx. With author’s calculations.
  6. 2009 population: Washington State Office of Financial Management. (2002). April 1
    intercensal estimates of population and housing: 1990-2000. Table retrieved from http://
    2012 population: (2012). April 1 post censal estimates of population: 1960-present. Table
    retrieved from
    pop_1960-present.xlsx. With author’s calculations.
  7. Onwuteaka-Philipsen, B.D., Brinkman-Stoppelenburg, A., Penning, C., de Jong-Krul, G.J.F, van Delden, J.J.M., and van der Heide, A. (2012, September). Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey. The Lancet, Vol. 380, Issue 9845, Pages 908-915. See Table 1, p. 912. (With author’s calculations.)
  8. 2005 and 2010 population: Statistics Netherlands. (2013). Population and population dynamics; month, quarter and year. Retrieved from,299-315&LA=EN&HDR=T&STB=G1&VW=T. With author’s calculations.

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