Euthanasia: Theory and reality

By Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

On Feb. 6, 2015, the Supreme Court of Canada struck down Canada’s assisted suicide law, opening the door to assisted death (Carter v. Canada).

Canadians have been sold the theory that euthanasia can freely end one’s life at the time and place of their choosing. This theory assumes that euthanasia will be voluntary and that the decision and the act is controlled by the person who dies by euthanasia.

The Euthanasia Prevention Coalition (EPC) contends that the theory of legal euthanasia and its practice are very different. Since euthanasia, by definition, means that the physician will cause the death of the patient, therefore misuse of the law resulting in a person’s death would normally be understood to be homicide.

Euthanasia in practice

A study published in March 2015 concerning end-of-life practices in 2013 in Belgium found that 4.6 per cent of all deaths were euthanasia. The same study also found that 1.7 per cent of all deaths were hastened without explicit request. This means that approximately 1000 people were intentionally killed without request in 2013. The data indicates deaths that were hastened without request were more likely to occur when a patient was in a hospital and incompetent to make medical decisions.

How did this occur?

The guidelines in Belgium and the Netherlands require the physician who causes death by euthanasia to report the euthanasia after the patient has died. Since the doctor who approves the death is the same doctor who submits the report, and since there is no third-party oversight of the law, therefore the system has been designed to “cover up” misuse of the law.

The same misuse of the law will likely occur in Canada. The proposed Quebec euthanasia guidelines also require the physician who lethally injects the patient to submit the report to the government. The Quebec system also provides no third-party oversight of the law, while enabling physicians to cover up misuse of the law when directly killing a patient.

The announcement that Quebec doctors will be sent euthanasia kits with step-by-step instructions is also rife with possible misuse of the law. The physician will receive the euthanasia kit, containing a double dose of lethal drugs. These kits will be used to lethally inject patients without third-party oversight of the use of the kit. Once again, reporting of the death will be done, after the death, by the doctor who lethally injects the patient.

The data in the Belgian study on end-of-life practices in 2013 also uncovered that almost half of the assisted deaths were not reported. The data in the study suggests that when the euthanasia death may not have followed the guidelines of the law, that Belgian physicians failed to report it.

Further to that, in January 2014, Dr. Mark Cosyns admitted in an article published in a leading Belgian newspaper that he does not report the euthanasia deaths that he does. Dr. Cosyns has not been penalized for his indiscretion.

The theory that euthanasia will always be voluntary

The Quebec government recently announced that doctors would need to falsify death certificates when the patient died by euthanasia (by representing the cause of death as the underlying illness of the person, rather than euthanasia). This is an affront to medical ethics, transparency and accountability.

When euthanasia becomes legal, doctors are given power to cause the death of their patients. Life and death decisions should require the highest level of oversight and transparency.

What about patients who are not terminally ill but living with psychological conditions such as mental illness, depression or loneliness?

In 2013, euthanasia for psychiatric reasons in the Netherlands tripled and euthanasia for dementia more than doubled.

The data from a study — published in July — concerning 100 requests for euthanasia for psychiatric reasons in Belgium indicated that: 58 people were depressed, 50 had a personality disorder, 13 had post-traumatic stress disorder, 12 were autistic, 11 had anxiety disorder and 10 had an eating disorder. The 100 requests for euthanasia resulted in 48 people with psychiatric conditions being approved for euthanasia.

The proposed Quebec euthanasia guidelines and the Supreme Court of Canada decision allows euthanasia for psychological suffering, a term that they did not define.

The practice of euthanasia is very different than euthanasia in theory.

In reality, legalizing euthanasia gives doctors the right, in law, to cause the death of their patients. The decision to lethally inject a patient is made by two doctors without third-party oversight and the doctor is required to report their decision after the patient has died.

The concept that euthanasia is about individual choice and autonomy is only a theory.

In other jurisdictions there is proof that the law is misused, that lives are ended without request, that the reporting procedure is intentionally ignored, and that euthanasia is regularly ending the lives of people who are depressed and/or incompetent.

In theory euthanasia appears to offer freedom; in reality, legalizing euthanasia is not safe.