Euthanasia pioneer provides new information concerning euthanasia for psychiatric reasons in the Netherlands.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Recently, several articles have been published quoting Dutch psychiatrist and euthanasia pioneer, Dr Boudewijn Chabot commenting on the recent developments concerning euthanasia in his country. Articles such as "A Dutch euthanasia pioneer surveys the wreckage and despair" make it sound like Chabot is now critical of euthanasia, but is he?

This is not the first time that Chabot appears to be challenging the Dutch euthanasia practice. In January 2014 he stated that the Dutch euthanasia law has derailed.

We must remember that Chabot was the psychiatrist who opened the door to euthanasia for psychiatric reasons and he is currently involved with a suicide promotion service. When reading his recent commentary it appears that he is saying that euthanasia should not be extended to "completed life" (whatever that means), I suggest that he is actually saying that it is not necessary to extend euthanasia to include "completed life" because these people can avail themselves of his suicide service.

After re-reading the text of the Chabot commentary it is my conclusion that his writing is most important because of the new information he provides concerning the practice of euthanasia in the Netherlands.

What do I mean by "new information?"

The Netherlands euthanasia law has a reporting mechanism that requires the doctor who does the euthanasia death to also be the person to report the euthanasia death. In other words, the euthanasia law requires self-reporting. For this reason we don't actually know what is happening int the Netherlands because people don't self-report acts that are possibly outside of the law or that may cause them problems.

Further to that, unless you are a member of a regional euthanasia review committee, such as Professor Theo Boer, or you are given the reports from the euthanasia clinic, you will only have the basic information that is published in the Netherlands annual euthanasia report. Sadly, Canada and Belgium use similar "self-reporting" systems.

What information does Chabot provide?

First of all he clearly outlines the growth of euthanasia in the Netherlands. Chabot states:

In the last ten years, the number of euthanasia reports has increased from two thousand to six thousand per year. People ask for it more often, doctors are more often willing to provide it, and consultants who assist the doctors give more often the green light. In 2016 the review committee found that only 10 of the 6,091 (0.16 percent) cases was done without due care.

Chabot then states, In and of itself, this increase does not disturb me – even if the number exceeds ten thousand in a few years, but he continues:

What does worry me is the increase in the number of times euthanasia was performed on dementia patients, from 12 in 2009 to 141 in 2016, and on chronic psychiatric patients, from 0 to 60. That number is small, one might object. But note the rapid increase of brain diseases such as dementia and chronic psychiatric diseases. More than one hundred thousand patients suffer from these diseases, and their disease can almost never be cured. Particularly in these groups, the financial dismantling of care has affected patients’ quality of life. One can easily predict that all of this could cause a skyrocketing increase in the number of euthanasia cases.

Chabot continues by explaining that nearly all of these controversial euthanasia deaths are done by the euthanasia clinic:

Strikingly, doctors from the End of Life Clinic Foundation* are often euthanizing these patients, while as a matter of principle they never treat patients for their illness. By 2015, a quarter of euthanasia cases on demented patients were performed by these doctors; in 2016 it had risen to one third. By 2015, doctors of the End of Life Clinic performed 60 percent of euthanasia cases in chronic psychiatric patients, by 2016 that had increased to 75 percent (46 out of 60 people).

Since more than 75% of the psychiatric euthanasia deaths are done at the euthanasia clinic, therefore very few lethal injections for psychiatric reasons are being done by anyone else. Chabot comments on the fact that this information is not published in the annual report:

For sure, the fact that in 2016 euthanasia has been granted to a total of sixty psychiatric patients is included in the annual report of the review committee. But nowhere in the report is it mentioned that in 46 of these cases, it was a physician at the End of Life Clinic who granted the request. That number you have to dig up from the annual report of the End of Life Clinic. Is this fog purely coincidental?

Chabot then comments on how the 2012 review of the law muddied the definition of “unbearable suffering without prospect of improvement.” Chabot states that the review committee stated:

The committee members found this difficult to evaluate, as was already apparent from the previous review of the law: “If the notifying physician and the consultant found the suffering to be unbearable, who are we to say something more about it here?”

Chabot then recounts the case of the woman with dementia who died by lethal injection even though she was saying NO

In 2016, the committee found in only one of the 201 cases of euthanasia in dementia and psychiatry that the evaluation had been careless [not in line with due care] because the requirement of “unbearable suffering” had not been met. What problem is this evaluation structure, which costs about four million euros annually, really solving? The researchers fail to answer this question.

In that case, a Netherlands Regional Euthanasia Review Committee decided that the forced euthanasia done on a woman with dementia, where the doctor sedated the woman by secretly putting the drugs in her coffee, was done in "good faith."

I thank Dr Chabot for sharing new information. Chabot, in his commentary, is saying that euthanasia for "completed life" is not necessary while promoting his suicide service, nonetheless, after reading his commentary, it is impossible to suggest that euthanasia has not been extended in the Netherlands, and in fact euthanasia is out-of-control.