Are Euthanasia Errors Acceptable?

By Fabian Stahle, a Swedish researcher.
Edited by: Alex Schadenberg, Euthanasia Prevention Coalition

When the advocacy for legalisation of euthanasia/assisted suicide approach a new jurisdiction it is always with the assurance that the proposed practise will only be used for extreme cases – persons in extreme pain and on their death bed. The advocates emphasize that strict safeguards will prevent anyone from being killed by mistake.

Dr Johan Andreen

These two speaking points in their sales pitch - only extreme cases and no mistakes – are constantly repeated in the first phase of introducing the idea of medical killing.

Currently the Swedish debate is in the introduction phase. A Swedish opponent of euthanasia, psychiatrist Johan Andreen, recently addressed the allegations about the proposed strict safeguards in an article in the Swedish Psychiatric Magazine, No 3, 2018. See page 54-56, (link) with translated title: "Taking Position In The Question About Euthanasia."

His article is a sharp and in-depth analysis of the weakness of the proponents claims and a passionate appeal for true compassion for the vulnerable.
The author asks the following question to those who propose euthanasia (and PAS) regime and to those who haven't yet made up their mind:

". . . Is it acceptable that any erroneous deaths at all take place in the context of something that should be a care measure?"

He then continues:

"If your answer is yes, the next question is: “why should we accept that when we do not accept it for other care measures?” Furthermore, how big a proportion is acceptable? Finally, how will we be able to establish and ensure safe control of that proportion of error with “assisted death"?

If the answer is no (which it reasonably ought to be), some of the follow-up questions would instead be: How can the law and its application ensure that mistakes and abuse of the law do not result in patients – who should have had care and support in a dignified life – having their lives shortened as well as a dishonourable ending to their life?

We had better watch out and navigate right in this paradoxical context. Because, although the existence and purpose of the act is to bring about death, and that this has been achieved, it will inevitably also have occurred in cases where care and treatment to live a meaningful and reasonably comfortable life should have been given. The assisted death will have the effect that some patients pass away as a result of the medical act, when this was incorrect and not the patient's actual desire and need. In the name of common sense and honesty, we should all be able to assume and agree that this will be unavoidable. In what world are there laws, doctors and healthcare systems that have no shortcomings and risks, or legal institutions that cannot be used for unintended and therefore illegal purposes?

The starting point must be, for empirical and logical reasons, that it will not be possible to introduce a "Swedish improved" version of the Oregon model that will not kill a number of people in error. . . . Let it be clear that this unintentional mortality would take place at a percentage or even permille level. It would also occur in a Swedish model.

Is any such mortality at all acceptable then? In our current situation, it is difficult to see, let alone find the opportunity to talk about this lethal side-effect or risk in the assisted death debate, since the act itself has the purpose of bringing about death!

So, here we need to see before us people who are depressed or just lonely and despondent. People who with pharmacological, psychotherapeutic and other treatment or just good care, compassion and counselling, together with their near and dear ones receive the support they need – but do not believe they can wish for – to be able to live out the time they have left. And no one can know the length of that time. 

There may be individuals who perhaps enter [into] their terminal condition due to the fact that in a state of depression – or sheer resignation – they stop taking or continuing treatment or investigation, or fail to ensure necessary intake of nutrition, fluid and basic activity and therefore become terminally ill. Is an outcome, involving an act that leads to death, acceptable in any or a few cases of these treatable and care-demanding non-terminal conditions? Should not our compassion, our strength and our resources instead be spent on scientifically developing – and with the use of care programs, focus and standardize – the help provided in cases of such suffering, the underlying disease and the social vulnerability?

In order to see with sharp clarity what we are talking about here – in a concrete corresponding care and treatment scenario – we need to begin to make comparisons with scientific pharmacological treatments.

When certain drugs appear to have clearly identified serious side-effects including fatality, severe illness or foetal damage, they are immediately withdrawn (the list could be long and will not here be encumbered with names). It does not matter that they have cost billions to develop and it does not matter that they may have a very good and important effect for the vast majority. It does not matter that these side effects are rare, if they cannot be safely prevented by any possible method. In those cases, we consider that to be enough. Our modern legislation guarantees that we should not have such drugs. The market for that drug will fall as soon as repeated reports of these outcomes occur. The company loses its credibility and status if, when the risk is clear, it does not immediately withdraw the drug before the drug authority in every country does.

In summary, the questions asked here are necessary and sufficient, and therefore crucial, to answer concerning euthanasia – regardless of model. Do we accept that the medical sector will be required to abolish and violate the thousands of years old parameters in our social contract – between individuals, people and the social system/state – that "you/we shall not kill"? Disregarding that a few countries have introduced euthanasia, do we not in the name of health care security and basic ethics have to talk about the fundamental risk to patients that this entails?

Do we accept that a societal change should be made that involves doctors and nurses participating in something that most of us agree is not, and can never be scientific treatment? Do we accept a state-imposed measure performed on the basis of patients' supposedly well-founded requests, following an arbitrary assessment by doctors – no science for this procedure exists – resulting in the death of a patient, a fellow human being, and that the possibilities for giving proper treatment and care are extinguished – forever? When this, apart from a series of risks and consequences for our society that have not been raised here, actually means that people who would have wanted and could have been helped to live will die of "assisted death"?"

As for Sweden we can already anticipate the second phase in the debate when it becomes clear for everyone, even for the proponents – although not admitted – that some collateral damage is inevitable. But the advocates play down the issue just like the Canadian doctor Ellen Wiebe, who in a debate in The Economist Magazine confessed (Link):

”I agree that one day I may make an error in my assessment and not realise that someone has been pressured into a decision to hasten their death. And the other independent assessor might make the same error. That might mean a person would die earlier than she or he may have preferred.”

Dr Wiebe continues with a rhetoric question that clearly demonstrates how the advocates in the implemantation phase shamelessly propagate for a miserable standard for protecting people from being killed.

"Should that error be the reason hundreds or thousands suffer needlessly against their will at the end of life? I am so glad to be Canadian in 2018 and to say, “No, that is not how it is here."

The confession that she "one day may make an error" may be an understatement in the view of her extensive experience of providing about 150 assisted deaths according to another article by her published in the The Economist Magazine (Link). 

Fabian Stahle is a Swedish researcher who, last year, uncovered hidden problems with the Oregon assisted suicide model.