Has euthanasia gone too far?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Christopher de Bellaigue in his comprehensive article published on January 18 in the Guardian asks the question: Has euthanasia gone too far?

de Bellaigue, (the author) examines the experience with euthanasia in the Netherlands, by interviewing supporters and critics of euthanasia. The author outlines how euthanasia was originally promoted as a response to exceptional circumstances and is now being considered for people who think their life is "complete." He writes:

As the world’s pioneer, the Netherlands has also discovered that although legalising euthanasia might resolve one ethical conundrum, it opens a can of others – most importantly, where the limits of the practice should be drawn.

The author interviews Theo Boer, who he calls the most prominent skeptic. Boer who was a member of a regional euthanasia review committee from 2005 - 14, says to interested inquiries:

“when I’m showing the statistics to people in Portugal or Iceland or wherever, I say: ‘Look closely at the Netherlands because this is where your country may be 20 years from now.’”

Theo Boer

Boer tells states:

“The process of bringing in euthanasia legislation began with a desire to deal with the most heartbreaking cases – really terrible forms of death,” 

“But there have been important changes in the way the law is applied. We have put in motion something that we have now discovered has more consequences than we ever imagined.” 

The author also interviews Bert Keizer, one of 60 doctors who work with the Levenseindekliniek (End of Life Clinic), which was responsible for 750 euthanasia deaths in 2017. Keizer, did his first euthanasia in 1984, when euthanasia was still illegal in the Netherlands. Keizer was not prosecuted.

Keizer states that the patient that he euthanized in 1984 was not in pain but he was experiencing symptoms indicating that he was nearing death. Keizer consider euthanasia as a new era and he believes that euthanasia prevents suicide.

The author explains how euthanasia was normalized:

As people got used to the new law, the number of Dutch people being euthanised began to rise sharply, from under 2,000 in 2007 to almost 6,600 in 2017. (Around the same number are estimated to have had their euthanasia request turned down as not conforming with the legal requirements.) Also in 2017, some 1,900 Dutch people killed themselves, while the number of people who died under palliative sedation – in theory, succumbing to their illness while cocooned from physical discomfort, but in practice often dying of dehydration while unconscious – hit an astonishing 32,000. Altogether, well over a quarter of all deaths in 2017 in the Netherlands were induced.

The author then explains why the number of euthanasia deaths increased quickly.

One of the reasons why euthanasia became more common after 2007 is that the range of conditions considered eligible expanded, while the definition of “unbearable suffering” that is central to the law was also loosened. At the same time, murmurs of apprehension began to be heard, which, even in the marvelously decorous chamber of Dutch public debate, have Concerns center on two issues with strong relevance to euthanasia: dementia and autonomy.

Euthanasia for the incompetent.

Berna Van Baarsen

The author continues by discussing euthanasia for people with dementia. The article explains that last January Berna Van Baarsen resigned from a euthanasia review board based on the growing number of people with dementia who are being euthanised on the basis of a written directive that they are unable to confirm Van Baarsen told the Trouw paper that

“It is fundamentally impossible to establish that the patient is suffering unbearably, because he can no longer explain it.”.

Since then a Dutch doctor has been prosecuted in a case of a woman with dementia who had previously requested euthanasia but at the time of the euthanasia she refused. The doctor put sedation in her coffee and then when she continued to resist the family held her down as the doctor injected her.

Patients demand euthanasia.

Patients have gone from requesting euthanasia to demanding euthanasia leading to some doctors refusing to do euthanasia. Theo Boer shared a story of a physician friend who has stopped doing euthanasia. Boer explains

“In the coldest weeks of last winter, a doctor friend of mine was told by an elderly patient: ‘I demand to have euthanasia this week – you promised.’ The doctor replied: ‘It’s -15C outside. Take a bottle of whisky and sit in your garden and we will find you tomorrow, because I cannot accept that you make me responsible for your own suicide.’ The doctor in question, Boer said, used to perform euthanasia on around three people a year. He has now stopped altogether.

Boer is also concerned about the effects that euthanasia has on the physicians. Boer stated:

“When you euthanise a final-stage cancer patient, you know that even if your decision is problematic, that person would have died anyway. But when that person might have lived decades, what is always in your mind is that they might have found a new balance in their life.”

Steven Pleiter

The author attended a conference organized by the NVVE on psychiatric euthanasia where he had the opportunity to speak with Steven Pleiter, the director of the Levenseindekliniek. Pleiter explains that his goal is to create a "shift in the mindset" about euthanasia. The author explains:

Pleiter said he hoped that in the future doctors will feel more confident accommodating demands for “the most complex varieties of euthanasia, like psychiatric illnesses and dementia” – not through a change in the law, he added, but through a kind of “acceptance … that grows and grows over the years”.

Pleiter clearly adds grease to the slippery slope. Pleiter believes that it is unethical for a doctor not to participate in euthanasia.

Pleiter then says that after opening the euthanasia clinic (Levenseindekliniek) that he negotiated with the insurance companies who agreed to pay the clinic 3000 euro per death, including the same payment if the patient changes his mind. When the author asks Pleiter if it is cheaper to do euthanasia rather than care for the person until they die Pleiter responds:

“This isn’t about money … it’s about empathy, ethics, compassion.” And he restated the credo that animates right-to-die movements everywhere: ‘I strongly believe there is no need for suffering.’

The author continues his investigation by recognizing that not all euthanasia deaths are "ideal" and collateral damage does exist. The author writes:

This legal nicety would become painfully significant to a middle-aged motorcycle salesman from Zwolle called Marc Veld. In the spring of last year, he began to suspect that his mother, Marijke, was planning to be euthanised, but he never got the opportunity to explain to her doctor why, in his view, her suffering was neither unbearable nor impossible to alleviate. On 9 June, the doctor phoned him and said: “I’m sorry, your mother passed away half an hour ago.”

Marc explains that his mother was not terminally ill but depressed. Since his mother wanted euthanasia she made complaints about her health and slumped over when speaking to her physician. Some people suggest that it was none of Marc's concern that his mother died by euthanasia. 

Theo Boer confirms the concern about euthanasia for depression. The author writes:

During his time on the review board, Theo Boer came across several cases in which the “death wish preceded the physical illness … some patients are happy to be able to ask for euthanasia on the basis of a physical reason, while the real reason is deeper”.

The author interviews a physician whose patient die by euthanasia without consent. The patient, who had dementia, had requested euthanasia will still competent. The patient had now changed his mind about euthanasia, but his wife strongly supported euthanasia. The man's wife exclaimed:

“If only he had the courage! Coward!”

When the doctor went on vacation, her colleague, who strongly supports euthanasia, lethally injected this patient. The doctor, who is now planning to move her practice, stated:

“How can I stay here?” 

“I am a doctor and yet I can’t guarantee the safety of my most vulnerable patients.”

The author completes his article by discussing the Netherlands debate concerning the "completed life pill" once known as the last will pill.

The concept of the "completed life" is that medical criteria would not be necessary to receive a lethal prescription only the desire to end one's life.

The author writes that some physicians support this idea because it frees them from euthanizing their patients and enables the patient to do it themselves. The reality is that most people would rather have the physician lethally inject them than the person take the lethal mixture themselves.

de Bellaigue does an excellent job of explaining the support for euthanasia while uncovering the concerns with euthanasia. Since de Bellaigue has received funding to research euthanasia it is likely that he will continue to write articles on this topic. I hope that his future articles will continue in this engaging style.