The true scale of demand for euthanasia in Canada (Who really wants to die? : Part IV)

This is the fourth in a series of articles by Gordon Friesen.

• Who really wants to die? Part 1: A brief quantative analysis of the purported "need" for euthanasia (Link).
• Who really wants to die? Part 2: The popular impact of celebrity suicide (Link).
• Who really wants to die? Part 3: Life choices of the common person (Link). 

Gordon Friesen

By: Gordon Friesen
http://www.euthanasiediscussion.net/

 -- What is really at stake here ?

Faced with the complete up-ending of the Canadian medical industry which has been forced upon us by the unprecedented legislative redefinition of medicalized suicide, as benign “care” – and presented, in fact, as a universal right;

Faced with the resulting obligatory and omnipresent intrusion of this practice into every corner of our public healthcare system;

Faced with a duty imposed upon every doctor to inform each eligible patient of their “right” to die by euthanasia (whether said doctor believes the procedure to be appropriate in a particular case or no, and notwithstanding the negative burden of inflicting such informational aggression upon those typical patients who have demonstrated no autonomous desire to be euthanized);

Faced, moreover, with an actual obligation (duty) to perform the act of euthanasia (when requested by an eligible patient) which can only be avoided by the affirmation of an “objection of conscience” founded in “deeply held” (ie, religious) beliefs;

Considering, that this exemption explicitly excludes the invocation of professional, medical, or scientific motives of refusal (because the legislative definition of euthanasia, as benign care, automatically denies any such pretension);

Considering, also, that even in the event that a physician exercises this restrictive “privilege of conscience” (to refuse to perform a specific euthanasia contrary to his or her best professional judgement), that such doctor must STILL collaborate, to the extent of providing an “effective” referral to a more willing colleague;

Faced, then, with all of these extraordinary circumstances, and with the extraordinary burdens they place upon the typical non-homicidal doctor (and the typical non-suicidal patient): We would, I believe, be entitled to expect the demonstration of an overwhelming patient demand for this service; entitled to expect, that is, that the ill and the disabled would accept this proffered clinical death, in near-unanimous fashion.

But such is simply not the case.

As a matter of fact, the true figures which represent the real choices statistically embraced by actual patients facing the prospect of medical “aid” in dying, diverge to an astonishing degree from the officially sanctioned narrative to which we have become so accustomed in recent years. May the reader be the judge.

The instructive cases of Belgium and the Netherlands

Let us stipulate, to begin with, that it would be little enlightening to begin this analysis in the Canadian context, because the arrival of euthanasia practice, in this country, is still too recent to permit accurate forecasting of future trends. Luckily, however, we do dispose of a large body of data -- much more informative – originating from two countries (and immediate neighbors), Belgium and the Netherlands, which are fairly similar to Canada culturally and economically, and which have now encouraged the practice of legal euthanasia for nearly twenty years.

Without any doubt, as concerns Europe (and perhaps the world), it is the Dutch, along with their cultural-ethnic Flemish cousins (living just across the Belgian border), who have shown the greatest enthusiasm for euthanasia. And much more, to be precise, than even their immediate Franco-Belgian (Walloon) neighbors. In fact, prior to the arrival of Canada (and the deliberately radical “Canadian model”) the systematic insistence of the Netherlands, and Belgium, on true euthanasia (rather than mere assisted suicide) represented a sort of singularity among nations permitting different forms of assisted death. The least we can say, however, is that our policy and attitudes, in Canada, were strongly influenced by the Dutch experience and intended, even, as an extension thereof.

Nothing but the facts...

Naturally, in the reporting of statistics, there is a journalistic tendency to deliberately present figures under their most dramatic aspect. And in the present case, the desire for journalistic hyperbole was further aided by a perception, on the part of both adversaries and promoters of euthanasia in Canada, that their respective causes would be assisted by the most extreme possible interpretations of Belgian euthanasia growth rates.

And objectively, also, we must admit that both were correct. For those who believe that even one act of euthanasia is wrong (categorically or medically) will also consider ever greater numbers, of euthanasia deaths, to be ever that much more wrong. And therefore, reference to rising death counts is a certain way of generating increased and continued outrage among those of us who share the required ethical reference points.

But on the other side, for the promoters of euthanasia -- for those who would wish to espouse a contrary moral position: a rapid expansion of recently legalized euthanasia practice, in Belgium, would seem to indicate a strong and growing demand. And this, they believed, would support the pretension that legalized euthanasia is a necessary service -- desired and desirable -- rationally provided in response.

The growth and stabilization of euthanasia rates in Belgium and the Netherlands

To take a particularly egregious example, journalistic reports in 2018 still made generous reference to the fact that the yearly number of Belgian euthanasia deaths had increased tenfold in the first 15 years of legality (up to and including 2017). Certainly, that does seem like prodigious growth! However, a more prudent analysis would remind us that ten times nothing remains nothing still, or in this case: that ten times 0.2% (of all deaths in Belgium) became only 2.2% at the end of that 15 year period.

Now it is true, that 2.2% of all deaths in that country would make a lot of bodies were they all brought together in one place. But it is also the property of large numbers and proportional relations that 2.2% is only a marginal fraction of the whole. And while it should, quite naturally, dismay the unconditional defenders of life, it is not a number which, I submit, should bring any comfort to the apologists of assisted death.

“But wait a minute”, some might exclaim, “at that pace of growth, the euthanasia rate would be 22% in another fifteen years, and ALL deaths would be due to euthanasia approximately 25 years out.”

Yes, of course. If we were talking about a straight-ahead exponential curve, there can be no doubt, that would indeed be so... But we are not. The greatest proportion of growth was observed in the first years, and has steadily declined thereafter, such that the Belgian rate has now been stable at the 2% level for several years. Nor is there any reason to believe that this rate will grow (unless new presently excluded client groups are subsequently granted access).

In the Netherlands, the portrait is similar. The rate of growth was slower, but the final proportion was actually much larger because of a higher starting point. To make the relation between the two countries easy to understand : after the first five years, the Belgians showed about half the Dutch number, and the two grew in lockstep thereafter, so that, as the Belgians stabilized at approximately 2 % of all deaths being due to euthanasia, so the Dutch number plateaued at 4% or a little more.

“And that”, as they say, “is that !” : 96 % of all Dutch deaths are NOT euthanasia ; 98 % of Belgian deaths are the same ; and barring changes in euthanasia policy in those countries, these numbers may be expected to remain constant. 

I recognize that several studies have indicated a large number of un-reported euthanasia deaths in Belgium and the Netherlands, nonetheless, the same issue with under-reporting may exist in Canada.

A return to the Canadian experience

My point here, with regards to the Canadian experience, is the following: Our policy was formed in the initial years of Belgian legalization when the numbers were soaring. In the minds of Canadian euthanasia enthusiasts, at that time, it seemed giddily clear that we would be required to prepare for a veritable tidal wave of euthanasia demand, from the very moment that the floodgates of legislation were broached. In fact, Canadian policy was obviously designed to maximize euthanasia supply, as an “improvement” on the framework of our European cousins, and intended to remove certain “barriers” denounced by their most radical practitioners, in a progressive display of legislative “leap frog”.

However, as we have seen, all of this was based merely upon fanciful statistical interpretation, similar to that of the eager stock broker who is willing to blindly follow the projected rising curve of his holdings, all the way out of his 50th floor window. Moreover, the error is not blameless. Because euthanasia was legalized in Belgium in 2002, but the Quebec law (Bill 52) was only passed in 2014, Carter vs Canada was rendered 2015, and the Canadian law (c-14) passed as late as 2016. By the first of those dates the Dutch-Belgian growth curve was clearly “flattening”, and by the last, that curve already appeared stable. Unfortunately, however, it now appears that the Canadian judicial-legislative juggernaut was decisively in movement at that time, and impossible to stop, even if there were no underlying data (in 2016) to support the extreme implementation of euthanasia that was finally embraced.

Canada by the numbers

If we look now at the little we do know of Canadian trends, after three full years of legality, we see the following proportions of euthanasia as a fraction of all deaths in Canada: 2016, 0.38 %; 2017, 0.99 %; 2018, 1.49%; 2019, 2.0%

Clearly, even though the data is scant, we already seem to notice, here, the same pattern as that observed in the Netherlands and in Belgium. The rate of the second year is more than twice that of the first, but the third year is only half again that of the second. Apparently, the curve is flattening in Canada as well.

Belgium. we remember, began at 0.2% and stabilized at 2.2%. Netherlands began at 1.5% and stabilized at 4.2%. Canada began at 0.38% and has now arrived at 2% after four years. What could be more natural than to speculate on a final stabilization, somewhere between our two overseas companions, in the 2% to 4% range?

And if that is the case, what conclusion can we draw concerning current Canadian policy?

A sad portrait of quantitative over-reach

The opening paragraph of this piece consisted of what I believe to be a very substantial list of negative consequences stemming from the definition of euthanasia as basic medical care, and from the formal state promise of universal accessibility that accompanied it. This policy stands in stark contrast to that of a country like Switzerland which, by comparison, only permits assisted suicide and makes no formal declaration on the medical ethics of that practice. Our policy, obviously, is based on the projected satisfaction of a much greater patient demand than that imagined by the Swiss. But, once again: on what evidence is such a demand postulated?

It is simply not rational, I would submit, for our entire traditional practice of medicine to have been turned upside down in this way, on the basis of a maximum client demand evaluated only at something between 2 and 4 percent. Nor can that life-centered medical care, which is required, and desired, by 96% (to 98%) of patients, be rationally fragilized in such an uncompromising, obsessive resolve, to maximize the access and recourse to euthanasia. Clearly, as the expression goes: “Mistakes were made...”.

Terrible mistakes, in fact, that must now be rectified.

Gordon Friesen is a member of the Euthanasia Prevention Coalition board.