Henk Reitsema |
Campaigners plan a new move to legalise assisted suicide in Scotland this year. The Netherlands, which legalised euthanasia in 2001, should offer a cautionary tale. My country expected a fall in backdoor euthanasia and the stopping of incremental extension by pinning down the definitions in law. But 20 years later it is clear we were profoundly mistaken.
There has been a massive greying of the lines, with a significant increase in life-shortening treatments that are not being called euthanasia. The term “unbearable suffering” has been expanded from physical suffering to include psychological and existential suffering — now even the term “tired of life” is sufficient. We have also seen the restrictions on age and mental competency shift.
The debate started in response to the many life-lengthening medicines that were being developed in the late 1960s. Rather than debate the medical imperative of treating patients one could not heal, professionals started taking matters into their own hands, with the first court case taking place in 1973 when a nurse killed her mother with a morphine overdose. Though the nurse got a one-week suspended sentence, more importantly the courts stipulated which procedures they would have wanted to have seen met in this case. This opened the door to legalisation in 2001.
Initially, it looked like reform had slowed down the euthanasia rate. From 2001 to 2005 numbers dropped from 3,500 to 2,300. Subsequently they started to rise again and are now at roughly 6,500 cases a year. This is more than 4 per cent of all deaths in any given year.
Once active killing by physicians was legalised, their attitudes towards pain treatments that shortened life changed. Palliative sedations, in which a patient is sedated for the final phase of life without hydration or food, rose from 5.6 per cent of all deaths in 2001 to 8.2 per cent in 2005. Now roughly 25 per cent of all deaths take place under these circumstances.
Since legalisation, the incentive to improve palliation has diminished and euthanasia has gone from being an exceptional situation to becoming the norm, with people who feel they are a “burden” to their next of kin requesting to end their lives even when they do not really want it.
When euthanasia is ever more frequently used, the tendency is then to move in the direction of euthanising those who are not able to request it owing to dementia or other incapacity. Paradoxically, that which was supposed to provide autonomy could lead to the ultimate loss of autonomy.
Reitsema started opposing euthanasia after his grand father was killed without request or consent.
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