Euthanasia: impossible to police once legal

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Professor Theo Boer

The Irish Law Society Gazette published an article on September 26, 2023 reporting on the presentation by Professor Theo Boer to the [Irish government] Oireachtas Committee on Assisted Dying.

Dr. Boer, who is from the Netherlands, supported the Netherlands euthanasia law in the past. However, after being a euthanasia case reviewer for 9 years (2005 - 2014) he has come to the conclusion that it is impossible to police the euthanasia law. 

Boer told the Committee:

Loneliness and meaningless are constituent reasons for asking for euthanasia.

Boer gave an example of how the law could not be upheld:

He cited a Dutch case where there was a question over the legitimacy of a signature requesting euthanasia, and from which an ethics committee had to step back, because it did not hold criminal investigatory powers.

“When the doctor was asked ‘are you sure that this signature is the signature of the patient’, the doctor said ‘I was told that it was’.

“So, in the end, we backed off,” Prof Boer said.

Boer commented on the "silent pressure" of euthanasia:

“Once you have a law … it is absolutely impossible to put a police officer in every hospital room or in every bedroom … and look [for] some silent pressure,”

“That is impossible, because that will infringe very much on the privacy of their patient-doctor relationship so there is no solution,”

'Assisted dying' and how it changes society:

‘Assisted dying’ is an umbrella term for two different things that reside under one law in the Netherlands – euthanasia by which the physician uses an infusion or injection to end a patient's life at their request, and secondly a physician-assisted suicide where a medic hands a patient a deadly poison to end their own life, he explained.

In 97 out of 100 assisted deaths in the Netherlands, up from 90 out of 100 in 2002, euthanasia is preferred over assisted suicide with the number strongly rising, he said.

Euthanasia has “sky-rocketed” in the Netherlands, he said.

“The legalisation of euthanasia has done much more than just providing some citizens the liberty to take a way out,” he said.

It has created death as a remedy against "unbearable suffering", he said, and moved society from the presumption of "not killing".

Boer's criticism of euthanasia is based on what he has seen happen: euthanasia has quadrupled in twenty years and in some regions of the Netherlands, 15% - 20% of the people are dying by euthanasia.

The numbers and reasons for euthanasia have expanded in the Netherlands:

“We see a shift to patients who fear years or decades of loneliness, alienation and care dependency,” he said.

In the Netherlands, as in other countries that have legalised assisted dying, this expansion is motivated by a “logic of justice”, he said.

The option of euthanasia expands from terminal cancer patients, to those with chronic illnesses, to anyone suffering from an illness, to non-medical suffering, to legalisation for anyone over the age of 75.

Parents can now request euthanasia for their young children he said. And teens over 16 may opt for euthanasia, simply by informing their parents, but without asking their consent.

The legalisation of euthanasia has altered the whole landscape of dying including the societal view of illness, suffering, ageing, and care dependency,

Psychiatric euthanasia, the grey areas in the law, and legalized euthanasia have not resulted in fewer violent suicides:

A Dutch voluntary society runs an end-of-life clinic that will perform euthanasia without any prior patient-doctor relationship, he said, particularly in psychiatric cases.

There is also a ‘grey zone’ sub section where physicians would describe their own actions as termination of life but do not report it, which accounts for 1500 cases yearly.

Societal pressure, because of positive media reporting about euthanasia, also drives the figures up, he said.

“It is what I call internalised pressure,” the academic said, because the existence of legalised euthanasia impacts those who don't want to feel they are a burden on family or society.

Legalised euthanasia has also not lowered violent suicide rates, which have in fact soared by 35%, he said, far higher than in neighbouring Germany which does not permit euthanasia.

Links to previous articles from Professor Theo Boer:

• Let's not romanticise the Dutch euthanasia experiment (Link).
• Be careful what you wish for when you legalize active killing (Link).
• Legalizing assisted dying can actually increase suicides (Link).
• Rushing toward death: Euthanasia in the Netherlands (Link).
• Dutch ethicist, "Assisted suicide: Don't go there" (Link).