The Covid-19 crisis has led to more cultural loneliness. Have you called your mom today?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

I have published several articles about the epidemic of loneliness and isolation and how it effects the physical and psychological health of people. Loneliness and isolation also leads to requests for assisted death.

• Loneliness is an epidemic among seniors that requires a caring response. 
• Loneliness is an epidemic that can be detrimental to your health.  
• Being with others cures the epidemic of loneliness.  
• Suicide epidemic exacerbated by loneliness.

A British study found that 22% of seniors, over the age of 65 will talk to only three or fewer people per week. A September 7, 2019 article in studyfinds.org reported:

According to the survey of 1,896 seniors over 65 in the United Kingdom, more than one in five (22%) will have a conversation with no more than just three people over the span of an entire week! That translates to nearly 2.6 million elderly folks who don’t enjoy regular human contact on a daily basis. Perhaps most alarming though is researchers say an alarming 225,000 individuals will go a week without talking to anyone face-to-face.

We can reduce the scourge of suicide and the cultural abandonment associated with assisted death, by caring for and being with others at their time of need. It is essential that people who feel that their life lacks value or purpose, or feel that no one cares, is offered purpose, support and genuine hope from their significant community.

The Covid-19 crisis and social distancing has led to more loneliness and social isolation.

One answer is to call your friends and family. A call to your family and friends can make a difference. Some families are communicating by video over the internet. This is an excellent way to communicate with others.

Your call may be the only call that your mother receives today.

Belgium euthanasia death linked to loneliness.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Brecht Paumen, who was paralyzed for 12 years after a swimming pool accident, died by euthanasia in Belgium last Friday.

The Belgian media emphasize his disability and his pain, but a closer read of the story links his death to loneliness and isolation.

An article by Marco Mariotti that was published by HLN quotes Paumen's mother as saying (google translated):

“For four years he lived alone in As. He hoped that friends would come to visit him that way. But unfortunately that did not happen. The home nurse, all adapted devices, you name it. Only the loneliness can hardly cope when the environment drops out. We suggested coming home again, but he refused. And he felt a burden to his parents. Often humiliating circumstances. Then he cried so often. "

In the past year he was trying to regain his ability to walk with assistance, but the article states that he had a set-back in November and December.

Studies show that people who are depressed, lonely or experiencing feelings of hopelessness are far more likely to ask for euthanasia.

A Netherlands study by Marije L van der Lee, et al, found that people who were depressed or had “feelings of hopelessness” were 4.1 times more likely to request euthanasia. This study was significant since van der Lee supported euthanasia and her hypothesis stated: “their clinical impression was that requests for euthanasia were based on well-considered decisions and not depression in the Netherlands.”

In other words, van der Lee was trying to prove that depression was not connected to requests for euthanasia but instead proved that the opposite is true.

In 2011, the Dutch Medical Association (KNMG) stated that euthanasia for loneliness, depression, disability and dementia were possible. 

A few years ago the Netherlands euthanasia clinic was reprimanded for lethally injecting a woman because she didn't want to live in a nursing home.

This sad story brings up two key points.

1. It was normal for Paumen to feel lonely and a loss of purpose. Even if you support euthanasia, loneliness should not be a reason for death by lethal injection.

2. The attitude towards euthanasia of people with disabilities is paternalistic. The article refers to his death as "redeeming" and his mother is quoted as saying that she is "relieved" for her son. I am not suggesting that his mother didn't love him, but Paumen needed support not pity.

Paumen's death is tragic, but once killing becomes an acceptable solution to human difficulties then the clear line has been crossed.

Paumen needed human friendship and support not death, but death is what he received.

Loneliness is an epidemic among seniors that requires a caring response.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Loneliness is an important topic because all of us are affected by loneliness while seniors and people with disabilities have greater issues with loneliness because they often have issues with their health mobility.

I am concerned about cultural loneliness because lonely and depressed people are more likely to die by suicide, assisted suicide or euthanasia.

• Depression and assisted suicide in Oregon.

The Grand Island Independent published an editorial: Loneliness an epidemic among seniors that provides some practical advice. The editorial states:

According to the U.S. Census Bureau, 12.5 million older adults live in one-person households, representing 28 percent of people age 65 or older. The National Poll on Healthy Aging reported earlier this year that 1 in 3 senior citizens suffer from loneliness. 

“Research shows that chronic loneliness can impact older adults’ memory, physical well-being, mental health and life expectancy,” write the authors of the report sponsored by AARP. “In fact, some research suggests that chronic loneliness may shorten life expectancy even more than being overweight or sedentary, and just as much as smoking.” 

More than a third of seniors in the poll said they felt a lack of companionship at least some of the time. Almost 30 percent said they socialized with friends, family or neighbors once a week or less.

The editorial offers some practical advice:

Those of us who live near elderly people also can help out with tasks such as clearing snow from sidewalks and carrying groceries in from the car. Then, at the same time, we can just stop in to say hi and spend some time talking. 

It’s important that we all look for ways to make connections with the people who have been so important to our communities in the past, but now may be struggling with the effects of aging and becoming more isolated. There is great value in their life experiences and we all can continue to contribute well into our 80s and 90s...

A very practical response is to visit people who are socially isolated due to their health or age related conditions.

The Compassionate Community Care (CCC) program has a Training Program for visiting people who are lonely and isolated.

CCC also exists to provide advice and direction concerning health issues related to end-of-life and euthanasia prevention as well as train volunteers to visit lonely and isolated people. Contact CCC at: 1-855-675-8749.

More articles on loneliness and depression

• Loneliness is devastating to your physical or mental health.
• Being with others cures the epidemic of loneliness.
• Suicide epidemic exacerbated by loneliness.

Loneliness is devastating to your physical and mental health

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

New research indicates that loneliness and isolation are devastating to your physical and mental health.

An article by Jack Rear that was published in the Telegraph on November 5, 2019 reports on a year-long study at Copenhagen University examining the health outcomes for 13,443 people who had a heart attack. Rear reports that:

The study found that women who described themselves as lonely were three times more likely to die within a year of the attack than those with an active social life; and men in the same position were twice as likely to die within a year.

In addition, patients who were lonely were also three times more likely to be anxious, depressed and reported a lower quality of life.

According to Rear, the Copenhagen study is one in a series of studies showing how loneliness and isolation are a deadly combination for your health:

The Copenhagen study is the latest in a long line of scientific work that substantiates the negative effect loneliness has on human health. For example, one study found that the health effects of loneliness are comparable to smoking or obesity, increasing the risk of death by 26pc. There might be multiple reasons for this, but the cause is thought to be increased inflammation of the body associated with stress, which can damage immune function.

Other studies have linked loneliness with an increased risk of developing coronary heart disease, stroke, high blood pressure, and an increased onset of physical disability.

Loneliness and depression cause some people to request euthanasia, when they are experiencing physical and/or psychological distress.

A British study found that 22% of seniors, over the age of 65 will talk to only three or fewer people per week. A September 7, 2019 article in studyfinds.org reported:

According to the survey of 1,896 seniors over 65 in the United Kingdom, more than one in five (22%) will have a conversation with no more than just three people over the span of an entire week! That translates to nearly 2.6 million elderly folks who don’t enjoy regular human contact on a daily basis. Perhaps most alarming though is researchers say an alarming 225,000 individuals will go a week without talking to anyone face-to-face.

Now that euthanasia is legal in Canada, people who care about others need to recognize the importance of being with people who are lonely and socially isolated.

The Compassionate Community Care  (CCC) program has also developed a training program for visiting people who are lonely and isolated.

CCC also exists to provide advice and direction concerning health issues related to end-of-life and euthanasia prevention as well as train volunteers to visit lonely and isolated people.

Contact CCC at: 1-855-675-8749.

More articles on loneliness and depression

• Loneliness is an epidemic that can be detrimental to your health.
• Being with others cures the epidemic of loneliness.
• Suicide epidemic exacerbated by loneliness.

Being with others cures the epidemic of loneliness.

This article was published by OneNewsNow on Oct 15, 2019.

Studies now provide a reason for siblings to stay in touch with one another and their parents as they grow older.

Loneliness is an epidemic that is detrimental to your health.

Alex Schadenberg

Alex Schadenberg of the Euthanasia Prevention Coalition cites a recent study from London to say research on loneliness shows it leads to potentially serious problems.

"22 percent of people in the U.K., in England, Scotland, and Wales, who are over the age of 65 do not speak to more than three people in a week,” he relays. "And many of those people never speak to anybody in a week, so you have this situation of an epidemic of loneliness."

The data also shows the link between health problems and loneliness and isolation. In fact, it is even worse than obesity as it affects health.

Further, a meta-analysis of 148 studies released in the past 

"concluded that a person who is experiencing social isolation, that their risk of death, an early death, is 60 percent higher,"

Schadenberg explains. 

"As for euthanasia and assisted suicide, we know by the data that quite a few people ask for euthanasia and assisted suicide because they're lonely and they feel they have no purpose for living."

With today's mobility, children as grown-ups often move elsewhere for the sake of jobs, which unfortunately makes it easier for them to become detached from family members. So Schadenberg says it is incumbent on society and on people who care about others to recognize the importance of being with others because it encourages the opposite of loneliness.

Loneliness is an epidemic that can be detrimental to your health

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Loneliness and depression causes some people to request euthanasia, when they are experiencing physical and/or psychological distress.

A recent British study found that 22% of seniors, over the age of 65 will talk to only three or fewer people per week. According to a September 7, 2019 article in studyfinds.org:

According to the survey of 1,896 seniors over 65 in the United Kingdom, more than one in five (22%) will have a conversation with no more than just three people over the span of an entire week! That translates to nearly 2.6 million elderly folks who don’t enjoy regular human contact on a daily basis. Perhaps most alarming though is researchers say an alarming 225,000 individuals will go a week without talking to anyone face-to-face.

The study indicates that a kind greeting or sharing time with others makes a difference in their lives:

About 40% of seniors say they’d feel more confident to head out each day if they knew their neighbors. Just the thought of someone stopping to chat with them brightens their outlook: 54% of respondents agree that even a short conversation with a neighbor or acquaintance would greatly improve their day overall. And a quarter of older adults say it makes them feel good when someone smiles or acknowledges them while waiting in line at places like the bank or grocery store. One in five would be thrilled if someone stopped to ask them how their day had gone.

Studyfinds.org published a commentary on August 6, 2017 on two meta-analysis studies by Dr. Julianne Holt-Lunstad, a professor of psychology at Brigham Young University that examined health issues related to loneliness and social isolation. Studyfinds.org stated about the first study:

In an analysis of 148 studies that included more than 300,000 people total, her research team found that “a greater social connection” cuts a person’s risk of early death by 50 percent. 

“Being connected to others socially is widely considered a fundamental human need — crucial to both well-being and survival. Extreme examples show infants in custodial care who lack human contact fail to thrive and often die,... “Yet an increasing portion of the U.S. population now experiences isolation regularly.”

The comment by Studyfinds.org about the second meta-analysis study states:

In her second analysis, she looked at the role that loneliness, social isolation, and living alone played in a person’s lifespan. Using 70 studies that included more than 3.4 million participants (mostly from North America, but some studies did look at people in Europe, Asia, and Australia), the research team concluded that all three were as much of — and in some cases more — a threat to a person’s health as obesity and other risk factors. 

All three conditions were found to be equally hazardous and significantly raised the risk of premature death. 

“There is robust evidence that social isolation and loneliness significantly increase risk for premature mortality, and the magnitude of the risk exceeds that of many leading health indicators,”

Now that euthanasia is legal in Canada, people who care about others need to recognize the importance of being with people who are lonely and socially isolated.

The Compassionate Community Care (CCC) program exists to provide advice and direction concerning health issues related to end-of-life and euthanasia prevention and to train volunteers to visit those who are isolated and lonely. 

Contact CCC at: 1-855-675-8749.

Kevin Dunn examines Fatal Flaws of assisted suicide laws

The following article was published by the HamiltonNews.com on July 4, 2018.

Kevin Dunn (Hague)

Kevin Dunn wants each and every one of us to be the reason for someone’s tomorrow.

The producer/director and his crew have logged over 50,000 kilometres in the past two years exploring the impact euthanasia and assisted suicide laws have on families and society.

The result is the film Fatal Flaws: Legalizing Assisted Death, produced by Dunn Media in association with the Euthanasia Prevention Coalition and co-produced by Alex Schadenberg,

• Fatal Flaws film will change the way you view assisted death.

Filming started last January with a visit to Holland for Euthanasia Week. During the five-day annual event organized by the Dutch Right-to-Die Society activities take place to raise awareness of “dying with dignity,” according to the World Federation of Right to Die Societies website.

Events in 2017 included a symposium for people under 40 to discuss euthanasia among youth, and a debate on “weary of life” to facilitate a dialogue among elderly people.

Dunn said wherever people stand on the issue of euthanasia and assisted suicide, it’s impossible to ignore the cultural shift in attitude.

“What was once considered murder under the law is now being accepted as medical treatment in many countries,” he said.

Fatal Flaws focuses on what Dunn calls the “under-represented viewpoint.” It features testimonies from those whose lives have been dramatically affected by a culture that sees killing as a form of caring.

Fatal Flaws debuted in Ottawa in May to an appreciative audience that included the filmmaker himself.

Dunn said he felt “a great load of responsibility” while watching his completed project appear on the screen.

“I took these very, very personal stories in four countries, and the people trusted me to tell their stories and to present them on camera in a way that does them justice and allows for meaningful discussion about the consequences of these laws over the long term.”

Take for example, said Dunn, the Netherlands, where legislation has expanded so much that the country is considering a law that would allow healthy people who feel their life is complete to die with the help of a physician.

“It’s a really crazy slippery slope, the incremental extensions of these laws all over the world,” Dunn said.

For the Ancaster resident, Fatal Flaws underscores the need for better palliative care, not only in Canada but around the world. He said pain was not cited as the number one cause for someone considering euthanasia or assisted suicide, rather, it was loneliness, depression and the fear of being a burden.

“We need to visit people and let them know they don’t have to go there,” said Dunn. “As friends and advocates, we have to be there for somebody’s tomorrow ... we need to be the reason for someone’s tomorrow.”

For more information, visit http://www.fatalflawsfilm.com/.

How Contemporary Society Promotes Elder Suicide

This article was published by National Review online on June 20, 2018

Wesley Smith

By Wesley Smith

I have worried and written about the growing normalization of elder-suicide, brought on in part — obviously, that is not the whole problem — by assisted-suicide advocacy and frequent media applause of such deaths among the elderly.

That opinion receives a peer-reviewed boost in the Journal of the American Geriatrics Society. The authors — two UCSF medical professors — warn about increasing “rational” elder suicides, by which they mean self-killing “in the absence of diagnosed psychiatric illness.”

Three forces are, in the authors’ view, contributing to this worsening phenomenon. First, “neo-liberalism. From, “Social Causes of Rational Suicide in Older Adults,” (my emphasis):

Neoliberalism changed human relationships within society from a civil sphere that enshrined a commitment to social solidarity and collaboration among fellow citizens to that of a universal market where human beings are pawns in calculations of profits and losses. Rather than emancipation and freedom, the markets created atomization and loneliness.

Second, technology and transhumanist ideology:

Technology companies, eager to “disrupt” everything from the way we drive to the way we dry clean, has declared their intention to conquer death itself by “curing aging” and “solving death.” . . . The declaration of aging as a disease, pathologizes aging as an entity to be shunned and avoided, in oneself and others. . . . 

Concerns about overly aggressive care at the end of life and of unrelenting suffering have in part fueled advocacy for PAD [physician assisted death, a.k.a. assisted suicide] with many people seeing aggressive medical interventions and unrelieved suffering at the end of life as avoidable only through premature self-inflicted death.

Many people don’t know that they have the absolute legal right to refuse such high-tech interventions.

Which brings us to assisted-suicide advocacy:

The growing acceptance of PAD and its legalization in six U.S. states and the District of Columbia plays an important role in changing attitudes toward rational suicide. An ethical concern of those opposed to PAD is the potential for the “slippery slope” whereby legalization of PAD and greater acceptance of PAD as a result of that legalization initiates a trend in social perceptions toward acceptance of rational suicide, something that was previously ethically unacceptable. We believe that the legalization and increasing acceptance of PAD was a necessary societal precursor to the rationalization of suicide in older adults.

The authors reach a strong conclusion:

Clinicians should also feel empowered to speak up against ageism and recognize it in themselves. Acceptance of the idea of rational suicide in older adults is in itself ageist. It implicitly endorses a view that losses associated with aging result in a life that is not worth living.

Indeed.

May the authors’ strong warning in a very respected professional journal be the vanguard of desperately needed focused push-back at the professional level against our metastasizing culture of death.

Suicide epidemic exacerbated by cultural loneliness.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The suicide epidemic is once again in the news possibly due to the celebrity suicide deaths of Anthony Bourdain, Kate Spade, and others. There have been many articles published on what may be causing the significant increase in suicide deaths.

The latest research from the Center for Disease Control indicates that between 1999 and 2016, the suicide rate in America increased in every state (except Nevada). Suicide deaths have increased by a staggering 30% in America where in 2016 alone, 45,000 people died by suicide.

After reading many articles and studies on the scourge of suicide, I am further convinced that the causes of suicide are the same or similar reasons why people ask for assisted suicide. Based on their feelings of hopelessness and despair, they feel like they have no other choice.

An article by Ross Douthat in the New York Times Sunday Review (May 18, 2013) concerning loneliness and suicide states:

Right now, the pessimistic scenario seems more plausible. In an essay for The New Republic about the consequences of loneliness for public health, Judith Shulevitz reports that one in three Americans over 45 identifies as chronically lonely, up from just one in five a decade ago. “With baby boomers reaching retirement age at a rate of 10,000 a day,” she notes, “the number of lonely Americans will surely spike.”

The same concerns were expressed by Ben Domenech in an article published in the Federalist (June 11) in commenting about the tragic death of Anthony Bourdain. Domenech states:

The answer is almost assuredly loneliness and depression – both of which Bourdain has talked about in multiple interviews over the years, and since his divorce. Listening to his conversations over the weekend with Marc Maron and David Remnick, it’s barely under the surface of his conversations – and if you’re familiar with his shows, they seem less like advocacy for an approach to life, and more like arguments with himself about the inherent goodness and beauty we can find in the world. 

The disturbing truth we have to recognize is that Bourdain is not alone in his loneliness and depression. We are experiencing an incredible increase in suicide levels according to the latest research from the CDC. From 1999 to 2016, suicide increased in every U.S. state but one (and that one is Nevada, which remains in the top ten states for suicides). It is one of the top ten causes of death and one of only three such causes on the rise. The rise is seen in every age group and across all demographics, but particularly among people who look like Bourdain: 84 percent of suicide victims are white, and roughly 77 percent are men. 

Last month, a CIGNA survey found that loneliness is epidemic, and that the youngest Americans proclaim the highest levels. “One in four Americans (27 percent) rarely or never feel as though there are people who really understand them. Two in five Americans sometimes or always feel that their relationships are not meaningful (43 percent) and that they are isolated from others (43 percent). One in five people report they rarely or never feel close to people (20 percent) or feel like there are people they can talk to (18 percent).

The pro-euthanasia "experts" claim that suicide has nothing to do with assisted suicide. The American Association of Suicidology accepted the false position of long-time assisted suicide activist Margaret Battin who wrote that suicide and assisted suicide are different acts done for different reasons. Battin is known for producing ideological studies that are not factually based. The assisted suicide lobby knows that assisted suicide becomes socially accepted when it is differentiated from suicide.

• Margaret Battin supports child euthanasia.

With 20 years of experience with the issues of euthanasia and assisted suicide I contend that the reasons people die by suicide are the same or similar reasons why people ask for assisted suicide, even when the circumstances differ.

Most people who ask for assisted suicide feel that their life lacks purpose, meaning or hope, they feel that no one cares about them or that they are a burden on others. Physical suffering rarely causes someone to seek a hastened death but loneliness, depression or feelings of hopelessness are primary reasons.

There aren't easy answers, but I contend that a culture can reduce the scourge of suicide and the cultural abandonment associated with assisted suicide, by caring for and being with others at their time of need. It is essential that people who feel that their life lacks value or purpose, or feels that no one cares, is offered purpose, support and genuine hope from their significant community.

The answer is not only talking about it (suicide), the answer is inclusion, caring and being with others as they journey through the difficult times of their lives.

• Elderly Dutch couple. Euthanasia is not the answer.
• Suicide is a symptom of mental illness, not a cure for it.
• Dying alone, the greatest fear.
• Distinguishing between sadness and depression at the end of life.
• Study uncovers problems with euthanasia for psychiatric reasons in the Netherlands.

Elderly Dutch couple: Euthanasia is not the answer.

This article was published by OneNewsNow on October 9, 2017

Alex Schadenberg

One opponent of euthanasia is disappointed to see that the Netherlands has taken yet another step toward approving the practice for any reason.

A case in point is the recent euthanasia of 91-year-old Nic and Trees Elderhors, a couple who had been married for 61 years. The two suffered frailty typical of older people and decided to commit suicide together. Alex Schadenberg of the Euthanasia Prevention Coalition says their deaths are another indication of how off-track euthanasia has gone.

"Further, I think that this represents a whole other issue, which is the promotion in the Netherlands of the concept of completed life, meaning that somebody doesn't need to be terminally ill and dying in order to have euthanasia," Schadenberg continues. "They simply have to decide that they think their life has been completed, however you might define that."

Schadenberg raises the question of what society is doing that would give elderly people the impression that death by lethal injection is better than life.

"I ask that question for a significant reason, because I think our society also has a problem with how it treats people who are getting elderly," he poses. "I find there's far too much loneliness and depression within our culture."

He suggests one solution to that is to change the culture.

Schadenberg adds that another problem is how the media painted such a rosy picture of the couple holding hands as they died in order to advance euthanasia to its obvious conclusion of committing suicide at any time and for any reason.

Rushing toward death - Euthanasia in the Netherlands.

Alex Schadenberg

Executive Director - Euthanasia Prevention Coalition

I

Professor Theo Boer

n July 2014, Professor Theo Boer, who was member for nine years of a regional review committee in the Netherlands, wrote an article that was published in the Daily Mail urging the British parliament to reject assisted suicide. Boer then gave the Euthanasia Prevention Coalition permission to publish the full text of his article titled "Assisted Suicide: Don't go there."

On March 28. Professor Boer published a significant critique of the Netherlands Euthanasia law under the title: Rushing toward death?

Boer first explains how euthanasia became legal, and how the law works in the Netherlands.

In 1994 the Netherlands became the first country to legalize assisted dying. The Dutch added a clause to the Burial and Cremation Act allowing doctors to help a person die as long as the patient made an informed request and faced unbearable suffering with no prospect of improvement; a second doctor concurred in the decision; and medically advised methods were used. The clause was further codified by the Assisted Dying Act in 2001. Belgium followed suit with similar legislation in 2002. 

In the Netherlands, five regional review committees, each consisting of a lawyer, a physician, and an ethicist, were charged with keeping an eye on the practice and assessing (after the fact) whether a case of assisted dying complied with the law. 

Two forms of assisted dying are legally practiced: euthanasia, in which the action of the physician causes death, and physician-assisted suicide, in which a physician provides the patient with a lethal drink administered by the patient. The overwhelming majority of patients who make use of the law (95 percent) choose euthanasia.

Boer then explains why he originally supported the Netherlands euthanasia law.

Although I was skeptical about this legislation at the beginning, I could and can imagine the exceptional case of killing a patient when nothing else can ease unbearable suffering. ... It was and is my conviction that some form of legalization of assisted dying may be needed when public support reaches a certain level. This is a matter of democratic respect. This is why I agreed to join one of the review committees 11 years ago. 

From 2005 to 2014, I reviewed close to 4,000 cases of assisted dying on behalf of the Netherlands’ Ministries of Health and of Justice. Almost all of them met the legal criteria; only a handful of them were sent on to the public prosecutor. I was impressed by the heartbreaking situations in which many patients found themselves at the end of a deadly disease. I had no doubt as to the professional and personal integrity of the physicians involved. Assisted dying was hardly ever administered lightly; in fact, most physicians needed time to prepare themselves for this intense decision, and afterward many of them needed time off to recover. 

For a decade and a half this system seemed to provide a means to stabilize the number of cases and prevent the expansion of grounds for seeking assisted dying. We told delegations from abroad that the Dutch solution was robust and humane. As recently as in 2011 I assured a European ecumenical audience that the Dutch system was a model worth considering.

Boer explains that in 2007, the practise of euthanasia started changing.

But that conclusion has become harder and harder for me to support. For no apparent reason, beginning in 2007, the numbers of assisted dying cases started going up by 15 percent each year. In 2014 the number of cases stood at 5,306, nearly three times the 2002 figure. 

With overall mortality numbers remaining level, this means that today one in 25 deaths in the Netherlands is the consequence of assisted dying. On top of these voluntary deaths there are about 300 nonvoluntary deaths (where the patient is not judged competent) annually. These are cases of illegal killing, extracted from anonymous surveys among physicians, and therefore almost impossible to prosecute. There are also a number of palliative sedation cases—the estimate is 17,000 cases yearly, or 12 percent of all deaths—some of which may involve shortening the life of a patient considerably. Furthermore, contrary to claims made by many, the Dutch law did not bring down the number of suicides; instead suicides went up by 35 percent over the past six years. 

A shift has also taken place in the type of patients who seek assisted dying. Whereas in the first years the vast majority of patients—about 95 percent—were patients with a terminal disease who had their lives ended days or weeks before a natural death was expected, an increasing number of patients now seek assisted dying because of dementia, psychiatric illnesses, and accumulated age-related complaints. Terminal cancer now accounts for fewer than 75 percent of the cases. Many of the remaining 25 percent could have lived for months, years, or even decades. 

In some reported cases, the suffering largely consists of being old, lonely, or bereaved. For a considerable number of Dutch citizens, euthanasia is fast becoming the preferred, if not the only acceptable, mode of dying for cancer patients. Although the law treats assisted dying as an exception, public opinion is beginning to interpret it as a right, with a corresponding duty for doctors to become involved in these deaths. A law now in draft form would oblige doctors who refuse to administer euthanasia to refer their patients to a willing colleague.

Boer then explains the influence of the Dutch euthanasia lobby (NVVE)

The Dutch Right to Die Society (NVVE), the largest of its kind in the world, offers course materials to high schools intended to broaden support for euthanasia as a normal death. NVVE seeks to make assisted dying available to children of any age. This is a groundbreaking development, given the fact that for decades the Dutch restricted euthanasia to competent patients. NVVE also initiated the End of Life Clinic, a network of traveling euthanasia doctors who provide assisted dying for patients whose own doctors will not agree to help them. On average, the traveling doctors see a patient three times before providing an assisted death. The clinic has neither the funding nor the license to provide any form of palliative care, so it offers death or nothing. Doctors at the End of Life Clinic report that they’ve handled about 500 cases since 2012.

NVVE regards the law on assisted dying as only a step in the right direction, not as the final outcome. Why grant an assisted death only to some? they ask. Why limit it to those with a life expectancy of only six months? This same logic can be found in the arguments of the United States–based Final Exit Network, which suggests that such laws also cover those suffering from debilitating diseases that may last many years. 

As part of its campaign, NVVE distributed pillboxes containing 50 tiny peppermints. Called the Last Will Pill, the box illustrates the organization’s resolve to make a suicide pill available to anyone aged 70 and older. All of this would be unthinkable were it not for the existence of the Assisted Dying Act. Rather than halting these developments, the review committees have welcomed some of them.

Boer then examines the outcome of the cultural shift toward euthanasia.

The dramatic shift in the Dutch and Belgian approach to death was documented in the Australian film Allow Me to Die, which features the case of Simona, an 84-year-old Belgian woman (link to the film). Only minutes after receiving news of the sudden death of her daughter, Simona decides that she too wants to dies and asks her doctor to help her. After treating her unsuccessfully with an antidepressant, Simona’s doctor decides to grant her request. 

Three months after the death of her daughter, Simona eats her last breakfast and rides her last miles on her stationary bicycle. Her last words are “I am ready to meet my daughter.” Although her physician assures himself that “all is well,” the audience is left wondering: Is this dying with dignity? Is this what the Dutch and Belgian lawmakers had in mind back in the 1980s and 1990s? 

I think not. When the Dutch law was enacted, the cases in view were those of dying patients enduring extreme suffering that doctors could not relieve. The law allowed doctors to break the rules in the name of humanity. Now the question has become: Can a nation allow such an exception without people coming to question the basic rules?

Boer then examines the question of the original intention of the euthanasia law.

When assisted suicide become banal

This article was published in the CMAJ blogs on November 24, 2015

Dr Rene Leiva

By Dr Rene Leiva

I read with interest the CMAJ Editor in Chief’s latest editorial about protecting the right of physicians to conscientiously object to being party to physician hastened death. Principled medicine has dealt with suffering since Hippocratic tenets were first formulated about 2400 years ago. It is only in the last fifty years that causing death has been construed as ‘medical treatment’ for suffering, which I firmly believe to be erroneous. I’m disturbed to see that while Quebec is leading the country on euthanasia only a fraction of its population has access to palliative care. Palliative Care has been around for close to forty years, but Quebec's new law on ‘medical aid in dying’ expects to make that option available to 100 per cent of Quebecers in a matter of months.

In Belgium, hastened death has become part of the culture: despite having initially focused on the competent adult who is terminally ill, it has quickly moved into euthanasia for mental suffering and dementia, and for those tired of living, as well as children; it is commonly practiced by other health professionals such as nurses despite this being illegal. Medically assisted deaths have risen by 640% in Belgium since the law was adopted in 2002 and there are a significant number of deaths without consent as well as under reporting.

When I first met Tom Mortier through mutual acquaintances, he impressed upon me his concerns about the dangers of living in a society that embraces hastened death and shared the sad and tragic account of his mother’s euthanasia under the Belgian law. Her story was the focus of a recent article in the New Yorker and part of an Australian TV documentary. He often forwards me information on euthanasia cases and events that in a different culture or time would have been unthinkable: from the doctor who euthanized his mother leading an ‘educational trip’ to the Nazi camp Auschwitz to leaders in the field celebrating euthanasia as having ‘a life-intensifying and sacred dimension’.

Not all the founders of the hastened death movement have remained convinced they were doing the right thing. Ann Humphry, the late co-founder of the Hemlock Society, now Compassion and Choices, deeply regretted her actions. She was concerned that sick and vulnerable people might feel subtle pressures to relieve their families and friends of the emotional burdens of their lingering death. Is this unrealistic? Last year, a Canadian woman committed suicide while promoting the legalization of hastened death. Part of her manifesto stated that ‘I can live or vegetate for perhaps ten years in hospital at Canada’s expense, costing anywhere from $50,000 to $75,000 per year,” she said. “Nurses, who thought they were embarked on a career that had great meaning, find themselves perpetually changing my diapers and reporting on the physical changes of an empty husk. It is ludicrous, wasteful and unfair”. Is this the message we want to communicate about the value of our parents’ and grandparents’ lives as the end approaches?

Fittingly, it was a Belgian doctor and Nazi death camp survivor who was instrumental in developing the World Medical Association position against euthanasia. He felt very strongly that ‘the natural duty of the physician is first to protect life and not to kill the patient. The main task of the doctor is to help his patient in defending his interest not only against the disease but also against any dangerous competition between the interests of the community of healthy people or society, even the family sometimes, and those of the patient’.

I, too, believe that behind the fears of existential suffering or of becoming a burden to loved ones, or feelings of hopelessness and worthlessness, there is a call for help to find meaning even in the midst of such suffering. When death seems to be the answer, we as human beings have abdicated the opportunity to go beyond our limitations, to try harder, and to offer hope to these people. To agree with patients’ requests for assisted suicide is to confirm their feeling that their life is without value. Under these overwhelming fears, a free chosen decision for hastened death is an illusion.

Dutch Health Minister calls for tighter euthanasia guidelines

By Alex Schadenberg
International Chair - Euthanasia Prevention Coalition

Edith Schippers

Dutch Health Minister, Edith Schippers, reacted to comments by Professor Theo Boer by calling for tighter guidelines for euthanasia. Boer, an ethicist who was a member of a Euthanasia Review Committee for 9 years and oversaw more than 4000 euthanasia cases in the Netherlands.

Recently Boer wrote an article calling for reform of the Dutch euthanasia law. Boer stated that euthanasia is being granted to people who have years to live. 

The media reported that Schippers is calling for tighter guidelines on euthanasia. The article stated:

Minister Schippers wants a geriatrician to be always involved in euthanasia of people with dementia and in the case of psychiatric patients a psychiatrist must always play a role. The latter often happens in practice though, but it should be according to Schippers clearly laid down in guidelines.

Schipper also wants: 

 a second specialist to always be involved in complex euthanasia cases.

Theo Boer

Last July Boer wrote an article opposing euthanasia where he stated:

I used to be a supporter of euthanasia. But now, with twelve years of experience, I take a different view.

Boer argued that the number of euthanasia deaths, and the reasons for euthanasia have greatly expanded since the introduction of the euthanasia law in 2002. Boer stated that:

"Cases have been reported in which a large part of the suffering of those given euthanasia or assisted suicide consisted in being aged, lonely or bereaved. 

Whereas the law sees assisted suicide and euthanasia as an exception, public opinion is shifting towards considering them rights, with corresponding duties on doctors to act. 

Pressure on doctors to conform to patients’ (or in some cases relatives’) wishes can be intense. Pressure from relatives... is in some cases an important factor behind a euthanasia request."

Links to similar articles:

• Theo Boer: Assisted Suicide - Don't Go There.
• What happens when euthanasia becomes legal.
• Netherlands 2013 euthanasia report.
• Dutch euthanasia clinic lethally injects woman who didn't want to live in a nursing home.

Netherland 2013 euthanasia report - 15% increase, euthanasia for psychiatric problems and dementia.

By Alex Schadenberg
International Chair - Euthanasia Prevention Coalition.

The 2013 Netherlands euthanasia report was released today indicating a 15% increase of reported euthanasia deaths. There were also 42 assisted deaths for people with psychiatric problems and 97 assisted deaths for people with dementia. Assisted deaths refer to euthanasia and assisted suicide.

The 2013 report indicated that there were 4829 reported assisted deaths which was up from 4188 in 2012. As bad as it is, there are also unreported assisted deaths.

Every five year the Netherlands does a meta-analysis of the euthanasia law. In 2010 the study was published in the Lancet indicated that 23% of all assisted deaths were unreported in the Netherlands, which was up from 20% in 2005 report. Since the under-reporting of euthanasia in the Netherlands represents (20% - 23%) of all euthanasia deaths, therefore it is likely that the actual number of euthanasia deaths is (965 - 1100) deaths higher.

The number of reported euthanasia deaths in the Netherlands is continually increasing.

• There were 2331 reported euthanasia deaths in 2008.
• There were 2636 reported euthanasia deaths in 2009.
• There were 3136 reported euthanasia deaths in 2010.
• There were 3695 reported euthanasia deaths in 2011.
• There were 4188 reported euthanasia deaths in 2012.
• There were 4829 reported euthanasia deaths in 2013.

Theo Boer, a Dutch ethicist who had been a 9 year member of a euthanasia regional review committee recently wrote an article explaining why he has changed his mind and now opposes euthanasia. He explained how the Netherlands law has expanded its reasons for euthanasia and how the number of euthanasia deaths was constantly increasing turning euthanasia into a perceived right rather than an exception.

The reasons for euthanasia continues to expand in the Netherlands. For instance:

• Recently the euthanasia clinic was reprimanded (not shut down) for lethally injecting a woman because she didn't want to live in a nursing home.
• Dutch pediatricians are wanting euthanasia extended to children under 12.
• A healthy woman, who was going blind, was euthanized because she was obsessed with cleanliness and feared being unable to clean the dirt on her clothes.

EPC predicted that there would be a continuous increase in the number and reasons for euthanasia after the Netherlands euthanasia lobby launched six mobile euthanasia teams.

The mobile euthanasia teams claimed that they would fill the "unmet demand" for euthanasia for people with chronic depression (mental pain), people with disabilities, people with dementia and loneliness, and for those whose request for euthanasia was declined by their physician.

Dutch ethicist, Theo Boer, stated in his recent article that: 

I used to be a supporter of legislation. But now, with twelve years of experience, I take a different view. 

Once the genie is out of the bottle, it is not likely to ever go back in again.

We need to heed the warning from Theo Boer. 

We need to reject killing people by euthanasia and assisted suicide.