Slovenian interview with Alex Schadenberg and Theo Boer.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Slovenian rally against euthanasia.

Earlier this year, Slovenia became the first Eastern European country to legalize euthanasia. 

A citizens group formed and collected more than 40,000 signatures to require a referendum to overturn the Slovenian euthanasia law. 

The referendum is happening on Sunday, November 23, 2025.

EPC is working with the citizens group in Slovenia. We have sent articles and video interviews that the Slovenian group is using to support the referendum. The video project was mentioned in the recent letter to our supporters. Some of the footage from the video project was shared with the Slovenian group.

Please consider donating to the EPC video project (Donation Link).

Planet TV in Slovenia recorded an interview with myself and Theo Boer that was played on November 18 and 19. (Link to the interview).

In the interview I explain (54 seconds) how Canada legalized euthanasia based on a Supreme Court of Canada decision (Carter case). Planet TV then shares the data on the growth of euthanasia in Canada (1:20).

I then explain (1:44) how euthanasia, in Canada, expanded to people who are not terminally ill:

A court decision in Québec (Truchon) decided that it was a form of discrimination to not allow someone who is not terminally ill to have euthanasia. It is the same reason why we (Canada) are now discussing euthanasia for children, euthanasia for mental illness, euthanasia for people who have previously requested it, etc,. All these are based on the concept of discrimination.

I continue by commenting (2:15) on medical treatment wait times in Canada:

It might take several months to get the treatment that you need in Canada but you can get euthanasia, often, the next day.

So people for instance who have cancer and who are going through difficult conditions and not receiving treatment for that, often they are saying, well if I can't get treatment then I would rather be dead.

Planet TV also interviewed Theo Boer (2:53) who is an ethicist in the Netherlands. Boer was a member of a euthanasia review committee from 2005 - 2014 who states:

I think it can be proven with absolute certainty that whenever and where ever and however you legalize assistance in dying, which is either euthanasia or assisted suicide, once you legalize it, the numbers will go up and up.

Not one single country in the world where the numbers did not go up.

Boer explains why he resigned from the euthanasia review committee (3:34):

The situation was getting out of hand. There were an increasing number of cases that I could no longer support and these were expecially cases where there were no longer terminal illness cases but it was increasingly people who were tired of living, not people being afraid to die, but people being afraid to live.

Boer explains the expansion of euthanasia in the Netherlands (4:09): 

Since about 2005 we have seen an increase of about 10 - 15% per year steadily so we started with about 2,000 cases for year and now we are up to more than 10,000.

I was then asked for my message to Slovenia (4:34).

My message to Slovenia is don't open the door to this. Because when you open the door to allowing doctors to kill people, because that is actually what you are doing, there is always another door.

Boer concluded his interview by stating (4:45):

It will not only be a liberty for some to have their lives but in the longer run it will lead the whole society to embrace the idea that some people are not worth living and I think that will inevitably happen.

More articles about Slovenia (Articles Link).

Lessons from the Netherlands 2024 euthanasia report.

"once legal euthanasia and assisted suicide will expand in both numbers and reasons for approving and providing death."

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

On March 26, 2025 I published an article concerning the 2024 Dutch euthanasia report. My article was based on an article by Bruno Waterfield who reported for The Times on March 24 that there were 9958 reported euthanasia deaths in 2024 in the Netherlands which was up by 10% from 9068 in 2023. According to the report, Netherlands euthanasia deaths have increased by 88% since 2014.

Waterfield also reported that there were 219 psychiatric euthanasia deaths in 2024 which was up from 138 in 2023 and 115 in 2022. Euthanasia for psychiatric reasons has increased by 59% since 2023 and nearly 250% since 2020.

The growth of euthanasia and the acceptance of euthanasia for psychiatric reasons in the Netherlands is concerning. The Netherlands experience indicates that euthanasia must never be extended to psychiatric reasons. 

Canada is scheduled to expand euthanasia to psychiatric reasons alone on March 17, 2027. The United Nations Committee on the Rights of Persons with Disabilities (the CRPD Committee) recently condemned Canada's intention to expand euthanasia to psychiatric reasons alone. 

Canada needs to heed the United Nations Committee on the Right of Persons with Disabilities warning and acknowledge the experience with euthanasia for psychiatric reasons in the Netherlands.

But there is more.

Professor Theo Boer

On April 8, 2025 I published an article by Theo Boer who is a professor of health ethics at the University of Groningen and a former member of a Netherlands government euthanasia oversight committee. 

Boer wrote a profound article that was published by Le Monde on April 8, 2025 urging France to learn from the Dutch and not legalize euthanasia. (The text was google translated).

In his article Boer explains the euthanasia trends in the Netherlands. Concerning the growth of euthanasia Boer points out that the trend will likely continue. He wrote:

...the (Netherlands government euthanasia oversight) committee's chairman, Jeroen Recourt, predicts that the curve will continue to rise in the years to come. This is no longer a fluctuation: it is a structural trend.

Boer explains that even though the number of total deaths in the Netherlands is increasing that the percentage of euthanasia deaths is also increasing:

from 5.4% of deaths in 2023 to 5.8% in 2024. In 2017, in some regions, this percentage had already reached 15%, and it is expected to have increased since then. Euthanasia is no longer exceptional: in many cases, it is becoming just another end-of-life option.

Concerning the phenomenon of couple euthanasia Boer writes:

The emergence of "euthanasia for two," which allows couples or siblings to die together, is one such trend. In one year, the number of these planned deaths in tandem has jumped by 64%, reaching 108 deaths in 2024.

Boer also comments on the growth of euthanasia for psychiatric reasons:

Above all, euthanasia for psychiatric disorders has increased by 59%, affecting people who are sometimes very young. Patients who are physically healthy, but plunged into mental suffering that medicine struggles to alleviate, are now asking to die – and are succeeding. The number of cases related to dementia is also increasing rapidly.

Boer completes his concerns by stating:

With increasing "normality," healthcare workers are asking themselves: "How far will we go? At what point will this stop being an act of compassion and become an automatic response to patients who refuse to accept a refusal?"

Boer states that the government has launched an investigation into the reasons for this increase and comments on the fact that the government is investigating the reasons for the increase in euthanasia deaths while they are also considering future expansions of the law to include:

assisted suicide to anyone over the age of 74, even in the absence of serious illness. The sole criterion would be age.

Based on the Netherlands euthanasia data and the warnings from Professor Boer, it is wrong to suggest that the euthanasia "slippery slope" is a fallacy. 

Boer also points out that it is wrong to suggest that the same won't happen in other countries. As Boer states:

all countries where euthanasia or assisted suicide have been legalized, we observe a continuous growth in the number of cases. This is not a Dutch exception. This is a dynamic at work everywhere medically induced death becomes an option.

Canada needs to  heed the Netherlands warning. In Canada euthanasia has grown and expanded significantly. Euthanasia for psychiatric reasons alone remains prohibited until March 17, 2027. When examining the Netherlands euthanasia data it is clear that no country should follow their path.

Countries that are currently debating the legalization of euthanasia or assisted suicide must change their direction. Caring is always good and necessary killing is dangerous.

Based on the Netherlands, Belgium, Canadian, Oregon and California data, it is clear that once legal euthanasia and assisted suicide will expand in both numbers and reasons for approving and providing death.

Let's be clear. There is another way. Legalizing euthanasia or assisted suicide is not necessary for providing care and comfort in difficult cases. Further to that, no one is required to accept medical treatment to prolong their life, especially when the treatment has questionable benefits or has onerous outcomes.

Killing is not compassionate, but rather it is abandonment. Killing is not a solution. Once killing is approved that the acceptance and promotion of killing expands.

Dutch ethicist urges France to learn from the Dutch experience and reject euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

While a law on "assisted dying" will be debated in the French National Assembly starting May 12, a Dutch academic expresses his doubts about the continued expansion of the scope of its application in the Netherlands.

Professor Theo Boer

Theo Boer is a professor of health ethics at the University of Groningen, and a former member of a Netherlands government euthanasia oversight committee. Boer wrote a profound article that was published by Le Monde on April 8, 2025 urging France to learn from the Dutch by not legalizing euthanasia. (The text was google translated).

Boer begins by outlining the current situation in the Netherlands:

For more than twenty years, the Netherlands has been experimenting with euthanasia within a framework presented as strict, regulated, and ethical. However, the figures published in the latest report of the review committee, dated March 24, tell a different story of constant expansion, gradual trivialization, and a silent cultural shift. In 2024, the number of euthanasia cases increased by another 10%. One might have thought that the phenomenon would reach a plateau, especially after modest growth of 4% in 2023. This is not the case. The trend is picking up again, and the committee's chairman, Jeroen Recourt, predicts that the curve will continue to rise in the years to come. This is no longer a fluctuation: it is a structural trend.

Boer outlines the trends in the law:

It might be argued that this increase follows the aging of the population. But even as a proportion of overall deaths, the phenomenon continues to grow: from 5.4% of deaths in 2023 to 5.8% in 2024. In 2017, in some regions, this percentage had already reached 15%, and it is expected to have increased since then. Euthanasia is no longer exceptional: in many cases, it is becoming just another end-of-life option. But beyond the raw statistics, other developments are causing deep concern. The emergence of "euthanasia for two," which allows couples or siblings to die together, is one such trend. In one year, the number of these planned deaths in tandem has jumped by 64%, reaching 108 deaths in 2024. Above all, euthanasia for psychiatric disorders has increased by 59%, affecting people who are sometimes very young. Patients who are physically healthy, but plunged into mental suffering that medicine struggles to alleviate, are now asking to die – and are succeeding. The number of cases related to dementia is also increasing rapidly. Here, a request for euthanasia is often based on fears of dependency, a loss of dignity, or on a living will signed well before the first symptoms. We are entering a field where the patient's current wishes are sometimes unclear, and the medical procedure is based on interpretations. In my conversations with many Dutch doctors, one constant theme emerges: the pressure is increasing. It's no longer just an individual demand, but a social expectation. With increasing "normality," healthcare workers are asking themselves: "How far will we go? At what point will this stop being an act of compassion and become an automatic response to patients who refuse to accept a refusal?" For good reason, the government has now launched an investigation into the reasons for this increase.

Boer explains that the government continues to debate further expansions of euthanasia.

And yet, in the face of these doubts, the legislative movement continues. The Dutch Parliament will soon consider a bill to grant assisted suicide to anyone over the age of 74, even in the absence of serious illness. The sole criterion would be age. A major symbolic shift: we no longer die because we suffer, but because we feel we have lived enough. It's a radically new vision of old age and the value we place on our society.

As a former member of a euthanasia review committee, I believed, at the time, that a rigorous framework could prevent abuses: I'm no longer so sure. What I see is that each opening of the euthanasia field creates new expectations, new demands and a new normal. The internal logic of the system always pushes for expansion. Suffering deemed "unbearable" today is sometimes less so than that of yesterday, but the outcome remains the same.

Boer ends the article by urging France to reject euthanasia:

In France, some insist that "France is not Holland," and that these developments will not occur there. This is a risky bet because, in all countries where euthanasia or assisted suicide have been legalized, we observe a continuous growth in the number of cases. This is not a Dutch exception. This is a dynamic at work everywhere medically induced death becomes an option. I am not a fierce opponent of euthanasia. In certain extreme cases, it can be a last resort. But I am convinced that its legalization does not calm society: it worries it, transforms it, and weakens it. It changes our relationship to vulnerability, to old age, to dependency. It introduces the idea that certain lives, under certain conditions, are no longer worth living—or even worth caring for. I address the French here, not to lecture, but to share my country's experience. Look at what's happening in our country. Listen to the voices, however quiet, of those who doubt. Before opening that door, ask yourself a simple but fundamental question: are we ready for killing to become a medical option among others, even in the presence of cutting-edge palliative care, and even in the absence of illness? Are we ready to burden caregivers with the burden of such a choice? Learn from our experience. There is still time.

Previous articles by Professor Theo Boer:

• British must learn from the Netherlands experience with assisted dying (Link). 
• British proposed assisted death criteria are similar to how Canada's law began (Link). 
• Euthanasia: Impossible to police once legal (Link). 
• Let's not romanticize the Dutch euthanasia experiment (Link). 
• Be careful what you wish for when you legalize active killing (Link).

Britain must learn from the Netherlands experience with assisted dying.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Theo Boer

Professor Theo Boer, who was member of a Netherlands Regional Euthanasia Review Committee for 9 years wrote an article that was published in the Spectator (UK) on February 26. Boer is a respected critic of the Netherlands euthanasia law and has closely followed the developments in the Netherlands for many years. Boer writes:

As a former member of a euthanasia review board in the Netherlands, I have closely followed the debate surrounding Kim Leadbeater’s assisted suicide bill. In 2001, and with 15 years of experience with makeshift regulations behind us, the Netherlands became the first country to introduce a euthanasia law. In support of this law, I worked from 2005 to 2014 for the authorities in charge of monitoring euthanasia cases. I was convinced that the Dutch had found the right balance between compassion, respect for human life, and guaranteeing individual freedoms.

However, over the past two and a half decades, I have become increasingly concerned as I have witnessed the steady expansion of the euthanasia system and its eligibility criteria. A system designed to apply to comparatively rare cases was, by 2023, accounting for 5.4 per cent of all deaths in the Netherlands, with the numbers continuing to rise. In one region, euthanasia even accounts for up to one in every six deaths. Euthanasia in the Netherlands is now available to children, and indeed infants, of all ages, and there are continuing attempts to extend it to anyone over 74 who considers their life ‘complete’. In May 2023, a Kingston University study found that there were 39 cases of euthanasia in the country for people with learning disabilities, autism, or both between 2012 and 2021. We have also had our fair share of contested stories, including a well-known case in 2018 involving a woman with dementia being euthanised apparently against her will, as family members insisted that her advance directive should trump her present expressions.

Boer explains that the British assisted suicide debate is similar to the debate that occurred in the Netherlands.

Much about the debate in the UK reminds me of our experience in the Netherlands, including Leadbeater’s insistence that the rules will be strict. Our safeguards were presented that way too. Euthanasia campaigners assured us that it would only apply to a well-defined group of patients. It is through bitter experience, through being on the front-line here in the Netherlands for almost two decades, that I have concluded that it is not possible to regulate and restrict assisted dying safely in the way its advocates claim. Once the first step is taken, euthanasia advocates invoke the principle of equality: why is assisted death only for terminal patients, as chronically ill patients may suffer all the more? Why only for sick physically patients, given the absolute horrors of psychiatric suffering? Why not include people with non-medical causes of suffering, such as grief? And once we allow euthanasia for competent patients, why withhold this blessing from the incompetent?

I know that right now leading campaigners for assisted suicide laws in the UK are asking people to believe that somehow the UK will be the exception, that the safeguards will be unique and enduring. My message to my British friends would be to be incredibly cautious about letting such aspirations triumph over the hard-trodden experience of so many other jurisdictions that have introduced such laws.

Boer is concerned with the UK parliament assisted suicide debate.

I followed some of the parliamentary proceedings late last month where a committee of MPs took evidence from various experts about the bill. I was surprised that all eight of the invited international witnesses are on record as being in favour of assisted dying. The large majority of these experts were Australians, a country not even close to the Netherlands and Belgium in terms of years of experience. Leadbeater should have included witnesses from jurisdictions where assisted dying has been legal for a much longer time, and where things have not worked out as originally promised.

Boer comments on the proposed changes to the UK assisted suicide bill.

Extraordinarily, every single amendment relating to Clause 1 of the Bill, which aimed to strengthen the proposed safeguards, was rejected. Ahead of second reading, I recall Leadbeater trumpeting her ‘High Court safeguard’, which she said made her legislation the strictest in the world. Leadbeater has now said she is going to drop this safeguard and replace it with panels of experts, likely resulting in them being made up of supporters of assisted dying, as those who do not support the practice would not wish to be involved. The bill is being weakened, not strengthened.

I am also concerned that one MP on the committee has already tried replacing the six-month terminal diagnosis requirement with a 12-month one for certain conditions. Any physician knows how hard it is to make predictions about a six-month life expectancy, and adding a 12-month condition for some illnesses will make the life-expectancy criterion an empty formality. Britain is on a slippery slope. This is exactly what happened in the Benelux countries and in Canada. 

Some previous articles by Theo Boer:

• British proposed assisted death criteria are similar to how Canada's law began (Link). 
• Euthanasia: Impossible to police once legal (Link). 
• Let's not romanticize the Dutch euthanasia experiment (Link). 
• Be careful what you wish for when you legalize active killing (Link).
  

Once euthanasia is legal, the expansion of the act is inevitable.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Politico published a pro-euthanasia article by Claudia Chiappa and Lucia Mackenzie on December 29, 2024. Chiappa and Mackenzie are suggesting that the legalization of euthanasia is inevitable but when they interview Theo Boer, a former member of a Netherlands euthanasia review committee he actually tells them that the expansion of euthanasia, once legal is inevitable. Boer states:

"I have seen no jurisdiction in which the practice has not expanded, not one single jurisdiction,"

"By imposing really strict criteria we can slow down the expansion … but they will not prevent the expansion."

Chiappa and Mackenzie publish some of the Netherlands euthanasia statistics:

In several of the countries that have legalized assisted dying, the number of people using it to end their lives is increasing. In 2023, 9,068 people died from assisted dying in the Netherlands — 5.4 percent of deaths that year. This is up 4 percent compared with 2022 and up 87 percent from 2013.

Professor Theo Boer

Boer comments on why euthanasia continues to increase in the Netherlands:

"What I saw was not only the increase in the numbers — which for me was a sign that it was no longer the last exception, the last resort — but it became more and more a default way to die," said Boer. "In addition to the numbers, we saw an expansion of the pathologies underlying euthanasia requests."

Boer had initially supported the Dutch euthanasia law and was a member of the Dutch euthanasia review committee. But he has since become an outspoken critic of this law and has warned other governments debating similar bills of the possible "side effects."

We have seen the same outcome in Canada, even though Canada has had a shorter experience with euthanasia than the Netherlands. It is not only the number of deaths but also the number of conditions that are approved for being killed that expands once euthanasia is legal.

I do not believe that legalizing euthanasia is inevitable but experience confirms that once killing people by euthanasia is legal that the expansion of the killing is inevitable.

Dutch Professor: British proposed assisted death criteria are similar to how Canada's law began.

"When you legalise euthanasia, we see that all over the world, it will set in motion a new dynamic where supply will create demand."

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Theo Boer

Professor Theo Boer who was a member of a Netherlands Regional Euthanasia Review Committee, was interviewed on October 16 by the Times Radio (UK) concerning the upcoming assisted suicide bill that will be debated in the UK.

Kim Leadbetter, MP was to introduce the - Terminally Ill Adults (End of Life) Bill but we are informed that the language of the bill will not be available until sometime in November.

In his interview with the Times Radio, Boer responds to the proposed outline of the bill by comparing it to the Canadian and Netherlands experience with euthanasia:

When you legalise euthanasia, we see that all over the world, it will set in motion a new dynamic where supply will create demand.

What you are now saying about these British criteria is just about exactly the same as how Canada started. It said, it was for terminal illness, for only a physical illness and now we are way down the path because there were patients in Canada that said this is so unjust, a chronic patient, and I agree with that, a chronic patient can suffer so much more than a terminal patient.

Question: Was it a kind of a legal challenge that mean't that they could expand it?

Yes, In Canada it worked through litigation, through court cases. So they had the Truchon/Gladu case, where I was an expert witness for the Canadian government in 2018. It started with a court case, that was the litigation, and then, so it is really a matter of justice and I think that is inevitable.

As I said, how can you defend rights to a swift death to someone who is terminally ill, while there are people with chronic illnesses that suffer all the much more?

Question: Would that be anyone with a chronic illness?

Well, personally I think this is a slippery slope, so I'm very hesitant. But I think the most heartbreaking cases now in the Netherlands are young psychiatric patients. We have ground breaking cases.

A 17-year old girl who had psychiatric illness for five years and suffering unbearably.

It is so heartbreaking, not only the fact that they die, but also the suffering that they undergo. So really I don't know. And we don't know in the Netherlands where this will stop. So we are also, of course as you know, discussing a law that will grant anyone over 74 the right to euthanasia on the basis of a completed life.

Question: What did you say? A completed life?

Completed life means that old age is the only reason that you, I should say, a sufficient reason. You don't even need to be sick. That is a law that has been discussed for years, and now that we have a little more populist government in the Netherlands, I think they are more hesitant. But we were almost on the brink of having this "completed life" law.

Question: Do you agree with that?

No, No. As you may hear between the lines, I was advocating for the euthanasia law, but as I have seen the practice developed from euthanasia being an exception to euthanasia becoming a rule.

I now actually think that doctors, for example in Britain, when there's really unbearable suffering at the end of life, perhaps they should help the patient to die, for example, with an extra dose of morphine, but not legalising it because when you legalise euthanasia, we see all over the world, it will set in motion a new dynamic where supply will create demand.

Previous articles by Theo Boer:

• Euthanasia is impossible to police once legal (Link). 
• Let's not romanticize the Dutch euthanasia experiment (Link). 
• Be careful what you wish for when you legalise active killing (Link).
  

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).

Suicide deaths increasing in America. Elderly Americans have the highest suicide rate.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition.

The number of suicide deaths in America has been steadily increasing, with some exceptions over the past few years. It is particularly concerning that since 2019, elder Americans have the highest suicide rate.

The Centers for Disease Control and Prevention indicates that in 2021 there were 48,183 people who died by suicide representing 14.1 suicide deaths per 100,000. In 2020 there were 45,979 in 2020 representing 13.5 suicide deaths per 100,000 people. The US suicide rate was 10.7 per 100,000 people in 2001.

An argument used to legalize assisted suicide is the idea that assisted suicide will prevent some suicide deaths (deaths of despair) but the data indicates that where euthanasia and assisted suicide are legal suicide rates don't decrease or remain steady but in fact increase.

The assisted suicide lobby have published articles justifying the assisted suicide deaths of elderly people and people with disabilities. Does the promotion of assisted suicide lead to a suicide contagion effect among older Americans?

It is concerning that in the past few years, the suicide rates have become highest among older Americans. In 2021, Americans over the age of 85 had the highest suicide rate with 20.86 deaths per 100,000 people and those aged 75 to 85 had the second highest suicide rate with 18.43 suicide deaths per 100,000 people. I am convinced that the rapid increase in the suicide rates among older Americans is related to the promotion of assisted suicide.

The suicide rate in Oregon, where assisted suicide has been legal for more than 20 years, is higher than the national average at 19.5 suicide deaths per 100,000 people in 2021. 

It is important to note that in states that have legalized assisted suicide, such as Oregon that the assisted suicide deaths are not included in the suicide data.

Suicide rates have also increased in the Netherlands where euthanasia has been legal since 2002.

Professor Theo Boer, who is a former euthanasia case reviewer in the Netherlands published an article titled: Be careful what you wish for when you legalize active killing. Boer explains:

the percentage of euthanasia of the total mortality went from 1.6% in 2007 to 4.2% in 2019, the suicide numbers went also up: from 8.3 suicides per 100,000 inhabitants in 2007 to 10.5 in 2019, a 15% rise. If we would include the deaths through assisted suicide in patients considered to be at risk of committing suicide (psychiatric patients, people with chronic illnesses, dementia patients, elderly and lonely people), the total increase in self chosen deaths over the past decade would be closer to 50% than to 15%. Meanwhile in Germany, very similar to the Netherlands in terms of religion, economy and population, the suicide rates went down by 10%.

The difficulty with suicide data is that there are many factors that affect the suicide rate. Nonetheless, there have been several studies that have indicated that legalizing assisted suicide leads to a suicide contagion effect.

Considering the fact that elder Americans now have the highest suicide rates. It is likely that the promotion of assisted suicide for elderly people and people with disabilities has affected the suicide rate among those demographics.

What is most concerning is the silence concerning the increase in the elder suicide rate. Suicide is always a tragedy.

Canada ignored warnings that its euthanasia law immediately went too far.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Tristan Hopper wrote an excellent article that was published in the National Post on August 19, 2022 concerning the many stories that have been published in the past few months concerning the many unexpected victims of Canada's euthanasia law. Hopper examines the law based on how the law went too far from its inception.

Hopper writes:

Barely a week now goes by without some new case emerging of a sick Canadian being offered assisted death in lieu of treatment. Most recently, it was a Canadian combat veteran who was casually offered the option of dying after he approached Veteran Affairs Canada for help with his PTSD.

It’s a nightmare scenario that was envisioned by no shortage of ethicists and health figures when assisted death was first written into Canadian law. But with few exceptions, these warnings were ignored by the various court rulings that ultimately forced Canada into adopting the world’s most permissive regime of legal euthanasia.

Hopper points out that the Supreme Court of Canada 1993 Rodriguez decision stated that:

“Given the concerns about abuse and the great difficulty in creating appropriate safeguards, the blanket prohibition on assisted suicide is not arbitrary or unfair”

Whereas the Supreme Court of Canada 2015 Carter decision that legalized euthanasia nearly ignored the concerns about abuse even though experts witnesses explained how the safeguards in Belgium and the Netherlands have become an illusion, the Supreme Court responded by stating that the Belgium experience was:

“the product of a very different medico-legal culture” and said it offered no lessons for Canada.

Hopper quotes from NDP MP Joe Comartin, who during the parliamentary debate warned that:

“mercy killings” becoming a regular component of an underfunded Canadian health-care system. “The risk we have is sending a message to the country that life is expendable, that we are prepared to say that we do not care enough for people to take care of them”

Conservative MP Joy Smith quoted from Theo Boer, a Dutch bioethicist and former member of the euthanasia commission who had supported euthanasia and then changed his mind:

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

Hopper quotes from John C. Wootten who was published in the CMAJ as stating:

MAID’s core issue was that it was a 100 per cent successful procedure, with no way of telling whether it was a mistake. “Because few other medical acts can be accomplished with such impunity, we are likely to become more and more comfortable with it, and more and more permissive as times goes by,” he wrote.

Hopper then points out that the 2019 Truchon and Gladu Quebec court decision continued the delusion that there are no fears of abuse. Hopper writes:

In the 2019 decision Truchon and Gladu v. Canada, the Quebec Superior Court ruled that extending assisted suicide only to Canadians with terminal illnesses was similarly a violation of the “security of the person.”

“The fact that doubts have been raised is one thing, but any possible ‘slippery slope’ remains theoretical,” it read.

Hopper explains that the Truchon decision led to the passing of Bill C-7 in March 2021 which allowed euthanasia for people with chronic but not terminal conditions, it eliminated the 10-day waiting period for people who are dying and it extended euthanasia to people with mental illness alone to be instituted in March 2023.

Alan Nichols (left side)

He concludes his article with one of the most egregious stories of euthanasia abuse in Canada by writing about the euthanasia death of Alan Nichols. Hopper writes:

Last June, the Medical Assistance in Dying Committee heard from Trish Nichols, whose suicidal and severely mentally ill brother Alan was given assisted death at a Chilliwack, B.C., hospital in 2019, at a time when MAID was still limited only to Canadians with a terminal illness.

Alan had been taken by his family to the hospital only days before to recover from a psychiatric episode, and in the minutes before he received a lethal injection, Trish described Alan screaming uncontrollably, despite the hospital’s assurances that he had opted for a medically assisted death while “of sound mind.”

“Would you feel safe now, bringing your suicidal loved one to seek medical care for recovery when there are no oversight or stringent safeguards surrounding a procedure that kills people?” Nichols told the committee.

Hopper only misses one point. The committee that Trish Nichols was speaking to is debating the expansion of Canada's euthanasia law to children - "mature minors" -to requests by advanced directive, and to determine the rules for killing people for mental illness alone.

Here are some links to more stories of abuse of euthanasia in Canada:

• Veterans affairs worker advocates euthanasia for PTSD (Link).
• Shopping for doctor death in Canada (Link).
• Gwen is seeking euthanasia because she can't access medical treatment (Link).
• Euthanasia for disability and poverty (Link).
• Euthanasia for Long Covid and poverty (Link).
• Canada's MAiD law is the most permissive in the world. (Link).

Let's not romanticise the Dutch euthanasia experiment.

Theo Boer responds in the Irish Times to a letter from Corry de Jongh.

Professor Theo Boer

Sir, – I agree with Corry de Jongh that euthanasia is well-monitored in the Netherlands. In 1972 my own (Protestant) church was the first worldwide to support it. However, with hindsight, many regret supporting the law, including me. Since 2006, the numbers have increased incessantly. Last year 7,000 people received euthanasia, and in some neighbourhoods one in every five deaths is preceded by euthanasia. Is this the “last resort” we once advocated?

Given the excellent quality of palliative care in the Netherlands, there is only one explanation: supply creates demand.

Right-to-die societies have successfully made us believe that euthanasia is the most, if not only, dignified death. Let’s not romanticise the Dutch experiment. – Yours, etc,

THEO BOER,
(Professor of healthcare ethics, former member of a euthanasia review committee),
Groningen, The Netherlands.

Unexplained variation in regional euthanasia rates in the Netherlands.

Is it underuse, overuse or misuse?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The British Medical Journal (BMJ) recently published a study showing that there is an unexplained 7-fold variation in euthanasia rates across the Netherlands. 

According to the BMJ report, the researchers were not sure if the differences related to "underuse, overuse, or misuse."

The BMJ reported that there were also striking differences between the three largest cities in the Netherlands. The report stated that:

In Amsterdam, in the three districts with highest rates of euthanasia, the proportion of these deaths was between nearly 12% and around 14.5% higher than in Rotterdam, where the proportion remained more or less static at around 6%.

In The Hague the rate of euthanasia in the three districts with the highest rates of euthanasia, the proportion of these deaths rose from nearly 7.5% to more than 11%.

Throughout the five years, the rate in the top three municipalities was 25 times higher than that of the bottom three.

The NL Times based their article on postal codes and reported:

Euthanasia was most often used in postcode area 13, the area around Almere, in 2017. In that area, euthanasia was involved in 7.37 percent of all deaths. Almost the entire Kop van Noord-Holland is in the top 10 of most granted euthanasia requests. Postcode area 91, which includes Ameland, Schiermonnikoog and Dokkum, had the lowest percentage of euthanasia deaths at 2.15 percent.

The NL Times reported researchers Theo Boer and Stef Groenewoud saying:

"If we were to do this research for other medical procedures, say cataract operations, you'd rather think of a factor of two or one and a half,"

Researcher did not find a clear explanation for the differences in euthanasia rates but they suggested to the NL Times that it could be based on regional customs. They said: "it may be that in certain parts of the Netherlands people use euthanasia more."

 

According to research 20% - 23% of the Netherlands euthanasia deaths are not reported. A 5 year study sponsored by the Netherlands government that was released in August 2017 showed continued abuse of the law.

Researchers need to further examine the under-reporting, and the development of lax attitudes towards euthanasia in regions of the Netherlands.

Senator Kutcher: Suicide rates in jurisdictions that have legalized assisted death are not decreasing.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Senator Stanley Kutcher

On November 24, I had the opportunity to present our EPC brief on euthanasia Bill C-7 to the Senate Committee on Legal and Constitutional Affairs. 

After the presentations Senators asked questions and made clarifications of the witness presentations.

Senator Stanley Kutcher decided to challenge a witness by making a statement about suicide rates in jurisdictions where euthanasia is legal.

Senator Kutcher stated that in jurisdictions, such as Belgium and the Netherlands, where assisted death is legal, that the suicide rates have decreased. He then stated that there is no link between assisted death and the rate of suicide in jurisdictions where it is legal. He then challenged a witness, who is a suicide prevention expert, to explain why he is concerned about euthanasia, in relation to suicide prevention.

The problem is that Senator Kutcher is simply wrong.

According to the World Population Review Belgium has the highest suicide rate in Western Europe as 20.7 per 100,000 people die by suicide, which is the eleventh highest rate in the world. The Netherlands suicide rate has increased, over the past several years while the suicide rate in Europe has decreased.

Professor Theo Boer

Professor Theo Boer, who was a member of a Regional Euthanasia Review Committee in the Netherlands for 10 years wrote in an article published on October 5 by the Irish Indendent that:

The logic of many is that assisted dying will bring down the numbers of violent and traumatizing suicides. If true, this would be a powerful argument in favour of changing the law. But the Dutch statistics speak another language. Whereas the percentage of euthanasia of the total mortality went from 1.6% in 2007 to 4.2% in 2019, the suicide numbers went also up: from 8.3 suicides per 100,000 inhabitants in 2007 to 10.5 in 2019, a 15% rise... Meanwhile in Germany, very similar to the Netherlands in terms of religion, economy and population, the suicide rates went down by 10%.

In Oregon, where assisted suicide has been practiced since 1998, the suicide rate has increased from 16.6 per 100,000 people in 2011 to 19.6 in 2019. In Washington State, where assisted suicide was legalized in 2009, the suicide rate has increased from 13.7 per 100,000 people in 2011 to 17.6 in 2019. It is true that the US national suicide rate has increased from 12.3 per 100,000 people in 2011 to 14.2 in 2019, but the Oregon and Washington State suicide rates have increased faster than the national average.

There is no evidence that the suicide rate in jurisdictions that have legalized euthanasia and/or assisted suicide have lowered, while there is plenty of evidence that the suicide rates in these jurisdictions have increased.

Be careful what you wish for when you legalize active killing

This article was published by the Irish Independent on October 5, 2020 and reprinted with permission of the author.

Professor Theo Boer

By Professor Theo Boer,
Former reviewer of euthanasia cases in the Netherlands.

As early as next week, Irish Members of Parliament could be casting a vote on the complicated and emotive issue of assisted suicide and euthanasia. After euthanasia was legalised in 2002, I supported the Dutch legislation and worked for the authorities reviewing euthanasia cases between 2005 and 2014. I was convinced that the Dutch had found the proper balance between compassion, respect for human life, and respect for individual liberties. Over the years, however, I became increasingly concerned about some developments. After an initial stabilisation we saw a dramatic increase in the numbers, which went from 2,000 in 2002 to 6,300 in 2019. In some urban districts in the Netherlands, between 12 and 14% of all deaths are the result of assisted dying. The outgoing director of the Euthanasia Expertise Centre – which provides assisted dying to almost 1,000 patients yearly – expects the euthanasia numbers to double again in the near future. We also saw differences in the way the legal criteria were interpreted. In the pioneering years of Dutch euthanasia, it was found almost exclusively in terminally ill mentally competent adults. After some decades, the practice extended to include those with chronic conditions, disabled people, those with psychiatric problems, and incompetent adults with an advance directive. Expansion is under debate for euthanasia in young children and for elderly persons without a medical diagnosis.

Understandably, Irish advocates of assisted dying argue for a more restricted law than is found in the low countries. Here is my prediction: any law that allows assisted dying will by some be experienced as an injustice and will be challenged in the courts. A year ago the Superior Court in Quebec ruled that the condition of a terminal illness in Canadian law is discriminatory and thus unconstitutional. Why only euthanasia for terminally ill patients, who already have access to an ever widening array of palliative care, whereas chronic patients may suffer more intensely and much longer? We can envisage the next steps: why exclude psychiatric patients, many of whom are suffering most heartbreakingly of all? Why only an assisted death for people suffering from a disease, and not for those suffering from meaninglessness, alienation, loneliness, from life itself? The paradox of legalising assisted dying is that what starts out as a welcome opportunity for those who love their self-determination, becomes an invitation to despair to others. I have seen literally hundreds of euthanasia reports in which the wish to shield one’s relatives from the agony of witnessing their suffering and carrying the burden of long-time care was one of the reasons, if not the essential reason, for asking for an assisted death. In a society where assisted dying is available, people are confronted with one of the most dehumanizing choices possible: do I want to live on, or do I want to effectuate my death?

The logic of many is that assisted dying will bring down the numbers of violent and traumatizing suicides. If true, this would be a powerful argument in favour of changing the law. But the Dutch statistics speak another language. Whereas the percentage of euthanasia of the total mortality went from 1.6% in 2007 to 4.2% in 2019, the suicide numbers went also up: from 8.3 suicides per 100,000 inhabitants in 2007 to 10.5 in 2019, a 15% rise. If we would include the deaths through assisted suicide in patients considered to be at risk of committing suicide (psychiatric patients, people with chronic illnesses, dementia patients, elderly and lonely people), the total increase in self chosen deaths over the past decade would be closer to 50% than to 15%. Meanwhile in Germany, very similar to the Netherlands in terms of religion, economy and population, the suicide rates went down by 10%.

So as Members of Parliament start to look at this issue, the Netherlands must act as an alarm to what can happen. Look at the Netherlands and you may see Ireland in 2040. Like those currently arguing for a change in the law in Ireland, I once believed it was possible to regulate and restrict killing to terminally ill mentally competent adults with less than six months. (Paradoxically, I doubt whether my country would have legalised assisted dying if we had had the level of palliative care in 1994 that we have now.) Moreover, by taking this bold step I believed we could regulate suicide and death in this way that would curtail those all too familiar cases where someone ends their own life. I was wrong. If not even the most well-regulated and monitored system worldwide cannot guarantee that assisted dying remains a last resort, why would Ireland be more successful?

Theo Boer is Professor of Health Care Ethics at Groningen Theological University and Visiting Professor of Ethics at the University of Sunderland.

More articles by Theo Boer:

• 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).