How do intellectually disabled people fare in a country where euthanasia and assisted suicide are legal? Writing in BMC Medical Ethics, Baroness Ilora Finlay and three colleagues conclude that Dutch criteria for euthanasia “are not easily applied to people with intellectual disabilities and/or autism spectrum disorder, and do not appear to act as adequate safeguards.”
Their findings are based on an analysis of six case studies of people who were euthanased between 2012 and 2016 with intellectual disability and three with autism spectrum disorder. The case studies are publicly available. They write:
“Autonomy and decisional capacity are highly complex for patients with intellectual disabilities and difficult to assess; capacity tests in these cases did not appear sufficiently stringent. Assessment of suffering is particularly difficult for patients who have experienced life-long disability. The sometimes brief time frames and limited number of physician-patient meetings may not be sufficient to make a decision as serious as EAS.”
Despite the fact that assessing the capacity of intellectually disabled people is very difficult and a task for specialists, the authors found that only in one of the nine cases was a specialist consulted. This suggests that their requests for euthanasia are poorly understood:
The Dutch cases raise the possibility that the bar for assessment of intractable suffering is set lower for people with an intellectual disability or autism spectrum disorder than for the general population, by considering their long term disability as a medical rather than a social condition. We found no evidence of safeguards against the influence of the physicians’ own subjective value judgements when considering EAS decision, nor of processes designed to guard against transference of the physicians’ own values and prejudices.
In a concluding reflection, the authors observe that the intellectually disabled may be the “canary in the coalmine” in a society where euthanasia and assisted suicide are legal. “It may well be that the ability to use rationality and logic when weighing up the EAS option, and thus decision-making capacity in accordance with standard capacity tests, is impaired in most people affected by the emotional turmoil of terminal illness or suffering caused by chronic conditions.”
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