The Netherlands is normalising euthanasia, says Dutch ethicist


A former member of a euthanasia review board in the Netherlands has written a stinging attack on the policy he once formed part of.

Dr Theo de Boer, professor of health care ethics at the Theological University in Kampen and associate professor of ethics at the Protestant Theological University in Groningen, speaks from a unique perspective. Not only was he involved in the adminstration of legalised euthanasia, he is also intimately familiar with arguments put forward by some Christian theologians to justify it.

Writing in the American Protestant magazine Christian Century this week, Dr de Boer says that  from 2005 to 2014, he reviewed nearly 4,000 cases of assisted dying as a member of one of the five Dutch regional committees. He thought it was a “robust and humane system” and defended it at ecumenical gatherings.

However, in 2007, he says that the pace of euthanasia began to accelerate, rising by 15 percent each year. As the numbers soared, the criteria expanded. Even children became eligible. The biggest change was the reason for requesting death. Originally defenders of assisted dying described heart-breaking stories of tormented patients  who just wanted to die peacefully. But this changed. Nowadays, many people simply want to take an early exit from loneliness or bereavement or meaninglessness.

Although some patients still request assisted dying out of fear of ineffective palliative care, an increasing number see euthanasia as the form of a good death after a trajectory of good palliative care. The unbearable suffering that they refer to increasingly consists of meaningless waiting rather than physical suffering. The “burning truck” example no longer applies to most cases. The issue now is autonomy—the patient’s right to a swift death, brought about by a doctor.

Dr de Boer’s words are sobering. They suggest that once euthanasia has become established it becomes a normal treatment.

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.

This is obligatory reading for anyone interested in the debate over euthanasia and assisted suicide.




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