Wednesday, March 14, 2012

Euthanasia in the Netherlands - Again

By Tom Kando

The other issue I have had in front of me since my arrival in the Netherlands is euthanasia: for the past few weeks, our blog has addressed this issue. It started with presidential candidate Rick Santorum's assertion that the Dutch authorities, who have legalized euthanasia, also murder several thousand elderly/sick patients every year, i.e. euthanize them without their explicit consent, without following due process.

Madeleine and I wrote essays vehemently criticizing Santorum and defending the Dutch. I called Santorum a liar and declared categorically that NOBODY is EVER euthanized against his will in the Netherlands.

But then, I learned from some critical comments on the blog that, maybe, I had not done my homework. There is, among others, the 1991 REMMELINK Report, a Dutch Government Report, which raises important questions and documents several thousand "questionable" cases of euthanasia.

According to the Remmelink report, of 8,681 recorded cases of euthanasia up to 1990, 12% (1040) were cases whereby doctors "actively killed the patients without the patients' knowledge or consent." In addition, in 57% of the cases (4941) "doctors administered lethal morphine overdoses without the patients' explicit consent."

To be sure, there was criminal prosecution of at least some guilty physicians, and I hear that the number of "involuntary euthanasia" (a pseudonym for murder) has greatly declined since the 1990s.

Furthermore, looking more closely at the 1040 cases in which a doctor had deliberately ended the life of a patient without a clear and explicit request from the patient, the data indicated the following:

In more than half of these cases the decision had been discussed with the patient or the patient had in a previous phase of his or her illness expressed a wish for euthanasia should suffering become unbearable. In other cases, possibly with a few exceptions, the patients were near death and clearly suffering grievously, yet verbal contact had become impossible. The decision to hasten death was then nearly always taken after consultation with the family, nurses, or one or more colleagues. In most cases the amount of time by which, according to the physician, life had been shortened was a few hours or days only. (see: Breakdown of Dutch Euthanasia).

So things are not exactly as they appear to be. Also, it may be interesting to compare Holland with other countries where euthanasia is practiced but is illegal. In the UK, 20,000 get euthanized annually illegally. Is that better? To their credit, the Dutch do not shirk difficult issues. They debate them and try to improve their practices, just as in the case of prostitution, drugs, homosexuality and abortion.

And there is another new development, over the past few days: The Dutch have created a new authority to which patients can turn in order to expedite their euthanasia if their own primary care physician is reluctant to assist (due to ethical concerns, or out of fear of legal entanglements): Upon filling out an extensive questionnaire and undergoing an extensive interview, the patient may then receive euthanasia, administered at a local hospital. But the patient's suffering must be real and it must be physical. Psychological suffering (e.g. depression) does not qualify you to be euthanized. In other words, the policy forbids assisted SUICIDE, in the sense that a psychologically UNHAPPY individual wants help with his suicide.

I cannot do justice to all the complexities of the euthanasia issue in the Netherlands at this moment. I am still firmly in favor of legalized VOLUNTARY euthanasia, as a humane policy which can help reduce suffering and grant people the right to die with dignity. Benign, palliative treatment (such as increased use of morphine) may shorten a patient's life slightly but it is desirable and it spares the patient an agonizingly painful death. Euthanasia must also be an important option for comatose patients.

But In the interest of "balance," I will make one final observation which I have made since my arrival here: Whenever I have discussed this issue with my Dutch friends in recent days (including a physician and several other highly educated individuals), NONE of them had heard of the Remmelink report. When I mentioned it, they first asked whether it was one of those silly religion-based American sources, and when I told them that it was a Dutch government report, they dismissed it. In this regard, it is interesting that different populations are exposed to different sources of information. leave comment here