Euthanasia

Specialist euthanasia clinic is unable to cope with demand

October 27, 2017

The number of requests for euthanasia made to a special clinic for people whose doctors won’t help is rising so quickly that the organization is looking for some 50 new members of staff.

In 2016 the clinic received some 1,800 requests, of which around 500 led to euthanasia being carried out. This year, the clinic expects 2,500 requests, of which 750 will lead to euthanasia, the clinic’s director Steven Pleiter told the Volkskrant (in Dutch).

Pleiter said the 59 doctors now working for the foundation are unable to cope with the additional volume of requests and the clinic will need more than a hundred doctors next year.

The clinic also needs more psychiatrists because some 25% of requests are made by patients with psychological complaints.

The Dutch voluntary euthanasia society established the clinic in 2012. Pleiter said the rise in the number of requests for euthanasia is due to the fact that more people want to choose how they die,. ‘The taboo is disappearing. Many people feel the need to take to control themselves,’ he said.

VU university researcher Bregje Onwuteaka-Philipsen, who specializes in end-of-life care, told the Volkskrant requests for euthanasia have risen from around 13,000 in 2011 to 18,000 last year. One reason may be that the current generation approaching old age is less religious, she said.

Official cases

According to the Dutch law patients must be experiencing unbearable suffering without perspective of improvement in order to be eligible for euthanasia. The number of official cases rose 10% last year to 6091 and euthanasia now accounts for 4% of total deaths, according to government figures.

In 10 cases, the rules for euthanasia were not followed correctly, most of which involved a failure to properly consult a second doctor, the RTE annual report said. Of the total, 87% of assisted deaths involved people with cancer, serious heart or lung problems or diseases of the nervous system such as ALS.

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[...]
Brother René Stockman, worldwide leader of the Rome-based Brothers of Charity who opposes euthanasia, had warned its Belgian arm this summer that the group would lose the right to call themselves Catholic if they didn't abandon its defiant euthanasia policy adopted in March. He told The Wall Street Journal that the chain of hospitals could lose buildings that belong to the Catholic Church. He said that despite inviting the board to Rome to explain their position on euthanasia, the Vatican will be making no compromise on their stance against it.

Despite Pope Francis' open condemnation of euthanasia and the Catholic Church's defense of the inviolability of life, the board of the Brothers of Charity, Belgium's largest single provider of psychiatric care, insisted last month that it is more Christian to allow people who are in "hopeless mental suffering" to choose if they want to live or die than tell them that euthanasia isn't an option.

[...]
In the past year, 12 patients at the Brothers of Charity which was founded in 1807 in Ghent, Belgium, have asked for euthanasia. Two were transferred offsite to get fatal injections.

Brothers of Charity is considered the most important provider of mental health care services in the Flanders region of Belgium the Catholic Herald says. They serve 5,000 patients annually.

When they opted to change their euthanasia policy in March, they said they wanted to be in line with Belgian law. The decision explains the Catholic Herald also came a year after a private Catholic rest home in Diest, Belgium, was fined $6,600 for refusing euthanasia to a 74-year-old woman suffering from lung cancer.

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Man who helped mother (99) to die should be jailed, says prosecutor

December 4, 2017

An elderly man who helped his 99-year-old mother to die seven years ago should be given a three-month suspended jail sentence, the public prosecution department said on Monday.

Albert Heringa (75) was earlier cleared on all charges but the Supreme Court in March said there should be a retrial because euthanasia carried out by someone other than a doctor must be subject to ‘very strict rules’. In addition, his earlier appeal was ‘granted far too lightly’, the court said.

Heringa decided to help his mother die when doctors refused her request to administer a lethal dose of medication. He filmed his mother, who was almost blind and suffering from crippling back pains, as he helped her take the pills that would kill her.

The footage featured in a documentary called De laatste wens van Moek (Mum’s final wish) which was broadcast in 2010.

The public prosecutor told the court in Den Bosch that while it did not doubt Heringa had the best of intentions, he should be punished for going his own way.

‘Assisted suicide can only be carried out without punishment by a doctor,’ the prosecutor said. ‘The suspect is not a doctor and cannot therefore claim exclusion from prosecution on the grounds of the euthanasia legislation.’

In 2013, Heringa was found guilty but went unpunished and the appeal court in 2015 found him not guilty. The case was then referred to the Supreme Court which this year called for a retrial.

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News & Politics
High-Tech Suicide Machine Makes Death a Painless, Peaceful, Optimal Way to Go

The Sarco is a state-of-the-art death machine.

By Kali Holloway / AlterNet December 3, 2017, 12:56 PM GMT

In a world filled with chaos, a new “suicide machine” allows people to exit life in an orderly, peaceful manner. The Sarco is a technological marvel, resembling some kind of futuristic sleeping chamber, that aids in voluntary assisted dying. Australian doctor Philip Nitschke, whom Newsweek identifies as the "Elon Musk of assisted suicide,” unveiled the new apparatus earlier this week, just days after lawmakers in the state of Victoria voted to legalize euthanasia. The device simplifies what Nitschke dubs “rational suicides,” ensuring that the process is painless and easy—an optimal way to go.

The Sarco was developed by Nitschke’s organization, Exit International, which bills itself as an “aid-in-dying” organization. The machine includes a base topped by a translucent chamber perfectly proportioned to comfortably fit a human. After settling in the pod, the user will push a button and the chamber will start to “fill up with liquid nitrogen to bring the oxygen level down to about 5 percent.” Around the minute mark, the user will become unconscious, experiencing almost no pain, according to the Newsweek report. (The doctor describes the changes as akin to “an airplane cabin depressurizing.”) After death comes, which is fairly swift, the chamber can be used as a coffin. The base, just FYI, is reusable.

In a press release, Exit International notes the Sarco “was designed so that it can be 3D printed (PDF-file) and assembled in any location” and that blueprints “will be free, made open-source, and placed on the Internet.” While accessibility is a major selling point, there is one hurdle would-be users will need to clear: a “mental questionnaire” that’s available online. Once a client has established mental health, they’re given a 4-digit code that opens the capsule door, the first in a series of steps to “a peaceful death...in just a few minutes.”

According to Newsweek, a few suicide clinics in Switzerland have expressed interest in licensing the Sarco for use. There are also likely to be takers in other spots around the world. In addition to the new Victoria law, assisted suicide is now legal in Belgium, Canada, Colombia, Luxembourg and the Netherlands, where it’s become an increasingly popular choice. In the U.S., only terminally ill patients can opt for assisted suicide, and in many states, at least two doctors must verify the legitimacy of the request. State-specific legislative nuance governs "death with dignity" laws in California, Colorado, Oregon, Vermont, D.C. and Washington. All that said, support for the right to choose when and how one dies is on the rise. In 2016, 69 percent of Americans said, “doctors should be allowed to end a patient's life by painless means.” That number increased to 73 percent this year.

Philip Nitschke, who advocates for euthanasia to be a legal option for anyone over 70, continues to push for assisted suicide as a civil right. He says that the gray wave washing over Baby Boomers has helped create a sea change in thinking.

“These are people who are used to getting their own way, running their own lives,” Nitschke told the Big Smoke earlier this year. “A lot of the women have gone through political battles around abortion rights, feminism, the Pill. They don’t want to be told how to live or how to die. The idea that you can pat these people on the head and say ‘there, there, let the doctors decide’ is frankly ridiculous...People’s lives are people’s lives. Death is a part of that, and so it should be up to them to make the decisions.”


Kali Holloway is a senior writer and the associate editor of media and culture at AlterNet.

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How does assisting with suicide affect physicians?

January 8, 2018 3.57am GMT

Ronald W. Pies
Emeritus Professor of Psychiatry, Lecturer on Bioethics & Humanities at SUNY Upstate Medical University; and Clinical Professor of Psychiatry, Tufts University School of Medicine, Tufts University


When my mother was in her final months, suffering from a heart failure and other problems, she called me to her bedside with a pained expression. She took my hand and asked plaintively, “How do I get out of this mess?”

As a physician, I dreaded the question that might follow: Would I help her end her life by prescribing a lethal drug?

Fortunately for me, my mother tolerated her final weeks at home, with the help of hospice nurses and occasional palliative medication. She never raised the thorny question of what is variously termed “medical aid in dying” [MAID] or “physician-assisted suicide.” [PAS]

As a son and family member who has witnessed the difficult final days of parents and loved ones, I can understand why support for MAID/PAS is growing among the general public. But as a physician and medical ethicist, I believe that MAID/PAS flies in the face of a 2,000-year imperative of Hippocratic medicine: “Do no harm to the patient.”

Studies point out that even many doctors who actually participate in MAID/PAS remain uneasy or “conflicted” about it. In this piece, I explore their ambivalence.


Assisted suicides

In discussing end-of-life issues, both the general public and physicians themselves need to distinguish three different approaches.

MAID/PAS involves a physician’s providing the patient with a prescription of a lethal drug that the patient could take anytime to end life.
In contrast, active euthanasia or “mercy killing” involves causing the death of a person, typically through a lethal injection given by a physician.
Finally, the term “passive euthanasia” refers to hastening the death of a terminally ill person by removing some vital form of support. An example would be disconnecting a respirator.


Increasing international acceptance

In the U.S. some form of legislatively approved MAID/PAS (but not active euthanasia) is legal in five states and the District of Columbia. In my home state – following a passionate debate – the Massachusetts Medical Society recently decided to rescind its long-held opposition to the practice. MMS has taken a position of “neutral engagement,” which it claims will allow it to “serve as a medical and scientific resource … that will support shared decision making between terminally ill patients and their trusted physicians.”

In a few countries, MAID/PAS has grown increasingly common. In Canada, for example, MAID/PAS was legalized in 2016. In Belgium and the Netherlands, both active euthanasia and physician-assisted suicide are permitted by law, even for patients whose illnesses may be treatable, as with major depression; and whose informed consent may be compromised, as in Alzheimer’s disease. In the Netherlands, a proposed “Completed Life Bill” would allow any persons age 75 or over who decide their life is “complete” to be euthanized – even if the person is otherwise healthy.


U.S. physician response

Among U.S. physicians, MAID/PAS remains controversial, but national data point to its increasing acceptance. A report published in December 2016 found 57 percent of doctors agreed that physician-assisted death should be available to the terminally ill – up from 54 percent in 2014 and 46 percent in 2010.

Perhaps this trend is not surprising. After all, what sort of physician would want to deny dying patients the option of ending their suffering and avoiding an agonizing, painful death?

But this question is misleading. Most persons requesting PAS are not actively experiencing extreme suffering or inadequate pain control. Data from the Washington and Oregon PAS programs show that most patients choose PAS because they fear loss of dignity and control over their own lives.


Some physicians feel conflicted

Physicians who carry out assisted suicide have a wide variety of emotional and psychological responses. In a structured, in-depth telephone interview survey of 38 U.S. oncologists who reported participating in euthanasia or PAS, more than half of the physicians received “comfort” from having carried out euthanasia or PAS.

“Comfort” was not explicitly defined, but, for example, these physicians felt that they had helped patients end their lives in the way the patients wished. However, nearly a quarter of the physicians regretted their actions. Another 16 percent reported that the emotional burden of performing euthanasia or PAS adversely affected their medical practice.

For example, one physician felt so “burned out” that he moved from the city in which he was practicing to a small town.

Other data support the observation that MAID/PAS can be emotionally disturbing to the physician.

Kenneth R. Stevens Jr., an emeritus professor at Oregon Health and Science University, reported that for some physicians in Oregon, participation in PAS was very stressful. For example, in 1998, the first year of Oregon’s “Death with Dignity Act,” 14 physicians wrote prescriptions for lethal medications for the 15 patients who died from physician-assisted suicide.

The state’s annual 1998 report observed that:

“For some of these physicians, the process of participating in physician-assisted suicide exacted
a large emotional toll, as reflected by such comments as, ‘It was an excruciating thing to do … it
made me rethink life’s priorities,’ ‘This was really hard on me, especially being there when he took
the pills,’ and ‘This had a tremendous emotional impact.’”

Similarly, reactions among European doctors suggest that PAS and euthanasia often provoke strong negative feelings.


Why the discomfort?

As a physician and medical ethicist, I am opposed to any form of physician assistance with a patient’s suicide. Furthermore, I believe that the term “medical aid in dying” allows physicians to avoid the harsh truth that they are helping patients kill themselves. This is also the view of the very influential American College of Physicians.

I believe that the ambivalence and discomfort experienced by a substantial percentage of PAS-participating physicians is directly connected to the Hippocratic Oath – arguably, the most important foundational document in medical ethics. The Oath clearly states:

“I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.”

In 5th century BC Greece, Hippocrates was something of a revolutionary in this respect. As the classicist and medical historian, Ludwig Edelstein has pointed out some non-Hippocratic physicians probably did provide poisons to their dying patients, in order to spare them protracted suffering. Hippocrates opposed this practice, though he did not believe that terminally ill patients should be exposed to unnecessary and futile medical treatment.

Palliative care specialist Ira Byock has observed that:

“From its very inception, the profession of medicine has formally prohibited its members from using their
special knowledge to cause death or harm to others. This was – and is – a necessary protection so
that the power of medicine is not used against vulnerable people.”

Indeed, when patients nearing the end of life express fears of losing control, or being deprived of dignity, compassionate and supportive counseling is called for – not assistance in committing suicide.

To be sure, comprehensive palliative care, including home hospice nursing, should be provided to the subset of terminally ill patients who require pain relief. But as physician and ethicist Leon Kass has put it:

“We must care for the dying, not make them dead.”

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Suspended sentence for son who helped mother, 99, commit suicide

By Janene Pieters on January 31, 2018 - 16:10

The court in Den Bosch found 76-year-old Albert Heringa guilty of assisting his 99-year-old mother in committing suicide and gave him a conditionally suspended prison sentence of six months. The sentence is three months higher than what the Public Prosecutor demanded. This was the fourth time this case appeared in court, NOS reports (in Dutch).

On June 7th, 2008 Heringa mixed 130 pills into his 99-year-old mother's custard. She ate it, drank a Martini and died peacefully. Everything was done at his mother's express request and Heringa helped his mother because she no longer wanted to live, he always said. The case received a great deal of public attention, because Heringa filmed everything and it was made into a documentary a year and a half after his mother's death.

When Heringa was first tried in 2013, the court in Zutphen found him guilty of assisted suicide, but imposed no punishment. The Public Prosecutor appealed. In 2015 the Arnhem court of appeal acquitted him completely. The court found that Heringa rightly invoked a state of emergency, a form of force majeure, because the doctor refused to help. He felt morally obliged to help his mother have a painless, dignified death she wanted. According to the court, Heringa acted very carefully and transparently

The Public Prosecutor did not agree with this ruling, and filed cassation with the Supreme Court. A year later, the Advocate General of the Supreme Court recommended that the cassation be rejected because of force majeure. But the Supreme Court referred the case back to the court of appeal, now in Den Bosch. In December last year, the Public Prosecutor acknowledged that Heringa's motives were pure, but added that only doctors are allowed to assist with suicides. The Prosecutor demanded a three month suspended prison sentence against him.

The court in Den Bosch now ruled that Heringa is guilty of assisted suicide, and could not invoke force majeure. The court counted against Heringa that he left his mother alone after she had taken the deadly mixture, and that he did not immediately report what happened.

Heringa himself is disappointed (in Dutch) about the verdict, but told the court that ten years later he still does not regret what he did, because otherwise he would have felt that he betrayed his mother.

The Dutch association for a voluntary end of life NVVE is "enormously disappointed and bewildered", according to NOS. The association believes Heringa had no choice but to help his mother and his help should not be called a crime. The NVVE will continue to support Heringa if his legal battle continues.

The practice of assisted suicide in the Netherlands changed considerably in the years since Heringa's mother died. In 2011 doctors' association KNMG acknowledged that loneliness and an accumulation of old-age complaints can also cause hopeless and unbearable suffering, thereby no longer only allowing assisted suicide for people with a serious physical condition. If these rules were already in force in 2008, Heringa may have been able to find a doctor willing to help his mother with euthanasia.

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More euthanasia in the Netherlands, nearly all cases in line with the rules

March 7, 2018

The number of people helped to die under Dutch euthanasia legislation rose 8% last year to 6,585, the regional monitoring committee said on Wednesday. Of them, 99.8% were carried out carefully and in line with the guidelines, the committee says in its 2017 annual report.

In almost 90% of cases, the patient was suffering from cancer, heart and artery disease or diseases of the nervous system, such as Parkinson and MS. Three patients were in the advanced stage of dementia and 166 were in earlier stages.

In 83 cases, the patient was suffering from severe psychiatric issues, a trend which has raised questions among psychiatrists, RTL Nieuws reported earlier this year (in Dutch).

Twelve cases were labeled by the monitoring committee as not being carefully carried out – these were mainly problems with medical care or not having an independent second opinion.

Euthanasia is legal in the Netherlands under strict conditions. For example, the patient must be suffering unbearable pain and the doctor must be convinced the patient is making an informed choice. The opinion of a second doctor is also required.

The 8% rise in cases is in line with previous years and most patients are over the age of 70. ‘People are becoming older,’ said Jacob Kohnstamm, who chairs the committee, in the NRC (in Dutch). ‘Doctors know more about euthanasia and people are more aware of the issues. Given the post war population increase, this trend will continue.’

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Dutch public prosecutor investigates four new euthanasia cases

March 8, 2018

The public prosecution department said on Thursday it has begun investigations into four cases of euthanasia which may not have taken place in line with strict Dutch rules.

Two cases concern the same doctor in Noord-Holland, one happened in The Hague and the fourth in the east of the country. The cases were sent to the public prosecution department by the regional monitoring committee.

Since the euthanasia legislation was introduced in 2002, just one other case is known to have been submitted to the public prosecutor for formal investigation. That case, concerning an elderly woman with dementia, is still being looked into.

One of the Noord-Holland cases under investigation concerns an 84-year-old woman who felt her life had come to an end and had a variety of health issues. The second centres on a 67-year-old woman with Alzheimer. In that case, the woman had a living will but it had been drawn up years ago and not reconfirmed since.

The Oost-Nederland case concerns a woman with terminal cancer who underwent euthanasia while in a coma while the The Hague investigation focuses on a woman with severe lung emphysema. In that case, the committee felt that the doctors had not properly established that her situation was hopeless.

Policy

Last year, the public prosecution department updated its own policy rules for euthanasia and assisted suicide to focus on two criteria: whether a patient made a voluntarily and carefully considered choice for euthanasia and whether the patient’s suffering was ‘unbearable and hopeless’.

Chief prosector Rinus Otte, whose portfolio includes euthanasia, told Trouw (in Dutch) that the news of four new investigations does not mean that the law is being flouted. ‘It could be a few years before there is another investigation,’ he said. ‘We consider these four cases to be sufficiently serious. We are now investigating them, but that does not necessarily mean there will be a prosecution.’

Increase

The regional monitoring committee published its annual report on Wednesday which showed the number of people helped to die under Dutch euthanasia legislation rose 8% last year to 6,585.

In almost 90% of cases, the patient was suffering from cancer, heart and artery disease or diseases of the nervous system, such as Parkinson and MS. Three patients were in the advanced stage of dementia and 166 were in earlier stages.

Euthanasia is legal in the Netherlands under strict conditions. For example, the patient must be suffering unbearable pain and the doctor must be convinced the patient is making an informed choice. The opinion of a second doctor is also required.

Dementia

In 2016, the justice and health ministries relaxed the guidelines for performing euthanasia on people with severe dementia so that patients can be helped to die even if they incapable of making their current feelings known.

However, they do have to have signed a euthanasia declaration with their family doctor before they become seriously ill to be considered for help in dying.

‘In such cases, a doctor may carry out euthanasia, even if the patient cannot make this clear by word or gesture. But there must be a written euthanasia request which the patient completed earlier,’ the new guidelines state.

Read the public prosecution department statement (English).

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A woman’s final Facebook message before euthanasia: ‘I’m ready for my trip now...’

Assisted suicides in the Netherlands include a 29-year-old who had nothing wrong with her physically

Harriet Sherwood Sat 17 Mar 2018 21.00 GMT Last modified on Sun 18 Mar 2018 21.37 GMT

At 2pm on 26 January, Aurelia Brouwers lay down on her bed to die. Clutching a toy pink dinosaur and listening to her favorite music, the 29-year-old drank her prescribed medication as close friends gathered round. “She asked me to lie next to her. She had a smile on her face, and then she went softly into sleep,” Sjoukje Willering told the Observer. “It was very serene and calm. It was beautiful.”

Four hours earlier, Brouwers had posted her last message on Facebook. “I’m getting ready for my trip now. Thank you so much for everything. I’m no longer available from now on.” Brouwers died at home in the small Netherlands town of Deventer less than a month after being declared eligible for euthanasia under the country’s 2002 Termination of Life on Request and Assisted Suicide Act, which permits the ending of lives where there is “unbearable suffering” without hope of relief. Her death has triggered a fierce debate in a country that has one of the most permissive euthanasia laws in the world.

For not only was Brouwers young, she did not have a terminal disease such as cancer. She suffered from psychiatric illnesses, including severe anxiety, depression, eating disorders and psychosis. She self-harmed and had attempted suicide numerous times. She had spent nearly three years as an inpatient at a psychiatric hospital, and had served time in prison for arson.

Some say Brouwers’s death is a terrible illustration of the “slippery slope” inevitably associated with euthanasia legislation. Others who supported legalization now also fear it has gone too far. Her supporters see her case as an important precedent, an escape to those in hopeless situations. “Every day was so hard. She was in a deep black hole,” said Willering. “She said it felt like a hundred knives being stabbed into her head. She never had a moment of doubt that she wanted it to end.” Her death was inevitable, one way or another, she added. “But she wanted the right to die with dignity, and she wanted other psychiatric patients to know that they also have a choice. This was her message to the world.”

This month, annual figures from the bodies that review euthanasia cases in the Netherlands showed an 8.1% increase in assisted deaths in 2017, taking the total to nearly 6,600 people. It came on top of a 10% annual increase the previous year. The vast majority had cancer, heart and arterial disease, or diseases of the nervous system, such as Parkinson’s and multiple sclerosis. But 169 had dementia, up from 141 the previous year. And 83 had severe psychiatric illnesses – up from 64 in 2016. “Supply has created demand,” said Professor Theo Boer, who supported the 2002 legislation but resigned from a regulatory body in 2014 amid concern about rising numbers. “We’re getting used to euthanasia, that is exactly what should not happen. We’re no longer speaking about the exceptional situations that the law was created for, but a gradual process towards organized death.”

The review bodies found that in 99.8% of cases, euthanasia was carried out in line with legal guidelines. However, Dutch prosecutors have recently opened criminal investigations into four cases, and last year an investigation began into a 74-year-old woman with dementia who had requested euthanasia before her illness became severe. Confused and agitated, she had to be restrained by family members to allow a lethal injection to be administered.

The focus of the current review of Brouwers’s death is a large redbrick house in The Hague, close to a clutch of museums in the north of the city. It houses the Levenseindekliniek – End of Life Clinic – a last resort for those who have been refused euthanasia elsewhere. Brouwers came here after failing to convince her own doctors and psychiatrists that she met the criteria for euthanasia. According to Steven Pleiter, the clinic’s avuncular director, a doctor and a nurse assessed Brouwers and built a relationship with her over a long period.

Her case was also reviewed by a multidisciplinary group at the clinic. “Aurelia was known to us for years. She was young but had already been suffering for a long time. Our processes are very careful,” Pleiter said.

The Levenseindekliniek has 62 doctor-nurse teams working part-time, but is on a significant recruitment drive to meet the spiraling demand for euthanasia. In 2012, the first year it was open, the clinic helped 32 people to die. Last year the figure was 750. But, Pleiter pointed out, that was only 30% of 2,500 applicants. One in every four does not meet the legal criteria, another 25% withdraw their request, and 20% die while their cases are being evaluated. Last year 9% of those undergoing euthanasia through the clinic had psychiatric illnesses and 10% had dementia. The costs are covered by the country’s health insurance system.

“Death by euthanasia is 4% of all deaths in the Netherlands. Is that a slippery slope? I don’t think so,” said Pleiter. Much of the demand was coming from the baby-boomer generation, he added. “They are thinking differently about the way life ends. God and religion are less dominant in their lives. They want more autonomy. But every case is unique.”

The decision Brouwers had waited so long for came on New Year’s Eve. It was “the best present I could have”, she wrote. “She was very happy, but she also had some hard moments, knowing she had to say goodbye to friends and family,” said Willering. “She was very open about it. You could ask her at any moment, ‘Aurelia, is this really what you want?’ and she would say, ‘Yes, I want to die.’ ” Another friend, Toon Krijthe, also at her bedside when she died, said: “I was glad for her, because I knew this was her only option – and I knew if it wasn’t a yes, she would find another way.”

Brouwers spent the days until 26 January saying goodbye to friends and working on a television documentary that was broadcast after her death. “She also visited the crematorium to plan and rehearse her funeral,” Krijthe said. “She believed in God, and she prayed, but she didn’t go to church.”

On the appointed day, two doctors from the Levenseindekliniek were present as Brouwers swallowed the liquid medication prescribed for her. “It took about 10 or 15 minutes for her to fall into sleep. She was very ready for it,” Willering said. She was cremated a week later. Within the Netherlands, it was a huge news story. As well as the television documentary, Brouwers’s death was a front-page story in the regional paper, with an additional six pages inside. “Personally I sympathize with her, and I’m happy she got a humane death,” said Boer, who teaches ethics at the Theological University of Kampen. “But culturally, I’m concerned that her death is being portrayed as a brave solution to severe suffering. She had huge support on social media.

“A border is being crossed between individual empathy and societal acceptance. If it becomes a societal norm that a person who has a psychiatric condition can opt to die, that is a problem.”

However, according to Professor Agnes van der Heide, an end-of-life expert at Erasmus University in Rotterdam, public opinion surveys show “a substantial proportion of our population think the law should be even more liberal – especially with regard to dementia”. Many who see their parents or grandparents in the grip of advanced dementia wish to opt out of such a bleak end-of-life scenario for themselves.

Not all doctors agree. Last year a group of 220 took out a newspaper advertisement saying they would refuse to euthanize patients with dementia who were unable to give verbal consent, even if the individual had signed a declaration of wishes in advance. “Our moral abhorrence at ending the life of a defenseless person is too great,” they wrote.

“It’s difficult to see how you can administer a lethal injection to a patient who doesn’t understand what you’re doing. So there is a conflict between doctors and the public,” said Van der Heide.

Yet some want to go even further. Pia Dijkstra, an MP and member of the centrist-liberal D66 party, has proposed a law allowing anyone over 75, without a diagnosis of physical or mental illness, to request euthanasia. “There is a growing number of older people who want to decide themselves how their life should end – how, when and where, and in a dignified way. They feel their life has been good but it’s now complete. They want control. The existing euthanasia law doesn’t meet their needs,” she said.

A study is to be carried out before a bill goes to parliament, but Dijkstra said the proposal had the support of 60-70% of the public, with some arguing for no age restriction. “I have had an enormous number of emails and letters from elderly people who want this possibility. But it’s important to have a good debate. And it’s so important to let older people know they are valued by society, and that this should be their choice.”

Euthanasia advocates say people are helped to die regardless of the law. “About 80% of cases are reported to the review committees, which means 20% are not,” said Van der Heide. Some were in the area of so-called mercy killings, carried out by medical staff or family members; some involve palliative sedation, to relieve suffering but which ends in death. Penney Lewis, head of the Center of Medical Law and Ethics at King’s College London, said: “Underground euthanasia happens in permissive and prohibitive jurisdictions. It happens everywhere.”

Despite the permissiveness of Dutch law, many applicants are refused, she said. “There is a lot of debate among Dutch doctors about what constitutes unbearable and hopeless suffering. But I think a model based on suffering is preferable to one based on a diagnosis.

“I’m not convinced by the ‘slippery slope’ argument. Of course, there’s evidence that the more people understand that this is an option, a greater proportion will avail themselves of it.”

The “normalization” of euthanasia is of deep concern to Boer. “It is not good for society to have organized death facilitated by the state. A culture of euthanasia undermines our capacity to deal with suffering, and that is very bad for society.”

The Netherlands, Belgium and Luxembourg all have permissive laws on assisted dying and voluntary euthanasia, based on applicants’ suffering, and restricted to citizens of those countries. Switzerland allows assisted dying on compassionate grounds, and some clinics there, such as Dignitas, accept people who are not Swiss residents.

More restrictive laws exist elsewhere: assisted dying is legal in six US states (California, Colorado, Montana, Oregon, Vermont and Washington) plus Washington DC; in Canada; and in the Australian state of Victoria (after a campaign, pictured above (not available)). New Zealand is considering legislation. These are based on the “Oregon model”, which permits assisted dying for people with a terminal illness who are mentally competent and have a defined life expectancy.

In 2015, MPs in the UK voted against an assisted dying bill by 330 votes to 118. The campaign group Dignity in Dying advocates a law based on the Oregon model, covering people with less than six months to live. “Aurelia Brouwers made her choice in a very different legal context from the one we are campaigning for,” said Tom Davies of Dignity in Dying. The group is supporting Noel Conway, 68, who has motor neuron disease and has mounted a lawsuit to allow him a “peaceful and dignified death” by taking medication prescribed by a doctor. The court of appeal is expected to hear his case in May.

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David Goodall: 104-year-old scientist to end own life in Switzerland
Goodall’s decision is reigniting a debate about euthanasia in Australia where assisted suicide is illegal

Agence France-Presse in Sydney Mon 30 Apr 2018 16.18 BST Last modified on Tue 1 May 2018 00.58 BST

Australia’s oldest scientist, who caused a stir when his university tried to vacate his office aged 102, will fly to Switzerland in early May to end his life, reigniting a national euthanasia debate.

David Goodall, who is now 104, does not have a terminal illness but his quality of life has deteriorated and he has secured a fast-track appointment with an assisted dying agency in Basel, euthanasia advocates said.

“I greatly regret having reached that age,” the ecologist told broadcaster ABC on his birthday earlier this month. “I’m not happy. I want to die. It’s not sad particularly. What is sad is if one is prevented.

“My feeling is that an old person like myself should have full citizenship rights including the right of assisted suicide,” he added.

Assisted suicide is illegal in most countries around the world and was banned in Australia until the state of Victoria became the first to legalize the practice last year.

But that legislation, which takes effect from June 2019, only applies to terminally ill patients of sound mind and a life expectancy of less than six months.

Other states in Australia have debated euthanasia in the past, but the proposals have always been defeated, mostly recently in New South Wales state last year. It was legalized in the Northern Territory, which is not a state, in 1995, but the commonwealth government overturned that legislation in 1997.

Exit International, which is helping Goodall make the trip, said it was unjust that one of Australia’s “oldest and most prominent citizens should be forced to travel to the other side of the world to die with dignity”.

“A peaceful, dignified death is the entitlement of all who want it. And a person should not be forced to leave home to achieve it,” it said on its website Monday.

The group has launched a GoFundMe campaign to get plane tickets for Goodall and his helper upgraded to business class from economy and has so far raised more than A$17,000 ($13,000).

Goodall, an honorary research associate at Perth’s Edith Cowan University, made international headlines in 2016 when he was declared unfit to be on campus.

After an uproar and support from scientists globally, the decision was reversed.

He has produced dozens of research papers and until recently continued to review and edit for different ecology journals.


• This article was amended on 1 May 2018 to acknowledge the legalization of euthanasia in the Northern Territory from 1995 to 1997.

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'I Look Forward' To Ending My Life, Assisted Suicide Backer Says Before Dying

May 10, 20187:35 AM ET James Doubek

Australian scientist David Goodall attends a press conference on Wednesday on the eve of his assisted suicide in Basel.
Sebastien Bozon/AFP/Getty Images

With assisted suicide illegal in his home country of Australia, scientist David Goodall of Perth traveled to Basel, Switzerland to die at the facility of the assisted suicide advocacy group Life Circle.

The 104-year-old man told reporters Wednesday that he had no doubts about his decision, hours before he ended his life by assisted suicide on Thursday.

He died "peacefully" at 12:30 p.m. Thursday, Philip Nitschke of the assisted suicide advocacy group Exit International tweeted.

Goodall was an advocate for assisted dying for years as a member of Exit International; the group helped arrange his trip to Switzerland.

"It's my own choice to end my life ... and I look forward to that and am grateful to the Swiss medical profession to make that possible," Goodall said in Basel Wednesday, wearing a shirt bearing the words "Ageing Disgracefully."

"At my age, and even rather less than my age, one wants to be free to choose the death and when the death is the appropriate time," he added.

He said he hoped his story would "increase the pressure" for governments to change laws around assisted suicide.

Switzerland allows assisted suicide "for anyone who acknowledges in writing that they are taking their lives willingly — without being forced," according to The Associated Press. "The decades-old legislation that authorized the practice also says, somewhat vaguely, that people who help others to die cannot do so for 'selfish' reasons."

In 2015, 965 people died by assisted suicide in Switzerland, according to the country's federal statistics bureau.

Assisted suicide is outlawed in Australia, though the Australian state of Victoria passed a law to allow it last year that will go into effect in the middle of next year.

Several countries allow assisted suicide, including Belgium, Canada, Luxembourg and the Netherlands. The laws differ for euthanasia, in which a doctor actively administers a lethal drug, than for assisted suicide, which require the participants to take a type of active measure, like taking pills themselves.

In the U.S., California, Colorado, Hawaii, Oregon, Vermont, Washington state and Washington, D.C. have "death with dignity" laws, according to the advocacy group Death with Dignity, though these require a person to have a terminal illness.

Goodall, on the other hand, was not terminally ill. But he was "losing his faculties of sight and sound" and "his quality of life [was] fast diminishing," according to Exit International.

Goodall was asked if there was any particular song he wanted played in his final moments. He said, "If I had to choose something, I think it would be the final movement of Beethoven's Ninth Symphony," then Goodall burst out with a few bars of the tune in German.

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A judge in Riverside County on Tuesday overturned California's controversial assisted death law nearly two years after it took effect, ruling that the Legislature improperly passed the measure during a special session on health care funding.

The court is holding its judgment for five days, according to representatives for supporters and opponents of the law, to give the state time to file an emergency appeal.

"We're very satisfied with the court's decision today," said Stephen G. Larson, lead counsel for a group of doctors who sued in 2016 to stop the law. "The act itself was rushed through the special session of the Legislature and it does not have any of the safeguards one would expect to see in a law like this."

The state plans to seek expedited review in an appellate court, according to Attorney General Xavier Becerra, who said in a statement that he strongly disagreed with the ruling.

Assemblywoman Susan Talamantes Eggman, the Stockton Democrat who carried the bill, said Californians who are in the process of obtaining life-ending drugs through the law have had "the carpet ripped out from under their feet."

"It's a reminder for all of us that there are those out there who would like to take our rights away," she said. "When we move forward, there are those who would like to drag us back."

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