Euthanasia

Palinurus

The Living Force
Update on post #105 (September 28, 2017).

Source: Formal reprimand for doctor who performed euthanasia on dementia patient - DutchNews.nl

July 24, 2018

A doctor who performed euthanasia on a woman with severe dementia has been given a formal reprimand by the Dutch medical complaints board.

The case centers on a 74-year-old woman, who was diagnosed with dementia five years ago. At the time she completed a living will, saying she did not want to go into a home and that she wished to die when she considered the time was right.

After her condition deteriorated, she was placed in a nursing home where she became fearful and angry and took to wandering through the corridors at night. The nursing home doctor reviewed her case and decided that the woman was suffering unbearably, which would justify her wish to die.

The doctor put a drug designed to make her sleep into her coffee which is against the rules. She also pressed ahead with inserting a drip into the woman’s arm despite her protests and asked her family to hold her down, according to the official report on the death. This too contravenes the guidelines.

The medical complaints committee said the doctor was at fault for not trying to discuss the decision with the patient. The doctor has already been given a formal reprimand by the euthanasia complaints council for breaking the guidelines and the public prosecution department is also investigating the case.

Once the public prosecution department has finished its investigation it will decide whether or not the doctor, a specialist in geriatric medicine, should face criminal charges.The doctor has since retired.

Legislation

In 2016, the justice and health ministries relaxed the guidelines for performing euthanasia on people with severe dementia a little 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 too seriously ill to be considered for help in dying.

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.

Since the legislation was introduced in 2002, there have been a number of controversial cases, including a woman suffering severe tinnitus and a serious alcoholic.
 

Gary

The Living Force
FOTCM Member
Source: Doctors and families do not need legal permission to allow vegetative patients to die, court rules (UK court ruling).

End-of-life care: Doctors and families do not need legal permission to allow patients to die, court rules

No need for judge approval where experts and loved ones are in agreement about withdrawing food and water in best interests of patients unlikely to regain consciousness

Families will no longer need to go before the courts for approval to withdraw feeding tubes from loved ones in a permanent vegetative state, after a ruling by the UK’s highest court upheld the end of life decision making of a man with an extensive brain injury.

The 52-year-old, who can only be identified as Mr Y, had been in a vegetative state since June 2017. Experts said it was improbable he would ever regain consciousness and agreed with the family members’ decision to withdraw hydration and nutrition – something that usually requires approval from the Court of Protection.


Groups representing people with diminished capacity had appealed an earlier High Court ruling allowing this withdrawal, and Mr Y died in December while still being artificially fed. This appeal was dismissed by the Supreme Court on Monday, with lawyers warning a “vital legal safeguard” has now been compromised.

The decision means that where doctors and families are in agreement of the best interests of patients then there should be no need for a judge’s authorisation – a process which can take years to complete and cost local health authorities tens of thousands of pounds in legal bills for appeals.


Mr Y’s condition was classed as a prolonged disorder of consciousness (PDOC), which covers comas, vegetative and minimally conscious states after a brain injury. If he were to regain consciousness his doctors said he would likely have profound physical and cognitive disabilities and would be dependent on others for his care.

Though he had not drawn up an advance decision notice saying he would decline treatment in the event of falling into a vegetative state, Mr Y’s family were of the view that he would not want to be kept alive.

His family and doctors had agreed on a plan to withdraw clinically assisted nutrition and hydration (CANH), which would lead to him dying naturally within two to three weeks.

In November 2017, a High Court judge granted a declaration that it was not mandatory to bring before the court the withdrawal of CANH from Mr Y in circumstances where there was no dispute between his relatives and specialists.


She gave permission for an appeal by the official solicitor – who represents people who lack mental capacity – and CANH was provided in the meantime, but Mr Y died in December.

It was decided that the appeal before five Supreme Court justices should proceed because of the general importance of the issues raised.

Richard Gordon QC, for the official solicitor, said that the central issue was whether the obtaining of an order from the Court of Protection, before CANH could lawfully be withdrawn from a person in a PDOC, was unnecessary where treating clinicians and the family agreed it was not in the patient’s best interests.


He added: “This case is not about whether it is in the best interests of a patient to have CANH withdrawn. It is about who decides that question.”

Although the official solicitor accepts there is no statutory requirement to bring such cases to court, he argues that the common law or human rights law require that every case involving the withdrawal of CANH be the subject of a best interests application regardless of whether there is a dispute.

On Monday, the justices unanimously dismissed the appeal.

Lady Black, a Supreme Court justice, said: “Having looked at the issue in its wider context as well as from a narrower legal perspective, I do not consider that it has been established that the common law or the ECHR (European Convention on Human Rights), in combination or separately, give rise to the mandatory requirement, for which the official solicitor contends, to involve the court to decide upon the best interests of every patient with a prolonged disorder of consciousness before CANH can be withdrawn.


“If the provisions of the MCA 2005 (Mental Capacity Act) are followed and the relevant guidance observed, and if there is agreement upon what is in the best interests of the patient, the patient may be treated in accordance with that agreement without application to the court.”

She emphasised that, although application to court was not necessary in every case, there would undoubtedly be cases in which an application would be required – or desirable – because of the particular circumstances and there should be no reticence about involving the court in such cases.

“The court heard evidence that it is difficult even to diagnose some of the conditions,” said David Foster, a partner at Barlow Robbins law firm who has been involved in many of the major end of life cases in the past 12 years and acts as an intervener for the Care Not Killing alliance.

“The oversight of the official solicitor was helpful and we fear a vital legal safeguard has been compromised for those who are the most vulnerable.”
 

Palinurus

The Living Force
BBC's Radio Four recently dedicated a program to the Aurelia Brouwers case already mentioned on March 28, 2018 in Reply #115, then in response to an article in the Guardian newspaper.

The troubled 29-year-old helped to die by Dutch doctors (eight photos omitted):

The troubled 29-year-old helped to die by Dutch doctors

By Linda Pressly BBC News, The Netherlands
9 August 2018

In January a young Dutch woman drank poison supplied by a doctor and lay down to die. Euthanasia and doctor-assisted suicide are legal in Holland, so hers was a death sanctioned by the state. But Aurelia Brouwers was not terminally ill - she was allowed to end her life on account of her psychiatric illness.

"I'm 29 years old and I've chosen to be voluntarily euthanized. I've chosen this because I have a lot of mental health issues. I suffer unbearably and hopelessly. Every breath I take is torture…"

A team from the Dutch TV network, RTL Nieuws spent two weeks recording Aurelia as she journeyed towards her date with death - 2pm on Friday, 26 January. On a whiteboard in her home, she crossed off the days with a heavy black marker pen.

During those last weeks, she spent her time with loved ones, doing craftwork and riding her bike in Deventer, the city she adored. She also visited the crematorium - the place she had chosen for her own funeral service.

In many ways her story is uniquely Dutch. Euthanasia is against the law in most countries, but in the Netherlands it is allowed if a doctor is satisfied a patient's suffering is "unbearable with no prospect of improvement" and if there is "no reasonable alternative in the patient's situation".

These criteria may be more straightforward to apply in the case of someone with a terminal diagnosis from untreatable cancer, who is in great pain. And the vast majority of the 6,585 deaths from euthanasia in Holland in 2017 were cases of people with a physical disease. But 83 people were euthanized on the grounds of psychiatric suffering. So these were people - like Aurelia - whose conditions were not necessarily terminal.

Aurelia Brouwers' wish to die came with a long history of mental illness.

"When I was 12, I suffered from depression. And when I was first diagnosed, they told me I had Borderline Personality Disorder," she says. "Other diagnoses followed - attachment disorder, chronic depression, I'm chronically suicidal, I have anxiety, psychoses, and I hear voices."

Aurelia's doctors would not endorse her requests for euthanasia. So she applied to the Levenseindekliniek - the End of Life Clinic - in The Hague. This is a place of last resort for those whose applications have been rejected by their own psychiatrist or GP. The clinic oversaw 65 of the 83 deaths approved on psychiatric grounds in Holland last year, though only about 10% of psychiatric applications are approved, and the process can take years.

"The psychiatric patients we see are younger than others," says Dr Kit Vanmechelen, a psychiatrist who assesses applicants and performs euthanasia, but was not directly involved in Aurelia's death.

"Aurelia Brouwers is an example of a very young woman. And that makes it harder to make the decision because in those cases, you take away a lot of life."

During her last two weeks of life, Aurelia was often distressed and had self-harmed.

"I'm stuck in my own body, my own head, and I just want to be free," she said. "I have never been happy - I don't know the concept of happiness."

"She was really not as stable during the day," remembers Sander Paulus, the RTL Nieuws journalist who spent much of that last fortnight with her. "You just felt there was a lot of pressure in her head. She didn't speak that well any more - except when we talked about euthanasia. She was very clear on that."

But does clarity mean someone has the mental capacity to choose death over life? According to Dutch law, a doctor must be satisfied a patient's request for euthanasia is, "voluntary and well-considered".

Aurelia Brouwers argued she was competent to make the decision. But could a death wish have been a symptom of her psychiatric illness?

"I think you never can be 100% sure of that," says Kit Vanmechelen. "But you must have done everything to help them diminish the symptoms of their pathology. In personality disorders a death wish isn't uncommon. If that is consistent, and they've had their personality disorder treatments, it's a death wish the same as in a cancer patient who says, 'I don't want to go on to the end.'"

This view is not universally held by psychiatrists in the Netherlands.

"How could I know - how could anybody know - that her death wish was not a sign of her psychiatric disease? The fact that one can rationalize about it, does not mean it's not a sign of the disease," says psychiatrist Dr Frank Koerselman, one of Holland's most outspoken critics of euthanasia in cases of mental illness.

He argues psychiatrists should never collude with clients who claim they want to die.

"It is possible not to be contaminated by their lack of hope. These patients lost hope, but you can stay beside them and give them hope. And you can let them know that you will never give up on them," he says.

Aurelia Brouwers' death provoked huge debate in the Netherlands, and made headlines around the world. No-one has suggested it was illegal, although critics have asked whether it was the kind of case for which the 2002 legislation allowing euthanasia was enacted.

Opinions divide on whether there was an acceptable alternative. For example Kit Vanmechelen argues that when people apply for euthanasia on psychiatric grounds, in some cases they will kill themselves if they don't get it. In her view, they should be regarded as people with terminal illnesses.

"I've treated patients that I knew were going to commit suicide," she says. "I knew. They told me, I felt it, and I thought, 'I can't help you.' So to have euthanasia as an alternative makes me very grateful we have a law. The ones I know will commit suicide are terminal in my opinion. And I don't want to abandon my patients who are not able to go on with their lives. That makes me willing to perform euthanasia."

"I simply disagree," says Frank Koerselman. "My whole career I worked with suicidal patients - none of them was terminal. Of course I had patients who committed suicide, but as a matter of fact these were always cases when you didn't expect it."

In RTL's film, Aurelia Brouwers talks about attempts to end her own life.

"I think I tried about 20 times. I was critical a few times, but I often got to hear that my heart and lungs were so healthy. The doctors said, 'It's a miracle, she made it.'"

And surviving a suicide attempt is not unusual - people do it every day.

Monique Arend, like Aurelia Brouwers, was diagnosed with psychiatric illness including Borderline Personality Disorder. People with this condition may self-harm, have intense feelings of anger, find it hard to sustain relationships, and experience emotional instability. Monique made many attempts to kill herself.

"It happened everywhere - at home, in the forest... But I'm very grateful I'm still alive today," she says.

Monique is a survivor of violent sexual abuse, and terrifying psychiatric episodes. She thought long and hard about euthanasia.

"I thought I was a big problem for everyone, and I just didn't want to be that burden, and the pain became unbearable. So I requested the forms for euthanasia, and filled them in. But I never filed them."

Monique did not file those papers because she found help. In the early days of her illness, a counselor had advised her not to talk about the abuse - this is when she began to self-harm. But then she found a new therapist who specialized in trauma.

"She told me I'm not crazy, but I'm traumatized - that's a big difference. We worked very hard together - it was very painful. But we went through it, and since then I've been on a recovery trip," Monique says.

She has written a book about her experiences, and has some advice for people struggling with suicidal thoughts or considering euthanasia in Holland.

"It's heavy, hard and tough," she says. "But keep a candle burning. Look for people who can support you. You guys are so powerful because you've been through so much - there's still room for you on this planet."

The discomfort around euthanasia for psychiatric patients is partly to do with a concern that all options may not have been explored. At the End of Life Clinic in The Hague more than half of those who come seeking euthanasia on psychiatric grounds are turned away because they have not tried all available treatments.

"I had a patient who had a lot of treatments, and was convinced nothing more could help him. But he had never been in a clinic to help with abuse of prescription medicine and alcohol," says Kit Vanmechelen. "So I said to him, 'For half a year you must make a real effort to lessen your use of those, and if then you still have a death wish, well, come back and we'll talk.'"

But Vanmechelen believes that after a patient has undergone multiple treatments for the same diagnosis, it is reasonable to say, enough is enough.

This was what Aurelia Brouwers argued too. She had been treated for her illness - she had therapy and took medication - but we do not know the details.

"We need to get rid of the taboo that you should always remain in treatment, until the bitter end," she said. "For people like me there isn't always a solution - you can't keep taking medicine, you can't pray indefinitely… At some point you just have to stop."

But people can and do live for decades with psychiatric disorders.

"They're not treatable like an infection, they're like diabetes - you've got the disease, you will have it the rest of your life, but we, as doctors, are going to make it possible for you to live with it," argues Frank Koerselman.

"Like people with diabetes, psychiatric patients are also treated for years, but this is not an argument to stop treatment.

"It's very well known that after the age of 40 things might go much better for people with Borderline Personality Disorder - their symptoms might become much milder."

Aurelia Brouwers died more than a decade before she reached 40. On her last full day on Earth she was visited by her favourite singer, Marco Borsato. That night, she had dinner with her friends - there was laughter, and a toast. On the morning of 26 January she posted for the final time on social media:

"I'm getting ready for my trip now. Thank you so much for everything. I'm no longer available from now on."

Aurelia Brouwers' loved ones assembled in her bedroom. Two medics were in attendance.

"I'm sure that the moment I give the poison - because that's what you do, you give poison - I'm very sure that is the only thing the patient wants at that moment and has wanted for a long period, otherwise I wouldn't be able to do it," says Kit Vanmechelen.

"In the first meeting with a patient, I tell them, this will be the last question I ask you: 'Are you sure you want this? And if there is a little doubt, we will stop, come back, and talk about it again.'"

And has that ever happened to her?

"No. It doesn't happen."

In Aurelia's case, doctors did not administer the drugs that killed her - she drank the medication herself.

In the RTL Nieuws documentary, she has a last conversation with Sander Paulus, as she holds the small, sealed medicine bottle.

"This is the drink," she says. "I know it tastes bitter, so I'm just going to drink it down. And then I'm going to sleep."

Sander Paulus asks her if she has any doubts.

"No doubts," Aurelia says. "I'm ready - ready to go on a journey."

"I hope you find what you're looking for," he says.

"I definitely will," is Aurelia's reply.

Aurelia Brouwers turns her back on Sander Paulus, and climbs the stairs. It is just after 2pm on Friday, 26 January, 2018.

NOTE: The RTL Nieuws documentary (in Dutch, no subs) is still available here after free registration to log in.
 

Palinurus

The Living Force
Source: Living wills are often too old to sanction euthanasia: research - DutchNews.nl

Living wills are often too old to sanction euthanasia: research

August 22, 2018

A large number of the euthanasia declarations signed by people in the Netherlands are useless because they have not been regularly updated, according to research by a Dutch family doctor.

Matthijs van Wijmen has followed thousands of people who have set down their wish to die by euthanasia should they become senile, incapacitated or terminally ill.

However, doctors cannot perform euthanasia on the basis of an old declaration, and fewer than half of people with a living will update it, Van Wijmen told Trouw on Wednesday (Dutch only).

Anyone can draw up a living will but the two Dutch voluntary euthanasia societies publish standard versions. However, just 42% of NVVE and 28% of NPV members had discussed their wishes with their family doctor within the six year period of the research, meaning their declarations were likely to be considered void, Van Wijmen found.

There is no official guideline for determining how often a living will should be updated. However, earlier this year a doctor was reprimanded by the euthanasia regulatory body because she had carried out euthanasia on someone whose living will was five years old.

‘This [is] one of the most pressing issues,’ an NVVE spokesman told Trouw. ‘We are in talks with doctors about coming up with guidelines.’

Rules

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

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

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.
 

Palinurus

The Living Force
Source: Fewer cases of euthanasia last year; doctors' concerns may be to blame - DutchNews.nl

Fewer cases of euthanasia last year; doctors’ concerns may be to blame

October 16, 2018

The number of reported cases of euthanasia has fallen for the first time since the practice was formalized in 2002, Trouw reported [in Dutch] on Tuesday.

There were 4,600 cases of euthanasia in the Netherlands in the first nine months of this year, a drop of 9% on the same period in 2017, Trouw said.

Jacob Kohnstamm, chairman of the regional euthanasia monitoring committee, told the paper he is surprised at the reduction. ‘Given the greying of the population, an increase was to have been expected,’ he said.

One possible explanation for the downturn is last winter’s flu epidemic, which may have led to some people who would have requested euthanasia having a natural death, the paper quoted him as saying.

However, family doctors dispute this, saying that euthanasia is usually requested by cancer patients and it is the frail elderly who are worst affected by flu.

And a spokesman for the voluntary euthanasia society told Trouw that the decision by the public prosecution department to launch five criminal investigations into euthanasia cases may have had an impact.

‘Our members are telling us that doctors are becoming more wary,’ spokesman Dick Bosscher told the paper.

Cancer

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.
 

Palinurus

The Living Force
Source: Doctor will not be prosecuted for euthanasia of semi-conscious woman of 72 - DutchNews.nl

Doctor will not be prosecuted for euthanasia of semi-conscious woman of 72

October 26, 2018 - By Senay Boztas

Prosecutors will not pursue a case against a doctor who performed euthanasia on a 72-year-old woman in a state of semi-consciousness, the public prosecutor announced on Friday [Dutch only].

The case in April 2017 was one of a number referred to the public prosecution for potentially breaking strict rules by the Regional Euthanasia Review Committees, which assesses all cases each year.

She had advanced and incurable cancer, was suffering ‘unbearably’, and two days before the procedure had a cerebral hemorrhage resulting in a coma. Afterwards, she found it difficult to speak and was less aware of her surroundings.

The public prosecution service, however, said it was convinced that the woman’s wish for euthanasia was voluntary, well-considered, and that she could properly communicate her wishes by nodding her head and gesturing with her hands.

‘This meant that a written declaration of intent was not necessary,’ said the service in a news release. She had also expressed her wish for euthanasia several times before the brain hemorrhage, and was clearly in pain and suffering unbearably with no hope of treatment, it concluded.

The RTE had referred on the case (2017-73) saying that the doctor breached its criteria for due care but the public prosecutor has confirmed that the doctor – who has not been named – did ‘act in accordance with care standards’.

Another four criminal investigations are underway into other euthanasia cases, and earlier this year Trouw reported that numbers are apparently falling for the first time since the 2002 euthanasia law – possibly due to increased criminal investigations.
 

Palinurus

The Living Force
Archiving the latest from SOTT (Will Maule - Faithwire - Wed, 17 Oct 2018):

Canadian hospital releases assisted suicide plan for kids, may not even inform parents -- Sott.net

A group of medics from a Toronto children's hospital have released a shocking paper which outlines its controversial position on child euthanasia. In the paper, published at the British Medical Journal, Toronto's Hospital for Sick Children revealed that in some cases, the young person's parents will not be notified of the intention to end their own lives until after the death is confirmed.

"Usually, the family is intimately involved in this (end-of-life) decision-making process," the pediatric doctors, administrators and ethicists noted in a Sept. 21 paper published in the BMJ.
"If, however, a capable patient explicitly indicates that they do not want their family members involved in their decision-making, although health care providers may encourage the patient to reconsider and involve their family, ultimately the wishes of capable patients with respect to confidentiality must be respected."​
In the east-central Canadian province of Ontario, parents are not required to be involved in any "capable" child's decision to end their own life.

It is a terrifying prospect - that a child could choose to engage in physician-assisted suicide without the involvement of their own parents. Obviously, this has caused grave concern among certain ethicists and pro-life researchers.

"It is not difficult to imagine how such a protocol could wreak havoc on society," commented Monica Burke, a research assistant in the DeVos Center for Religion and Civil Society at The Heritage Foundation. "When a culture differentiates between lives worth living and lives worth ending, the consequences to vulnerable populations - the young, the old, the sick, and disabled - are disastrous."

Burke added that, as a result of the twisted and dark progression of euthanasia legislation, "those who most require our compassion and protection become the most likely to be pressured to prematurely end their lives." We can be sure that a truly heinous cultural moment has arrived when children are offered "suicide assistance" instead of "suicide prevention."

The scholar noted that this Canadian hospital's ethically bankrupt policy is a clear-cut signal that there is now "no natural, logical limit to who qualifies for physician-assisted suicide." Assisted suicide is on its way to becoming utterly indiscriminate, with little legal constraint and a subsequent whittling away of the sanctity of life.

But despite Canada's insatiable penchant for liberalizing euthanasia laws, a damning study published by the Canadian Institute for Health Information revealed that a mere 15 percent of dying Canadians have access to quality palliative during the last year of their life. Indeed, it is clear that the legislative emphasis has been placed on the ending of life, rather than the sustaining of it.

"We all know that in Canada, an ER visit for a frail elderly person (the main clientele for palliative care) means lying on a gurney in a hallway for hours," wrote André Picard at Canadian newspaper, the Globe and Mail. "That is the last place a dying person - often confused, incontinent and in pain - should be. This kind of humiliation is untenable and we should be ashamed at how commonplace it is."

Earlier this year, a leading American bioethicist backed a Dutch law that effectively eradicates all age limits for euthanasia - meaning children can be medically, and legally, executed. Presently, euthanasia in The Netherlands is legal starting at age 12. You would expect that American experts would be appalled by this law, but that's not the case. U.S. Ethics Professor Margaret P. Battin actively supported it, and essentially advocated for the 2004 infant euthanasia policy called the "Groningen Protocol."

The Protocol contains directives with criteria under which physicians can perform "active ending of life on infants" without fear of prosecution.
"I generally support [the] change in Dutch law governing eligibility for euthanasia.‍ Given that euthanasia is currently legal for infants <1 year of age and children and adults >12 years of age, I believe that opponents would have to show evidence that at least 1 and perhaps many of the following propositions are true if they are to persuade you [a hypothetical Dutch health minister] not to support the change in the law," Prof. Battin said in a round-table discussion on the issue in the Pediatrics journal.​
Battin then listed a few shocking propositions that must be proved wrong, one of which being, "parents aren't harmed by seeing their children suffer." So, if a parent feels that they are suffering from the sight of their child going through pain, it is OK to "put them down."

Euthanasia is illegal in most of the United States, with exceptions made in California, Colorado, Oregon, Vermont, Hawaii and Washington.
 

Palinurus

The Living Force
Source: Euthanasia doctor faces prosecution over dementia patient death - DutchNews.nl

Euthanasia doctor faces prosecution over dementia patient death

November 9, 2018

A geriatric doctor who helped a nursing home patient with severe dementia to die will be prosecuted for breaking euthanasia guidelines the public prosecution department said on Friday.

The case will be the first to come to court since the guidelines were established by law 2002. The doctor was given a formal reprimand earlier this year after the case was highlighted by the regional euthanasia monitoring committee.

‘This case addresses important legal issues regarding the termination of life of dementia patients,’ the department said in a statement. ‘This case has been referred to court to get these questions answered.’

The case centers on a 74-year-old woman who had drawn up a living will some years before her admission to the nursing home, ‘but it was unclear and contradictory’, the department said.

‘Although the woman had regularly stated that she wanted to die, on other occasions she had said that she did not to want to die,’ the department said in a statement.

‘The department believes the doctor should have checked with the woman whether she still had a death wish by discussing this with her,’ the statement said. ‘The fact that she had become demented does not alter this, because the law also requires the doctor to verify the euthanasia request in such a situation.’

Two other cases referred to the public prosecutor by the monitoring committee are still being assessed.

Controversy

In 2016, the justice and health ministries relaxed the guidelines for performing euthanasia on people with severe dementia a little 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 too seriously ill to be considered for help in dying.

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.

Since the legislation was introduced in 2002, there have been a number of controversial cases, including a woman suffering severe tinnitus and a serious alcoholic.

Similar coverage here: Dutch to prosecute doctor in euthanasia case; A first since legalizing assisted suicide
 

Palinurus

The Living Force
Source: Death on demand: has euthanasia gone too far?
(three photographs omitted)
Death on demand: has euthanasia gone too far?

Fri 18 Jan 2019 06.00 GMT

Countries around the world are making it easier to choose the time and manner of your death. But doctors in the world’s euthanasia capital are starting to worry about the consequences

By Christopher de Bellaigue

Fri 18 Jan 2019 06.00 GMT Last modified on Fri 18 Jan 2019 09.09 GMT


Last year a Dutch doctor called Bert Keizer was summoned to the house of a man dying of lung cancer, in order to end his life. When Keizer and the nurse who was to assist him arrived, they found around 35 people gathered around the dying man’s bed. “They were drinking and guffawing and crying,” Keizer told me when I met him in Amsterdam recently. “It was boisterous. And I thought: ‘How am I going to cleave the waters?’ But the man knew exactly what to do. Suddenly he said, ‘OK, guys!’ and everyone understood. Everyone fell silent. The very small children were taken out of the room and I gave him his injection. I could have kissed him, because I wouldn’t have known how to break up the party.”

Keizer is one of around 60 physicians on the books of the Levenseindekliniek, or End of Life Clinic, which matches doctors willing to perform euthanasia with patients seeking an end to their lives, and which was responsible for the euthanasia of some 750 people in 2017. For Keizer, who was a philosopher before studying medicine, the advent of widespread access to euthanasia represents a new era. “For the first time in history,” he told me, “we have developed a space where people move towards death while we are touching them and they are in our midst. That’s completely different from killing yourself when your wife’s out shopping and the kids are at school and you hang yourself in the library – which is the most horrible way of doing it, because the wound never heals. The fact that you are a person means that you are linked to other people. And we have found a bearable way of severing that link, not by a natural death, but by a self-willed ending. It’s a very special thing.”

This “special thing” has in fact become normal. Everyone in the Netherlands seems to have known someone who has been euthanized, and the kind of choreographed farewell that Keizer describes is far from unusual. Certainly, the idea that we humans have a variety of deaths to choose from is more familiar in the Netherlands than anywhere else. But the long-term consequences of this idea are only just becoming discernible. Euthanasia has been legal in the Netherlands for long enough to show what can happen after the practice beds in. And as an end-of-life specialist in a nation that has for decades been the standard bearer of libertarian reform, Keizer may be a witness to the future that awaits us all.

In 2002, the parliament in the Hague legalized euthanasia for patients experiencing “unbearable suffering with no prospect of improvement”. Since then, euthanasia and its close relation, assisted dying, in which one person facilitates the suicide of another, have been embraced by Belgium and Canada, while public opinion in many countries where it isn’t on the national statute, such as Britain, the US and New Zealand, has swung heavily in favor.

The momentum of euthanasia appears unstoppable; after Colombia, in 2015, and the Australian state of Victoria, in 2017, Spain may be the next big jurisdiction to legalize physician-assisted death, while one in six Americans (the majority of them in California) live in states where it is legal. In Switzerland, which has the world’s oldest assisted dying laws, foreigners are also able to obtain euthanasia.

If western society continues to follow the Dutch, Belgian and Canadian examples, there is every chance that in a few decades’ time euthanasia will be one widely available option from a menu of possible deaths, including an “end of life” poison pill available on demand to anyone who finds life unbearable. For many greying baby boomers – veterans of earlier struggles to legalize abortion and contraception – a civilized death at a time of their choosing is a right that the state should provide and regulate. As this generation enters its final years, the precept that life is precious irrespective of one’s medical condition is being called into question as never before.

As the world’s pioneer, the Netherlands has also discovered that although legalizing euthanasia might resolve one ethical conundrum, it opens a can of others – most importantly, where the limits of the practice should be drawn. In the past few years a small but influential group of academics and jurists have raised the alarm over what is generally referred to, a little archly, as the “slippery slope” – the idea that a measure introduced to provide relief to late-stage cancer patients has expanded to include people who might otherwise live for many years, from sufferers of muscle-wasting diseases such as multiple sclerosis to sexagenarians with dementia and even mentally ill young people.

Perhaps the most prominent of these skeptics is Theo Boer, who teaches ethics at the Theological University of Kampen. Between 2005 and 2014, Boer was a member of one of the five regional boards that were set up to review every act of euthanasia and hand cases over to prosecutors if irregularities are detected. (Each review board is composed of a lawyer, a doctor and an ethicist.) Recent government figures suggest that doubts over the direction of Dutch euthanasia are having an effect on the willingness of doctors to perform the procedure. In November, the health ministry revealed that in the first nine months of 2018 the number of cases was down 9% compared to the same period in 2017, the first drop since 2006. In a related sign of a more hostile legal environment, shortly afterwards the judiciary announced the first prosecution of a doctor for malpractice while administering euthanasia.

It is too early to say if euthanasia in the Netherlands has reached a high-water mark – and too early to say if the other countries that are currently making it easier to have an assisted death will also hesitate if the practice comes to be seen as too widespread. But it is significant that in addition to the passionate advocacy of Bert Keizer – who positively welcomes the “slippery slope” – Boer’s more critical views are being solicited by foreign parliamentarians and ethicists who are considering legal changes in their own countries. As Boer explained to me, “when I’m showing the statistics to people in Portugal or Iceland or wherever, I say: ‘Look closely at the Netherlands because this is where your country may be 20 years from now.’”

“The process of bringing in euthanasia legislation began with a desire to deal with the most heartbreaking cases – really terrible forms of death,” Boer said. “But there have been important changes in the way the law is applied. We have put in motion something that we have now discovered has more consequences than we ever imagined.”

Bert Keizer carried out his first euthanasia in 1984. Back then, when he was working as a doctor in a care home, ending the life of a desperately ill person at their request was illegal, even if prosecutions were rare. When a retired shoemaker called Antonius Albertus, who was dying of lung cancer, asked to be put out of his misery, Keizer found that two sides of himself – the law-abiding doctor and the altruist – were at odds.

“Antonius wasn’t in pain,” Keizer told me, “but he had that particular exhaustion that every oncologist knows, a harrowing exhaustion, and I saw him dwindle before me.” In the event, Keizer, who as an 11-year-old watched his mother suffer an excruciating death from liver disease, went with the altruist. He injected 40mg of Valium into Antonius – enough to put him in a coma – then gave him the anti-respiratory drug that ended his life.

Keizer was not investigated after reporting an unnatural death at his own hand, and his career did not suffer as he feared it might. But what, I asked him, had prompted him to break the law, and violate a principle – the preservation of life – that has defined medical ethics since Hippocrates? Keizer paused to brush away a spider that had crawled uninvited on to my shoulder. “It was something very selfish,” he replied. “If ever I was in his situation, asking for death, I would want people to listen to me, and not say, ‘It cannot be done because of the law or the Bible.’”

Over the past few decades the Bible has been increasingly sidelined, and the law has vindicated the young doctor who put Antonius to sleep. As people got used to the new law, the number of Dutch people being euthanized began to rise sharply, from under 2,000 in 2007 to almost 6,600 in 2017. (Around the same number are estimated to have had their euthanasia request turned down as not conforming with the legal requirements.) Also in 2017, some 1,900 Dutch people killed themselves, while the number of people who died under palliative sedation – in theory, succumbing to their illness while cocooned from physical discomfort, but in practice often dying of dehydration while unconscious – hit an astonishing 32,000. Altogether, well over a quarter of all deaths in 2017 in the Netherlands were induced.

One of the reasons why euthanasia became more common after 2007 is that the range of conditions considered eligible expanded, while the definition of “unbearable suffering” that is central to the law was also loosened. At the same time, murmurs of apprehension began to be heard, which, even in the marvelously decorous chamber of Dutch public debate, have risen in volume. Concerns center on two issues with strong relevance to euthanasia: dementia and autonomy.

Many Dutch people write advance directives that stipulate that if their mental state later deteriorates beyond a certain point – if, say, they are unable to recognize family members – they are to be euthanized regardless of whether they dissent from their original wishes. But Last January a medical ethicist called Berna Van Baarsen caused a stir when she resigned from one of the review boards in protest at the growing frequency with which dementia sufferers are being euthanized on the basis of a written directive that they are unable to confirm after losing their faculties. “It is fundamentally impossible,” she told the newspaper Trouw, “to establish that the patient is suffering unbearably, because he can no longer explain it.”

Van Baarsen’s scruples have crystallized in the country’s first euthanasia malpractice case, which prosecutors are now preparing. (Three further cases are currently under investigation.) It involves a dementia sufferer who had asked to be killed when the “time” was “right”, but when her doctor judged this to be the case, she resisted. The patient had to be drugged and restrained by her family before she finally submitted to the doctor’s fatal injection. The doctor who administered the dose – who has not been identified – has defended her actions by saying that she was fulfilling her patient’s request and that, since the patient was incompetent, her protests before her death were irrelevant. Whatever the legal merits of her argument, it hardly changes what must have been a scene of unutterable grimness.

The underlying problem with the advance directives is that they imply the subordination of an irrational human being to their rational former self, essentially splitting a single person into two mutually opposed ones. Many doctors, having watched patients adapt to circumstances they had once expected to find intolerable, doubt whether anyone can accurately predict what they will want after their condition worsens.

The second conflict that has crept in as euthanasia has been normalized is a societal one. It comes up when there is an opposition between the right of the individual and society’s obligation to protect lives. “The euthanasia requests that are the most problematic,” explains Agnes van der Heide, professor of medical care and end-of-life decision-making at the Erasmus Medical Center in Rotterdam, “are those that are based on the patient’s autonomy, which leads them to tell the doctor: ‘You aren’t the one to judge whether I am to die.’” She doesn’t expect this impulse, already strong among baby boomers, to diminish among coming generations. “For our young people, the autonomy principle is at the forefront of their thinking.”

The growing divisions over euthanasia are being reflected in the deliberations of the review boards. Consensus is rarer than it was when the only cases that came before them involved patients with late-stage terminal illnesses, who were of sound mind. Since her resignation, Berna Van Baarsen has complained that “legal arguments weigh more and more heavily” on the committees, “while the moral question of whether in certain cases good is done by killing, threatens to get snowed under”.

In this new, more ambiguous environment, the recent dip in euthanasia numbers doesn’t seem surprising. Besides their fear of attracting prosecutors’ attention, some doctors have been irked by the growing public perception that they are no-questions-asked purveyors of dignified death, and are pushing back. For Dutch GP's, fielding demands for euthanasia from assertive patients who resent the slightest reluctance on the part of their physician has become one of the more disagreeable aspects of their job.

“In the coldest weeks of last winter,” Theo Boer told me, “a doctor friend of mine was told by an elderly patient: ‘I demand to have euthanasia this week – you promised.’ The doctor replied: ‘It’s -15C outside. Take a bottle of whisky and sit in your garden and we will find you tomorrow, because I cannot accept that you make me responsible for your own suicide.’ The doctor in question, Boer said, used to perform euthanasia on around three people a year. He has now stopped altogether.

Although he supported the 2002 euthanasia law at the time, Boer now regrets that it didn’t stipulate that the patient must be competent at the time of termination, and that if possible the patient should administer the fatal dose themselves. Boer is also concerned about the psychological effect on doctors of killing someone with a substantial life expectancy: “When you euthanize a final-stage cancer patient, you know that even if your decision is problematic, that person would have died anyway. But when that person might have lived decades, what is always in your mind is that they might have found a new balance in their life.”


In November 2016, Monique and Bert de Gooijer, a couple from Tilburg, became minor celebrities when a regional paper, the Brabants Dagblad, devoted an entire issue to the euthanasia of their son, an obese, darkly humorous, profoundly disturbed 38-year-old called Eelco. His euthanasia was one of the first high-profile cases involving a young person suffering from mental illness. Of the hundreds of reactions the newspaper received, most of them supportive, the one that made the biggest impression on the de Gooijers came from a woman whose daughter had gone out one day, taking the empty bottles to the store, and walked in front of a train. “She envied us,” Monique told me as I sat with her and Bert in their front room, “because she didn’t know why her daughter had done it. She said: ‘You were able to ask Eelco every question you had. I have only questions.’”

Privately, even surreptitiously undertaken, suicide leaves behind shattered lives. Even when it goes according to plan, someone finds a body. That openly discussed euthanasia can cushion or even obviate much of this hurt is something I hadn’t really considered before meeting the de Gooijers. Nor had I fully savored the irony that suicide, with its high risk of failure and collateral damage, was illegal across Europe until a few decades ago, while euthanasia, with its apparently more benign – at least, more manageable – consequences, remains illegal in most countries.

Whatever the act of killing a physically healthy young man tells us about Dutch views of human well being, the demise of Eelco de Gooijer didn’t traumatize a train driver or a weekender fishing in a canal. Eelco was euthanized only after long thought and discussions with his family. He enjoyed a good laugh with the undertaker who had come to take his measurements for a super-size coffin. He was able to say farewell to everyone who loved him, and he died, as Monique and Bert assured me, at peace. There might be a word for this kind of suicide, the kind that is acceptable to all parties. Call it consensual.

“You try to make your child happy,” Monique said in her matter-of-fact way, “but Eelco wasn’t happy in life. He wanted to stop suffering, and death was the only way.” Eelco came of age just as euthanasia was being legalized. After years of being examined by psychiatrists who made multiple diagnoses and prescribed a variety of ineffective remedies, he began pestering the doctors of Tilburg to end his life.

Euthanasia is counted as a basic health service, covered by the monthly premium that every citizen pays to his or her insurance company. But doctors are within their rights not to carry it out. Unique among medical procedures, a successful euthanasia isn’t something you can assess with your patient after the event. A small minority of doctors refuse to perform it for this reason, and others because of religious qualms. Some simply cannot get their heads around the idea that they must kill people they came into medicine in order to save.
Those who demur on principle are a small proportion of the profession, perhaps less than 8%, according to the end-of-life specialist Agnes van der Heide. The reason why there is no uniformity of response to requests for euthanasia is that the doctor’s personal views – on what constitutes “unbearable suffering”, for instance – often weigh decisively. As the most solemn and consequential intervention a Dutch physician can be asked to make, and this in a profession that aims to standardize responses to all eventualities, the decision to kill is oddly contingent on a single, mercurial human conscience.

A category of euthanasia request that Dutch doctors commonly reject is that of a mentally ill person whose desire to die could be interpreted as a symptom of a treatable psychiatric disease – Eelco de Gooijer, in other words. Eelco was turned down by two doctors in Tilburg; one of them balked at doing the deed because she was pregnant. In desperation, Eelco turned to the Levenseindekliniek. With its ideological commitment to euthanasia and cadre of specialist doctors, it has done much to help widen the scope of the practice, and one of its teams ended Eelco’s misery on 23 November 2016. A second team from the same clinic killed another psychologically disturbed youngster, Aurelia Brouwers, early last year.

Ideally euthanasia is a structure with three struts: patient, doctor and the patient’s loved ones. In the case of Eelco de Gooijer, the struts were sturdy and aligned. Eelco’s death was accomplished with compassion, circumspection and scrupulous regard for the feelings of all concerned. It’s little wonder that the Dutch Voluntary Euthanasia Society, or NVVE, vaunts it as an example of euthanasia at its best.

After leaving the de Gooijers, I drove northwards, bisecting hectares of plant nurseries, skirting Tesla’s European factory, to a conference organized by the NVVE. Apart from being the parent organization of the Levenseindekliek, the NVVE, with its membership of 170,000 (bigger than any Dutch political party) and rolling program of public meetings, is one of the most powerful interest groups in the Netherlands. The conference that day was aimed at tackling psychiatrists’ well known opposition to euthanasia for psychiatric cases – in effect, trying to break down the considerable opposition that remains among psychiatrists to euthanizing disturbed youngsters like Eelco and Aurelia.

The conference center on the outskirts of Driebergen stood amid tall conifers and beehives. I was offered a beaker of curried pumpkin soup while the session that was underway when I arrived – titled “Guidelines for terminating life on the request of a patient with a psychiatric disorder” – came to an orderly close in the lecture hall. Precisely three minutes behind schedule, the Dutch planned-death establishment debouched for refreshments.

I had met my first NVVE member quite by chance in Amsterdam. After watching her mother die incontinent and addled, this woman of around 70 signed an advance directive requesting euthanasia should she get dementia or lose control of her bowels. These conditions currently dominate the euthanasia debate, because so many people in their 60s and 70s want an opt-out from suffering they have observed in their parents. When I mentioned to the woman in Amsterdam the reluctance of many doctors to euthanize someone who isn’t mentally competent, she replied, bristling: “No doctor has the right to decide when my life should end.”

At any meeting organized by the NVVE, you will look in vain for poor people, pious Christians or members of the Netherlands’ sizeable Muslim minority. Borne along by the ultra-rational spirit of Dutch libertarianism (the spirit that made the Netherlands a pioneer in reforming laws on drugs, sex and pornography), the Dutch euthanasia scene also exudes a strong whiff of upper-middle class entitlement.

Over coffee I was introduced to Steven Pleiter, the director of the Levenseindekliniek. We went outside and basked in the early October sun as he described the “shift in mindset” he is trying to achieve. Choosing his words with care, Pleiter said he hoped that in future doctors will feel more confident accommodating demands for “the most complex varieties of euthanasia, like psychiatric illnesses and dementia” – not through a change in the law, he added, but through a kind of “acceptance … that grows and grows over the years”. When I asked him if he understood the scruples of those doctors who refuse to perform euthanasia because they entered their profession in order to save lives, he replied: “If the situation is unbearable and there is no prospect of improvement, and euthanasia is an option, it would be almost unethical [of a doctor] not to help that person.”

After the Levenseindekliniek was founded in 2012, Pleiter sat down with the insurance companies to work out what they would pay the clinic for each euthanasia procedure its doctors perform. The current figure is €3,000, payable to the clinic even if the applicant pulls out at the last minute. I suggested to Pleiter that the insurance companies must prefer to pay a one-off fee for euthanizing someone to spending a vast sum in order to keep that person, needy and unproductive, alive in a nursing home.

Pleiter’s pained expression suggested that I had introduced a note of cynicism into a discussion that should be conducted on a more elevated plane. “There’s not an atom in my body that is in sympathy with what you are describing,” he replied. “This isn’t about money … it’s about empathy, ethics, compassion.” And he restated the credo that animates right-to-die movements everywhere: ‘I strongly believe there is no need for suffering.’

That not all planned deaths correspond to the experiences of Bert Keizer or the de Gooijer family is something one can easily forget amid the generally positive aura that surrounds euthanasia. The more I learned about it, the more it seemed that euthanasia, while assigning commendable value to the end of life, might simultaneously cheapen life itself. Another factor I hadn’t appreciated was the possibility of collateral damage. In an event as delicately contractual as euthanasia, there are different varieties of suffering.


Back in the days when euthanasia was illegal but tolerated, the euthanizing doctor was obliged to consult the relatives of the person who had asked to die. Due to qualms over personal autonomy and patient-doctor confidentiality – and an entirely proper concern to protect vulnerable people from unscrupulous relatives – this obligation didn’t make it into the 2002 law that legalized euthanasia.

This legal nicety would become painfully significant to a middle-aged motorcycle salesman from Zwolle called Marc Veld. In the spring of last year, he began to suspect that his mother, Marijke, was planning to be euthanized, but he never got the opportunity to explain to her doctor why, in his view, her suffering was neither unbearable nor impossible to alleviate. On 9 June, the doctor phoned him and said: “I’m sorry, your mother passed away half an hour ago.”

Marc showed me a picture he had taken of Marijke in her coffin, her white hair carefully brushed and her skin glowing with the smooth, even foundation of the mortuary beautician. Between her hands was a letter Marc had put there and would be buried with her – a letter detailing his unhappiness, resentment and guilt.

There is little doubt that Marijke spent much of her 76 years in torment, beginning with her infancy in a Japanese concentration camp after the invasion of the Dutch East Indies, in 1941, and recurring during her unhappy adulthood in the Netherlands. But Dutch doctors don’t euthanize people because of depression – even if the more extreme advocates of the right to die think they should. As a result, it isn’t uncommon for depressives or lonely people to emphasize a physical ailment in order to get their euthanasia request approved. During his time on the review board, Theo Boer came across several cases in which the “death wish preceded the physical illness … some patients are happy to be able to ask for euthanasia on the basis of a physical reason, while the real reason is deeper”.

In Marijke’s case, the physical reason was a terminal lung disease, which, Marc told me, she both exacerbated and exaggerated. She did this by cancelling physiotherapy sessions that might have slowed its progress, bombarding her GP with complaints about shortness of breath and slumping “like a sack of potatoes” whenever he visited. “To be sure of being euthanized,” Marc said drily, “you need above all to take acting lessons.”

What torments him today is that his mother died while there was hope that her illness could be slowed. “If she had cancer and was feeling pain and it was the last three months of her life, I would have been happy for her to have euthanasia. But she could have lived at least a few more years.”

Defenders of personal autonomy would say that Marc had no business interfering in his mother’s death, but beneath his anger lies the inconsolable sadness of a son who blames himself for not doing more. Marijke’s euthanasia was carried out according to the law, and will raise no alarms in the review board. It was also carried out without regard to her relatedness to other human beings.

For all the safeguards that have been put in place against the manipulation of applicants for euthanasia, in cases where patients do include relatives in their decision-making, it can never be entirely foreclosed, as I discovered in a GP’s surgery in Wallonia, the French-speaking part of Belgium.

The GP in question – we’ll call her Marie-Louise – is a self-confessed idealist who sees it as her mission to “care, care, care”. In 2017, one of her patients, a man in late middle-age, was diagnosed with dementia and signed a directive asking for euthanasia when his condition worsened. As his mind faltered, however, so did his resolve – which did not please his wife, who became an evangelist for her husband’s death. “He must have changed his mind 20 times,” Marie-Louise said. “I saw the pressure she was applying.”

In order to illustrate one of the woman’s outbursts, Marie-Louise rose from her desk, walked over to the filing cabinet and, adopting the persona of the infuriated wife, slammed down her fist, exclaiming, “If only he had the courage! Coward!”

Most medical ethicists would approve of Marie-Louise’s refusal to euthanize a patient who had been pressured. By the time she went away on holiday last summer, she believed she had won from her patient an undertaking not to press for euthanasia. But she had not reckoned with her own colleague in the practice, a doctor who takes a favorable line towards euthanasia, and when Marie-Louise returned from holidays she found out that this colleague had euthanized her patient.

When I visited Marie-Louise several months after the event, she remained bewildered by what had happened. As with Marc, guilt was a factor; if she hadn’t gone away, would her patient still be alive? Now she was making plans to leave the practice, but hadn’t yet made an announcement for fear of unsettling her other patients. “How can I stay here?” she said. “I am a doctor and yet I can’t guarantee the safety of my most vulnerable patients.”


While for many people whose loved ones have been euthanized, the procedure can be satisfactory and even inspiring, in others it has caused hurt and inner conflict. Bert Keizer rightly observes that suicide leaves scars on friends and family that may never heal. But suicide is an individual act, self-motivated and self-administered, and its force field is contained. Euthanasia, by contrast, is the product of society. When it goes wrong, it goes wrong for everyone.

Even as law and culture make euthanasia seem more normal, it remains among the most unfamiliar acts a society can condone. It isn’t enough that the legal niceties be observed; there needs to be agreement among the interested parties on why it is taking place, and to what end. Without consensus on these basic motivations, euthanasia won’t be an occasion for empathy, ethics or compassion, but a bludgeon swinging through people’s lives, whose handiwork cannot be undone.

Two years ago the Netherlands’ health and justice ministers issued a joint proposal for a “completed life” pill that would give anyone over 70 years of age the right to receive a lethal poison, cutting the doctor out of the equation completely. In the event, the fragmented nature of Dutch coalition politics stopped the proposal in its tracks, but doctors and end-of-life specialists I spoke to expect legislation to introduce such a completed-life bill to come before parliament in due course.


Assuming it could be properly safeguarded (a big assumption), the completed-life pill would not necessarily displease many doctors I spoke to; it would allow them to get back to saving lives. But while some applicants for euthanasia are furious with doctors who turn them down, in practice people are unwilling to take their own lives. Rather than drink the poison or open the drip, 95% of applicants for active life termination in the Netherlands ask a doctor to kill them. In a society that vaunts its rejection of established figures of authority, when it comes to death, everyone asks for Mummy.

Even those who have grave worries about the slippery slope concede that consensual euthanasia for terminal illness can be a beautiful thing, and that the principle of death at a time of one’s choosing can fit into a framework of care. The question for any country contemplating euthanasia legislation is whether the practice must inevitably expand – in which case, as Agnes van der Heide recognizes, death will eventually “get a different meaning, be appreciated differently”. In the Netherlands many people would argue that – for all the current wobbles – that process is now irreversible.

Christopher de Bellaigue will chair a discussion on euthanasia at the Dutch Center in London EC2 on 23 Wednesday Jan at 7pm. See dutchcentre.com. This article was supported by funding from the Pulitzer Center for Crisis Reporting
 

gdpetti

Jedi Council Member
Most people aren't around dying people to experience it... so the control is left to those detached from the situation... the system doesn't like to give up power... over anything.

NHK had a couple of documentaries on this, both rather well done: A Doctor Beside the Deathbed - NHK WORLD PRIME | NHK WORLD-JAPAN On Demand
A Doctor Beside the Deathbed
NHK WORLD PRIME
50m 00s
Broadcast on January 12, 2019 Available until March 31, 2019


80-year-old Dr. Kobori is as old as many of the people he cares for. Every day, he visits his elderly patients at their homes, offering advice and support as well as medical treatment. But sometimes the families who care for these patients require support as well. We follow this dedicated physician as he attends to people at the end of life, ensuring that their final hours are filled with comfort and dignity.
Can't find the other one.. maybe it's not available on their site anymore, KCET had it but not now, might show up elsewhere later, as Youtube had it too, but not now.... called An Honest Death: A Palliative Care Doctor’s Final Days
December 9, 2017
It all began with an unusual request: "Could you film everything about me until I die?" Masahiro Tanaka was a palliative care doctor and Buddhist priest who was diagnosed with terminal cancer. He was an end-of-life specialist who helped thousands of patients die peacefully. Now he had to face his own impending death. The film crew set out to document an "ideal death", but what they witnessed was quite different. This program offers an unflinchingly honest look at human nature at its most vulnerable.
His wife worked with him as an end of life care doctor... they had it all setup.... but things didn't turn out as planned... nice moving documentary.
 

Mariama

The Living Force
FOTCM Member
This week it is Euthanasia Week in the Netherlands (9-16 February 2019), which offers several parties like the media and government the opportunity to propagate euthanasia. On the 11th of February the left-wing opposition party GroenLinks launched a plan which is meant to curtail care to people older than 70 by stating that a geriatric doctor has to be involved when a 70+ year old person needs treatment in a hospital, using "quality of life" as the reason. The secretary of 'Medical Care' has already declared that he will be looking into it and apparently came up with the same kind of plan, but in his case it applies to all age brackets: Week vd Euthanasie: Kabinet wil kijken of zorg 70-plussers 'zinnig' is -- Sott.net

Flavia Dzodan (the article was mentioned in this thread: A Dutch policy of eugenics? How a 'soft death' is forced on the people in times of great need -- Sott.net) put it as follows:
It is in this context of never ending austerity that euthanasia is presented as the ultimate individual success story. A matter of personal choice where the State has eschewed all sense of obligation towards aging or chronically ill persons and where the ruling Party, with ongoing support from opposition neoliberal [or left-wing] Parties such as D66, pushes narratives of "completed lives". The underlying message, one where a life outside the capitalist system of production, a life that requires care (and a budget allocation) is a life that has outgrown its usefulness. The "soft death", in its pastel colored rhetoric, presented as the lesser form of suffering, the individual triumph over the inevitable. However when all options of care and support are removed, is there really any choice left? When the State insists that the care for those in need should be left in the hands of unpaid neighbors and strangers, the "soft death" for a "completed life" is obliquely presented as the best viable alternative. The supposedly non violent "soft death" as a mask for the violence brought upon by endless budget cuts.
I haven't finished reading the entire thread about Michael Behe's Darwin's Black Box, but I think that euthanasia is just another example of materialistic, Darwinian, survival of the fittest, psychopathic thinking.:evil:
 

Palinurus

The Living Force
Source: Euthanasia cases drop by 7%, accounting for 4% of total deaths in NL - DutchNews.nl

Euthanasia cases drop by 7%, accounting for 4% of total deaths in NL

April 11, 2019

The number of reports of euthanasia in the Netherlands fell last year for the first time in 10 years, the regional monitoring committee RTE [Dutch only] said on Thursday, confirming figures published last October.

The reason for the 7% drop is unclear, and health minister Hugo de Jonge told MPs last year, when the decline first became apparent, that he had commissioned a report to try to establish what has changed. That report is due later this year.

Some had argued that a number of high profile cases involving the public prosecution department may have made doctors more wary.

However, the new report shows just six of the 6,126 registered cases last year were classed as problematic and two of the total of five cases referred to the public prosecution department have been dropped.

And while the debate about euthanasia often focuses on psychiatric patients and people with severe dementia, in over 90% of cases, patients are suffering from cancer or other terminal or untreatable illnesses, RTE chairman Jacob Kohnstamm said.

Of the cases reported to the committee last year, 146 from people with dementia and 67 people had severe psychiatric problems. In 205 cases, patients had multiple problems derived from the ageing process.

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.
 

Mariama

The Living Force
FOTCM Member
Interesting. Yesterday the Dutch daily Trouw wrote that it is unlikely that the demand for euthanasia (AND the number of euthanasia cases) has dropped: Dat de vraag naar euthanasie daalt is onwaarschijnlijk

So, what is going on?

The latest estimate of the number of euthanasia requests is from 2015, and is based on a survey among doctors. In that year, 8.4 percent of people who died first made an explicit request for euthanasia (over 12,000 people). Of these requests, 55 percent were granted. Doctors do not always report euthanasia to the regional committees of inquiry, according to the same research: this has been the case for years in approximately 80 percent of the cases. In 20 per cent of cases, the doctor does not consider his intervention to be a 'life-ending act' and therefore not an euthanasia, even if it actually is.

New figures will not be released until the next evaluation of the euthanasia law. How many people asked their doctor for euthanasia last year is unknown. But it is not likely that fewer people have been euthanasized. Due to the ageing of the population more euthanasia cases are to be expected, especially because the baby boomer generation considers self-determination to be of paramount importance.

There are signs that something is changing, especially among the doctors. According to the End of Life Clinic, which supervises many euthanasia pathways, doctors have become more cautious for fear of persecution by the Public Prosecution Service. This only happens in a very small number of cases: out of 18,000 euthanasia cases in the past three years, this has happened once so far. However, the Public Prosecution Service has started five criminal investigations in the past year and a half, which have received a great deal of media attention. Whereas in the past prosecution was imaginary, nowadays it feels like a real risk to doctors.

Don't sneak around.

Perhaps even more important is the social debate on euthanasia, and the counter-movement that has begun among doctors. In recent years, many of them have felt pressured by patients and their loved ones to decide on euthanasia.

At the beginning of 2017, 450 of them supported the call 'Don't sneak in with dementia'. They feel that a limit is being crossed for people with dementia who are no longer able to confirm their earlier death wish. Last year, two of these patients received euthanasia, three in 2017. However, the fierce discussion about this may also influence the opinion of doctors in other difficult cases.

The euthanasia in psychiatric patients is also the subject of much debate. Some of the doctors have fundamental objections. After all, when will a patient be treated out? And is it really the patient who wants to die, or is that wish the result of his illness? The number of euthanasia cases in psychiatric patients fell by almost 20 percent last year.

Next year it will become clear whether this year was a one-off downward leap, or whether doctors, under the influence of the social debate and the Public Prosecution Service, have taken a structurally different view of euthanasia.

There is another factor that should not be underestimated: the wave of flu in late 2017 and early 2018. Then more people died than one would expect: more than 9,000 more, especially the elderly. These undoubtedly included patients who would otherwise have wanted euthanasia. That, too, may have had an impact on the figure. But it is unlikely that there has been a change in patient demand for euthanasia.

Translated with www.DeepL.com/Translator
 
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