Euthanasia
Never before have so many people been euthanized as last year: 7,666
Seriously ill people chose euthanasia more often last year. It amounts to 4.5 percent of all deaths. That is higher than ever, despite the fact that many people died of corona.
Marten van de Wier - March 31, 2022
The number of people who received euthanasia in the Netherlands last year was higher than ever: 7,666. This is evident from the annual report (in Dutch; press release} of the Regional Euthanasia Review Committee (RTE), which was presented to the Lower House on Thursday afternoon. This is an increase of more than 10 percent compared to 2020.
In euthanasia, a doctor gives a seriously ill patient a lethal drug on request via infusion or in the form of a drink. 4.5 percent of all deaths were by euthanasia. That too has not been so high before. In 2020, it was 4.1 percent.
Number of reported cases:
Image: Brechtje Rood
Corona almost never led to euthanasia
The growth is striking because last year relatively many people died from corona. That disease almost never led to euthanasia. According to the RTE, only in a few cases did corona weigh in alongside another serious illness.
Could it be that seriously ill patients were more likely to choose euthanasia because of corona restrictions, which made life more difficult? "I don't get that from the hundreds of cases I handled myself. In them I did sometimes read that corona time was an unpleasant time, that people could not meet their children. But that was not the reason for euthanasia. Loneliness should never be the reason," says Jeroen Recourt, chairman of the RTE.
Euthanasia rate increasing by 10 percent for years
Moreover, Recourt had expected this increase. "In recent years we usually see an increase of 10 percent. Also in the first months of 2022 this continues."
Only in 2018 and 2019 was the number of patients receiving euthanasia lower than in 2017. That appears to be a temporary dip. According to knowledge institute Nivel which studied that dip, it could be related to the fact that a relatively large number of people died of influenza in 2018. It could also be linked to the criminal investigations announced by the Public Prosecutor's Office into a number of doctors for euthanasia. Possibly this made doctors less willing to perform euthanasia. In the end, only one doctor went to trial. She was discharged from prosecution.
'We must rule out people choosing euthanasia because there is no good alternative'
Recourt calls it "socially very relevant" to understand better what causes this steady growth. He has submitted the question about the backgrounds of the growth to a scientific committee that will evaluate the euthanasia law next year. "The fact that people choose to be in charge of their own death is in keeping with an individualized society. That is bound to be an element," Recourt said when asked.
"Although we see no evidence for this, we must also discount the possibility that the increase is partly because alternatives are not readily available," Recourt believes. "For example, because the care in the terminal phase would not be well organized or because the nursing homes would be horrible. Although it can also be an individual consideration not to want to go to the nursing home."
The Christian Dutch Patients Association (NPV), which has always been critical of euthanasia, is concerned about the increase. "The question is what is causing it," says Elise van Hoek. "Is the care in the dying phase failing? Is it fear of death? Or is support from the environment lacking? These, we believe, are important areas of concern."
Acceptance of euthanasia is increasing
Previous research (in Dutch; PDF-file, 48 pages; 2019) has also identified possible causes for the increase in dying by euthanasia. For example, public support for euthanasia increased. General practitioners are more willing to refer patients if they themselves do not want to perform euthanasia. There are more and more elderly people. And more and more people are dying of cancer, and less of cardiovascular disease.
Cancer is relatively often a reason for a request for euthanasia: more than half of the patients who received euthanasia suffered from cancer. In recent years there has been much discussion about euthanasia in people with psychiatric disorders or dementia. They form a much smaller group, whose share is growing slightly. Last year, 115 people were euthanized because of a psychiatric condition, and 215 people because of dementia.
Most people with dementia chose euthanasia at the time when they could still ask for it themselves. Six people could not, and were given euthanasia based on a request they had previously put in writing.
Nature of disorders in euthanasia:
Image: Brechtje Rood
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Physician must report euthanasia to review board
Physicians who provide euthanasia must comply with a number of rules. For example, they must be convinced that a patient voluntarily chooses euthanasia, and that he or she is suffering unbearably due to illness. After each euthanasia, they send a substantiated report to the Regional Euthanasia Review Committee (RTE). The RTE is actually made up of fifteen smaller committees of three people (a doctor, a lawyer, and an ethicist) who each do a portion of the cases.
In most reports it is so obvious that the doctor acted with care that the committees do not discuss them. A small proportion are discussed (last year 490). If the committee decides that a doctor has not met all the criteria, the opinion is passed on to the Public Prosecution Service. The Public Prosecutor's Office often has a serious discussion with the doctor. Usually it does not come to prosecution: this has only happened once since the Euthanasia Act of 2002.
Translated with www.DeepL.com/Translator (free version)
Opinion
Opinion: 'Make compassionate euthanasia rather than palliative sedation easier, even without a declaration of euthanasia'
Doctors' federation KNMG wants to amend its guideline on palliative sedation to broaden the possibilities to do so. Is this really desirable, wonders Wim van Dijk. Isn't it better in some cases to proceed to euthanasia, even if the patient does not yet have a declaration of euthanasia?
Het Parool - 13 April 2022, 17:00
The KNMG allows palliative sedation when the expected dying process will last less than fourteen days and now wants to start allowing it when life expectancy exceeds fourteen days. Should palliative sedation be necessary, it would be merciful if the person concerned, or their legal representative, could choose between palliative sedation and immediate euthanasia, even without a declaration of euthanasia.
Palliative care is often fine. Palliative sedation to put the patient in a state of diminished consciousness to die without eating and drinking, I think is completely pointless. The patient processes external and internal stimuli, such as pain stimuli, but can hardly respond to them.
This agony of usually a few to fourteen days seems merciful, but it is cruel. For the loved ones, the nursing staff who have come to care about the patient, and the physician, it is traumatic. Why does this happen? Everyone knows that the patient is suffering and dying, so why not euthanasia without a declaration of euthanasia?
Euthanasia laws prevent this merciful dying.
Arbitrary
Physicians are required by law to establish the standard of care "unbearable and/or hopeless suffering" and/or "another reasonable solution is possible." If not, they refuse end-of-life care. The legislation is immoral in part because it mandates doctors to make this assessment. After all, they cannot. Only the persons concerned can determine what is unbearable, hopeless and reasonable for them, and they may have previously recorded this in their declaration of euthanasia.
Objective criteria for these requirements of care cannot be determined. This would have been done long ago, and there would be no more discussions or experiences of arbitrariness. Not that the individual physician acts arbitrarily: everyone acts with integrity within their own knowledge, experiences, and beliefs. The problem is that different physicians can make different decisions about the same case. This is experienced as arbitrariness.
The use of palliative sedation, which by definition involves 'unbearable and hopeless suffering' and 'no other reasonable solution is possible', is irrational. The fact that the patient can no longer indicate a voluntary and deliberate desire to die should not prevent mercy euthanasia. If euthanasia is applied immediately, then patients, their loved ones, caregivers and physicians do not experience the traumatic process of deterioration, in which the patient often turns into a skeleton.
Increased desire for self-determination
By 2040, there will be at least 1,300,000 "euthanasia patients" (13.7 percent of adults), including people with Alzheimer's (500,000 deaths per year), Parkinson's (91,000), cardiovascular disease (670,000), cancer (45,000), and other hopeless conditions with unwanted suffering.
The required demand for care will gradually rise sharply. Meanwhile, 83 percent of citizens desire an end of life in their own control. Mainly due to the increased desire for self-determination and the shift from the general protectiveness of life to the evaluability of individual quality of life with possibly an individual death wish.
Yet in the Netherlands, being allowed to die with dignity under one's own direction remains a problem. At the Expertise Center for Euthanasia, it can take up to two years before a decision is made on whether or not to have euthanasia. According to official figures, in 2019, euthanasia was granted approximately 7,000 times and refused approximately 1,000 times. Palliative sedation took place 34,000 times. The question is whether these numbers are not underestimates and whether palliative sedation ("natural death") is not used to replace euthanasia (mandatory reporting according to euthanasia legislation).
Changing euthanasia legislation
I advocate a euthanasia legislation without the subjective requirements of care "unbearable/impossible suffering" and "a reasonable other solution is possible". End-of-life care is available to anyone who voluntarily and deliberately desires end-of-life care and has recorded this in a timely manner in a declaration of euthanasia (written and/or video), in a competent manner and well-informed about their own situation.
The declaration of euthanasia, which was made in a competent manner, remains in full force and effect when the patient becomes incapacitated. Anyone for whom the physician would decide on palliative sedation may be granted euthanasia. The end-of-life counselor (now the physician) obtains an end-of-life drug just before dying. It is carefully used immediately. When in doubt, a second opinion from a second end-of-life counselor is obtained.
W.F.M. van Dijk, psychologist
Translated with www.DeepL.com/Translator (free version)
