Wednesday, June 8, 2016

Euthanasia in the Netherlands: Dignity or Danger?

The issue of euthanasia is becoming more and more relevant in Europe today. As Secretary General of the Working Group for Human Dignity, on behalf of their members, I organized an event last month where all participants noted that the elderly and terminally ill should be treated with respect and human dignity. Unfortunately, in Belgium, euthanasia was also seen as a part of palliative care, focusing on the so-called "dignity to die". Also the country where I come from, the Netherlands, has become a "champion" for euthanasia, becoming the first country that legalized euthanasia. This article, which was written with the kind help of the De Nederlandse Patiëntenverening, the Italian Matchman News and my assistant Lefteris Kaloterakis, shows how this issue has evolved in the public discourse and how the practice of euthanasia threatens the life and human dignity of thousands of my compatriots.

EUTHANASIA SPREAD IN THE NETHERLANDSThe Netherlands is gradually expanding the opportunities for access to euthanasia. It's a short time ago since the Dutch Ministry of Health adopted a new measure that extend the possibility to apply euthanasia practices to patients with dementia who do not have the skills needed to ask his own death. This increases the likelihood of introducing in the near future the "kill-pill", a lethal pill that could be taken by all those who are over 70 years of age and who are "tired of living." Therefore, the growing trend towards euthanasia confirms that the practice is becoming more and more ordinary, less selective and more trivialized. This contradicts the traditional view of health care as a process that aims to cure, relieve and support never killing deliberately or "on demand." 

The debate on euthanasia in the Netherlands was initiated by a small elite. In 1973, Dutch doctor Miss Postma gave her mother a lethal injection. As a result, she was sentenced by the highest Dutch court to a week in prison. This case led to the creation of the Dutch Association for the Right to Death (Nederlandse Vereniging voor een Vrijwillig Levenseinde - NVVE), the most important Dutch pro - Euthanasia association. In 1984, the first draft of an euthanasia law was presented by E. Wessel - Tuinstra (D66). In 2001, Netherlands was the first country in the world to legalize euthanasia and, with it, assisted suicide. The law on euthanasia came into force on 1 April 2002.

Since then, there has been an increasing number of cases that were processed by the five regional euthanasia review committees, the bodies that, after the death of the patient, are responsible for an individual assessment and verification of the actual presence of all the necessary requirements for the application of the law. In essence, Netherlands entered the so-called "slippery slope" (i.e. in an "inclined plane") namely a situation where more and more deaths are recorded each year. For the first five years following the introduction of the law, the number of deaths by euthanasia was stable enough so that some doctors discounted the possibility that we could get into this "slope": it was thought in fact, that a "good" law on euthanasia would have averted the increased use of euthanasia procedures. However, things changed rapidly. 

Since 2008, the number of deaths by euthanasia has shown an annual increase of 15%. In 2011, 3695 people asked to die with the help of the National Health Service, through euthanasia or assisted suicide. This figure was 18 percent bigger than the previous year and it was double than the 2006 figure. In 2012, 4188 cases were reported to the euthanasia review committees compared to 1882 in 2002. More recent information shows that the number kept increasing (in 2014 the number reached 5306). It is important to note that at the moment, almost 4% of all deaths in the Netherlands is caused by euthanasia (data provided by the euthanasia review committees). 

Apart from the increase to the number of euthanasia deaths, there have been other negative developments as well. Under the name of "End of Life Clinic", NVVE founded a network of "mobile health teams" willing to travel by patients to perform euthanasia. Considering that the law assumes (but does not require) a stable relationship between the doctor - patient, in which law assumes (but does not require) a stable relationship between the doctor - patient, in which the death might be the end of a period of treatment and of interaction between the doctor and the patient, these doctors see the patient on average only three times before administering the drugs needed to end their lives. This is an absurd idea since no relationship between doctor and patient is established. We wonder if these "mobile health teams" actually consider the patient as a whole being guided by the real underlying question: "What lies behind someone's request to die?" This is the central aspect to focus on in the relationship with the patient. 

But you can never analyze this within a few days! There is simply not enough time to explore the alternatives. Research shows that around 10% of the requests for euthanasia were withdrawn when quality health care was offered to the patient. However, the clinic does not care that people can change their minds and withdraw the request. These doctors have only two options: to administer life - ending drugs or give up the patient. The "End of Life Clinic" deals now with hundreds of cases.



The pro-euthanasia lobby of the Netherlands has renewed since November 2015 its push to introduce and legalize the so-called "kill pill" (pill of death) that would be made available, free of charge and on demand, to people who are older than 70. It was also called the "Drion pill" from the name of a Dutch judge who advocated this idea early from the 90s. A public debate that focused on whether or not to grant legal options is still ongoing in the Netherlands for the assisted death of non diseased elderly over 70 years old that express the "desire" to die. According to a citizens' initiative signed by 116000 people in 2010, the possibility of death should be legalized. The government has discussed this initiative, but at the moment there is not enough consensus. There are many questions: how many people really want this?, what is the difference between this population and the population of elderly patients? But above all: is this the right solution for the elderly? 

The director of the pro-euthanasia lobby Robert Shurink has recently claimed that "the society wants a pill like that". This claim however has no basis whatsoever. It is not true that the society wants this pill. Robert Schurink represents only the NVVE members. As we saw earlier, the increase in cases of euthanasia since 2008 naturally includes a gradual change in the type of patients who receive these treatments. While the report of the first years after 2002, hardly includes any patient with psychiatric illness or dementia, these numbers are now rising sharply. As demonstrated, in January 2012 by researchers from the NIVEL (Nederlands Instituut voor onderzoek van de Gezondheidsorg - Netherlands Institute for Health Services Research), the profile of those that request euthanasia has changed in the last thirty years. In the seventies, the most important reason to ask for euthanasia was pain. Nowadays, the loss of dignity and the meaning of life have become important reasons for a request for euthanasia. In fact, many cases have been reported where the suffering - important element for almost all treatments - old age, loneliness or bereavement were mentioned. Some of these patients could still live for years or decades!

This shows that while the law considers assisted suicide and euthanasia are exceptions, public opinion however is starting to consider them as true rights with corresponding obligations on doctors to act. In fact, a law that is now in progress would require physicians who refuse to administer euthanasia, to send their patients to an "available" colleague In case of serious illness, the pressure on doctors to furthering the wishes of the patients (or, in some cases, relatives) may become increasingly intense. These pressures, combined perhaps with the concern of a patient for the welfare of his beloved / loved, are in some cases a major factor behind a request for euthanasia. Not even the review committees, despite their hard and conscientious work, were able to stop these developments. In essence, what is evident is that most people consider the unbearable pain and suffering (as seen by relatives) as a valid reason for euthanasia. However, many people are not sufficiently informed about new methods in controlling pain developed in recent decades.


The growing demand for euthanasia, in fact, is in contradiction with the development of palliative care in the Netherlands. According to the Dutch anesthesiologist Ben Crul, a pioneer in the field of pain management and palliative care, current progress in the field of techniques in these areas makes euthanasia unnecessary for most people with a terminal illness. This view is shared by many doctors in the Netherlands. Ben Crul is a respected Professor Emeritus of pain management for Radboud University of Nijmegen and has dedicated his life to the improvement of palliative care. Attention to Palliative Care has been increasing since 1990. However, a thorough research on its potential has not yet been conducted despite the fact that the "common feeling" in the Netherlands is that good palliative care can reduce the alarmingly increasing rates of euthanasia. In fact, the government is now beginning to promote palliative care and people that are either for or against euthanasia are convinced that this is a necessary policy.

Therefore, before creating "mobile euthanasia teams" it is necessary to ask: "What is the level of Palliative Care offered in the Netherlands?", "What is roughly the percentage of terminally ill patients who have access to Palliative Care?", What are the measures taken by the government to increase the number of facilities for palliative care and to improve the specific training of the medical staff?" The former Health Minister Els Borst - responsible for the introduction of the euthanasia law - admitted that "the law was introduced too hastily".

Vone Van der Meer, a Dutch writer, in his book "Winter in gloster huis" ("Winter in the gloster home") says: "Whoever hears often that he is a parasite, dreams of his end." Words have a huge impact on our mood. If you regularly hear of ever increasing health costs and a "gray tsunami", and when you're wondering about the possibility of going into nursing homes, you are lead to say: "I am not going there, I don't want to live any more". Euthanasia is therefore on track to become a "default mode", a way to seek death that is spreading gradually, involving cancer patients. The rise in death requests is not surprising in a secularized society and in a world that refuses to give answers to suffering and loneliness as it is cheaper and less onerous than a condition of unbearable suffering.

The Nederlandse Patientenvereniging (Dutch Patient Association -  NPV -, a pro - life Christian organization that rejects the practice of euthanasia) provides a "last will declaration" through which people can explain what medical care and nursing care they would like to receive in the final period of their lives, when they are no longer able to rule on the matter in order to avoid the application of euthanasia practices. It is a clear statement that calls for treatment and not for ending life. Up to know, around 7000 statements have been provided - thanks to the NPV. Therefore, the central question on which we must focus is not "How can we help people to die?" but on the contrary "How can we help people to live?".

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