‘Dying with dignity’ has become synonymous with euthanasia or doctor-assisted dying, i.e. the voluntary administration of a lethal drug at the patient’s request. Does this mean that dying naturally, would not be a dignified death? Especially, since today’s pain treatment is able to alleviate almost all kinds of all physical suffering? Does a person who suffers loses her dignity? Is one’s dignity dependent upon one’s full capacity to lead an autonomous life?
Let us take a look at the reality of countries where euthanasia has been legal for 15 years or more, which is the case in Belgium and the Netherlands. There are some essential questions we need to ask before we consider legalizing assisted suicide or euthanasia: Can the protection of the vulnerable person be guaranteed? What kind of society do we become if we legalize euthanasia? Is there a logical stopping point once we cross the red line and allow the intentional killing of people?
A society that calls itself democratic, equal, and free needs to be challenged as to how it treats those who are vulnerable, infirm, sick, elderly disabled and those who need our care.
Wherever euthanasia has been legalized in the world, a steep increase in demand follows. In Belgium, it has surged a hundredfold since the law passed in 2002 with over 2,000 registered cases in 2015. In the Netherlands, over 5,000 people died from a lethal injection that year. In Canada, doctors and nurses ended the life of almost 800 people in the first 24 weeks after the law has been passed in June 2016. Reliable reporting and functioning control mechanisms are often not in place – despite explicit legal requirements. Several studies suggest a significant underreporting of cases in Belgium (of around 50%). The co-president of the Federal Control and Evaluation Commission for Euthanasia (FCEC), Dr. Wim Distelmans, estimates that about half of all euthanasia cases are never declared officially, which would double the numbers of the official reports. Medical practitioners came out on Belgian media saying that they do not report their cases to the FCEC anymore, which is illegal. Dr. Marc Cosyns wrote in an opinion piece in the Flemish newspaper De Standaard in 2014 that he generally doesn’t declare his cases, because he considers them ‘normal medical interventions’.
Dr. Distelmans is not only the co-chair of the FCEC, but also one of the main advocates for euthanasia in Belgium. Under his leadership, the commission has referred only one solitary case to the prosecutor for investigation out of the 13,000 cases since the legalization of euthanasia in 2002. This fact gives rise to serious concerns, as the watchdog created as a safeguard against possible abuse of the law in Belgium has proven itself to be totally dysfunctional. Euthanasia is largely uncontrolled and has become increasingly uncontrollable.
Advocates for assisted dying say the practice is based on respect for individual autonomy. Yet, how autonomous can a person be, in particular in a situation of illness, physical or psychological suffering, or with decreasing physical and cognitive capacities? Isn’t such a law intrinsically risky that allows people to ask for their life to be ended based on their autonomous choice? The steepest relative increase in euthanasia requests in the last two years comes from patients who have been diagnosed with dementia. Some of them were not yet actually affected by it, but asked for their life to be ended out of fear of future suffering and loss of autonomy. But can we really speak of an autonomous choice when a person is in a situation of fear and vulnerability? Is a person, who is always a member of a family, a social network, a society, a work environment, ever fully autonomous? How genuinely autonomous are our personal medical decisions, which, in practice we never make alone, but in consultation with our practitioner, a specialist, our spouse, and children? Trust is essential for these decisions, but where euthanasia is legal, slowly but surely the doctor becomes nothing more than a service provider who must comply with the demands of the patient. The objective medical situation is of little importance when the law stipulates a generally subjective notion of ‘unbearable suffering’ as the ultimate criteria when demanding euthanasia.
In the Netherlands, patients can go to so-called ‘End-of-Life Clinics’ and have their life ended by a doctor they have never seen before. 107 such cases have been reported in 2013, the trend is growing. The total absence of a patient-doctor relationship should be a source of concern, especially with recent claims that euthanasia should be available to elderly people who are simply ‘tired of life’. A citizens’ initiative called ‘Out Of Free Will’, started in 2010, demanding that all Dutch people over 70 who feel tired of life should have the right to professional medical help in ending their lives. Thousands of people supported it.
Euthanasia is becoming a lifestyle choice and the variety of cases where a person subjectively experiences the suffering as ‘unbearable’ suggests, to a great extent, that we’ve lost the capacity to cope with life when it’s not all rosy.
In recent years, cases that were still unthinkable ten years ago have become increasingly frequent. A mother with tinnitus was assisted to kill herself in Holland, leaving behind her two teenage children of 13 and 15 years of age. A 54-year-old women with personality and eating disorder received a lethal injection at an ‘End-of-Life Clinic’ in Amsterdam. Official figures from the Netherlands show that in one year (2013), the number of mentally ill people killed through euthanasia has tripled.
One out of 33 people in the Netherlands use euthanasia to die today. Belgium is not much different. In recent years, we have seen people with depression, autism, troubled sexual identity or simply grief after the loss of a loved one being killed at their request. Having eliminated any age limit, euthanasia can be requested at any moment in life within the limits of the law. The first teenager died of euthanasia in 2016.
Looking at the development in Belgium and the Netherlands, it is clear that the availability of legalized euthanasia creates demand. It starts with cases of extreme suffering, but it quickly expands to situations that, until very recently, were a not unusual part of life. Once introduced, there is no logical end point to the circumstances where euthanasia will be demanded. It becomes an entirely normal choice at the end of life, which then starts to put an obligation on those who choose to die naturally to justify their choice. How long does it take until a patient, who makes use of palliative care for some weeks or months at the end of his life, will be considered a burden on society, on his own family, on the public coffers?
A study published in the Canadian Medical Association Journal in January 2017 comes to one stark conclusion; euthanasia saves money! The study found that the Canadian government could save up to 130 million EUR per year if euthanasia became a more frequent form of ending one’s life. This level of saving is not peanuts, and, after passing the most liberal euthanasia in the world, may well influence the government to advocate for euthanasia as the default death.
Without exception, the experience of legalized euthanasia shows that a slippery slope is in practice unavoidable. No matter how strict the law attempts to be, it is bound to fail to protect the vulnerable members of society. Doctors, experts, and victims of euthanasia are starting to speak out, as you will see in this short documentary.
Sweden should not make the same mistake. Society will become colder and the space for everyone except the fit, healthy, and productive, will shrink.