In part 1 of this article, Euthanasia Debated, we reviewed some pros and cons of the practice of euthanasia as a means of ending the suffering of someone with terminal illness. We left with the question, “Are these practices a compassionate advance in the field of medicine or a decline in the values of modern society?
The answer may be found if we examine the successes and failures of the countries and states that have legalized euthanasia. Where better to begin than with the Netherlands where it all started?
The Netherlands began accepting euthanasia in 1984 and legalized it in 2000. While experts estimate 60% of assisted suicide cases are not reported, figures show that in 1999, fifteen years after it was accepted, doctors helped 2,216 Dutch patients die. Polls find that an overwhelming majority of the Dutch believe euthanasia should be available to suffering patients who want it. Numbers of reported assisted deaths increased by 13% in 2009, 19% in 2010, 18% in 2011 and 13% in 2012 to a reported 4,188 deaths which is more than 3% of all deaths. The 2012 report also stated that the practice expanded to include 42 people with dementia and 13 people with psychiatric conditions.
The Right to Die-NL organization founded in 1973, has been at the forefront of making euthanasia widely available in the Netherlands. This organization has created mobile euthanasia teams to help patients die at home. They also are advocating for legislation to make euthanasia available to anyone over age 70, sick or not. Some think the Right to Die-NL organization may now be going too far. Critics charge that the “right to die” could quickly become "the duty to die" pressuring the terminally ill to take their own lives when they believe they have become a burden. They say the elderly will be afraid to enter hospitals for fear of being euthanized. And in fact it happened that a woman was euthanized because she didn't want to go to a nursing home.
Furthering the expansion of euthanasia to include children began in the mid-1990s. Two court cases regarding euthanasia of infants became the catalyst for the Groningen Protocol, a document providing guidance for both judges and physicians. Of the 200,000 children born in the Netherlands every year, about 1000 die during the first year of life. For approximately 600 of these infants, death is preceded by a medical decision regarding the end of life.
Theo Boer, an ethicist and former nine- year member of one of the five Euthanasia Review Committees in the Netherlands that oversees euthanasia cases, is saying that doctors, politicians and the review committees need to re-evaluate the euthanasia law. Boer has evaluated more than 4 thousand cases of euthanasia and says that it is often given to people who still had some time to live. The latest euthanasia figures for the Netherlands show that nearly one in seven deaths are at the hands of doctors. Despite their reports, the review committees have not have been able to halt these progressions.
The Netherlands is not alone. Having passed the law in September 2012, Belgium is now the third jurisdiction to legalize euthanasia. Doctors are euthanizing an average of five people every day – with a 27% surge in one year. Where euthanasia began as a way of dealing with the "hard cases" it has now expanded to include children, people with dementia, people with psychiatric issues, loneliness, and for those who are just "tired of living"
Germany is presently debating the legalization of euthanasia. It currently permits doctors to cease life-extending treatment or to administer powerful and dangerous sedatives at a dying person‘s request, but assisting a suicide is still a crime at this time.
In the US, Oregon was the first to pass a physician-assisted suicide law in 1997 and claims to have never extended its dispensing beyond those with terminal illness in its 17 years. Since then, a total of 1,173 people have had DWDA prescriptions written but just 752 patients have died from ingesting the prescribed medications.
According to the Oregon government report of January 22, 2014 there were 71 assisted suicide deaths and 122 prescriptions for suicide in 2013; 69% were aged 65 years or older, the median age was 71 years. The prescribing physician was present at the death in 8 of the 71 deaths. Only 2 of the 71 people who died by assisted suicide received a psychiatric evaluation. Is it ethical then to allow people who are in physical or emotional pain to make personal life and death decisions?
Yet according to an Oregon Public Health report, written in September of 2010, Oregon’s suicide rate is 35 percent higher than the national average. This increase does not take into account the number of deaths under assisted suicide act because the state does not recognize it as suicide. Whereas the law sees assisted suicide and euthanasia as an exception, public opinion is shifting towards considering them rights, with corresponding responsibilities on doctors to act. A law that is now in the making obliges doctors who refuse to administer euthanasia to refer their patients to a ‘willing’ colleague. And under Oregon’s law a doctor is not able to protect a depressed patient if they choose assisted suicide.
Jeanette Hall, was terminally ill and wanted to die by assisted suicide in 2000, but her doctor convinced her to try medical treatment. She has been in remission for many years and says she is happy to be alive today.
The Oregon assisted suicide act is not limited to terminally ill people. 2013 saw a significant increase in assisted suicide deaths related to "other illnesses" to include chronic conditions such as diabetes.
The three most frequently mentioned end-of-life concerns were: loss of autonomy (93.0%), decreasing ability to participate in activities that made life enjoyable (88.7%), and loss of dignity (73.2%). Other reasons were: Losing control of bodily functions, inadequate pain control or concern about it, burden on family, friends/caregivers and financial implications of treatment. All but one of these concerns relate to the quality of life and do not address the original purpose for euthanasia which was to alleviate pain and suffering for terminally ill patients with a short time to live.
If quality of life is subjective, how can any law concerning euthanasia be objective? Once you give physicians the right, in law, to cause death, ethical boundaries prohibiting the intentional killing of human beings are forever changed. The result is what we have seen in the Netherlands and Belgium where euthanasia began as a way of dealing with the “hard cases” and has now expanded to include euthanasia for children, people with dementia, people with psychiatric issues, loneliness and for those who are “tired of living”.
If pain and suffering are the primary focus for accepting euthanasia then are there other ways to address these needs? This will be addressed in part III.
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