In the Netherlands, debates about euthanasia have been going on since the 1970s. In 2002, euthanasia and physician assisted suicide were legalsied in specific circumstances. There’s been a few changes to the law since then as well. What was sold to the public as a law to help those suffering unbearably at the end of their lives has been expanded to allow unhappy teenagers to kill themselves. As CARE consultant, Professor Nigel Cameron argues, the Netherlands is the “world’s first Euthanasia lab, where the human race is experimenting with what happens once doctors get a licence to kill.”
As we consider the ongoing debate in the UK, cautionary tales from countries who have legalised euthanasia, or assisted suicide, should give us all food for thought. It cannot be stressed enough that changing the existing law to permit assisted suicide, even in limited circumstances, is a profound change in how we do end-of-life care.
We’re not talking about a slight tweak here and there. We’re not talking about ending some burning injustice. What we’re debating is whether we give doctors the power to kill patients. We are talking about trusting in individuals to express their will to be killed, despite the fact we all know humans are changeable in how we feel.
Let’s be honest that while on paper you could write a law with specific circumstances in mind, those circumstances are not always black and white. Any blanket admission of assisted suicide doesn’t grapple with the complex cases. The patient who is not at the end of their life, but is severely disabled and undergoing significant existential suffering. The patient with learning difficulties who potentially lacks capacity to understand their request to be euthanised. Or the patient with Alzheimer’s who now says they don’t want to be euthanised, despite leaving instructions to do so.
This last example refers to the most recent, headline making case in the Netherlands. The case involved a 74-year old woman with Alzheimer’s. She was diagnosed four years before her death in 2016. Having witnessed her mother suffering with the same condition, she drafted documents (advanced directives) while still competent, asking that she be euthanised.
Doctors then observed her carefully before concluding in early 2016 that she was suffering ‘unbearably’ and ‘incurably’. Euthanasia was scheduled for the morning of 22 April 2016.
But complications arose because the woman could no longer express clear volition. While a written, advanced directive suffices, doctors involved in the killing of a patient must stop if they detect “behaviour and utterances that may indicate resistance or objections to termination of life”.
In this particular case, the doctor decided to drug the patient with a sedative which she admitted was to prevent a struggle during the euthanasia. Then, the patient tried to stand up when the needle was inserted. At the doctor’s urging, family members held the woman down so the lethal injection could be administered.
Prosecutors brought charges against the doctor. They admitted that their purpose was not to see a doctor locked up in prison, but to try and clear up a murky bit of the law – specifically, whether or not a doctor needs to verify that a patient with Alzheimer’s or dementia has a current desire for death at the point of euthanasia.
In its final verdict, the Court acquitted the doctor. The ramification of this is clear: doctors may rely on advanced directives, even – as was the case here – if they are not especially clear. The most they could receive is a slap on the hand from a professional body. Again, in this case that is all that happened. A Dutch administrative review panel found fault with the doctor for administering the sedative, for calling on the family to physically restrain the patient, and for acting with such definitiveness on an ambiguously worded directive.
“We believe that given the deeply demented condition of the patient the doctor did not need to verify her wish for euthanasia”, said one of the three judges.
It’s a case that raises such questions as, what happens when euthanasia cases end up in court? How do judges decide if a patient truly is exercising their rights within the law and making a free, voluntary decision to end their own life? And what if the patient is suffering from dementia and deciphering what they actually want at the time of euthanasia is even harder? What happens if the patient changes their mind?
These are tough questions, but they need answers. Legalising assisted suicide (where a doctor helps you kill yourself) or euthanasia (where the doctor administers the killing ‘blow’) is a radical change to make. We’re talking about a fundamental shift in how we do end-of-life care. For centuries, the established medical code has insisted that physicians are there to help people live, not to die.
The power of the pro-assisted suicide lobby lies in their rhetorical flourishes around choice, autonomy and their absolute fear of any kind of end-of-life suffering. It is a hard narrative to counter. But counter it we must.
For there is a better story. One that avoids the pitfalls of a murky law that allows for widespread abuse. One that ensures that the most vulnerable are protected, particularly those who lack the capacity to express their will. Our law must encourage us not to look at unbearable suffering and choose suicide, but instead we must choose to sustain, help, encourage, equip and empower patients to live out their lives and die naturally with the best care possible. We must fight to keep our current law in the UK and do everything we can to avoid becoming the latest country to allow experimentation with people’s lives.