Dutch euthanasia law exists to protect doctors, not patients
Dutch physicians readily admit they do not want to be prosecuted for practicing euthanasia. They want their government to give them carte blanche whenever they decide a patient or categories of patients would be better off dead. In fact, they want to eliminate even the remote possibility of legal penalties if they terminate patients’ lives—especially when the patients do not qualify for euthanasia under Dutch law.
The euthanasia law, which officially took effect in 2002, is being expanded beyond the guidelines and requirements proponents claimed would be judiciously followed. Initially, to qualify for euthanasia and assisted suicide, patients had to be 12 or older, mentally capable of exercising informed consent, voluntarily and repeatedly request death, have unremitting and unbearable suffering, and have no other reasonable solution to remedy their situation. But Dutch doctors have repeatedly deemed death appropriate for patients who fall far outside of the law’s mandates.
Also significant is the fact that, if physicians choose to terminate lives or assist suicides, the law requires they do so “with due care,” meaning the procedure must be carried out in a medically professional manner. This provision transformed euthanasia and assisted suicide (crimes prior to 2002) into legitimate medical treatments, a change sponsored by the Minister of Health and the Minister of Justice, with prodding by the Royal Dutch Medical Association (KNMG).
The KNMG wields extraordinary power, particularly when it comes to induced death practices. In 2001, when the KNMG disapproved of a Dutch Supreme Court assisted-suicide ruling, it set up a commission to “study” the case and keep the “debate” going so as to render the questionable practice “transparent” for society to accept—a strategy used in the past with success.
The disputed court ruling involved Dr. Philip Sutorius, who was found guilty for the 1998 assisted-suicide death of former Dutch senator Edward Brongersma, 86. Brongersma was not physically ill, just “tired of life” and his aging, “hopeless existence.” The Dutch Supreme Court upheld a lower court ruling that being tired of living is not grounds for death under the euthanasia law. But the lower court declined to sentence Sutorius because, in the court’s opinion, he had acted out of compassion for his patient. The Supreme Court concurred. [Background on case.]
While Sutorius was essentially let off scot-free, the KNMG was not happy with the guilty precedent set in this case. The commission it established to study and challenge the ruling was headed by Dr. Jos Dijkhuis, an emeritus professor of clinical psychology, for whom the commission was named.
The results of the commission’s three year inquiry were released in December 2004. The Dijkhuis Commission report, entitled Lijden aan het Lrven (“Suffering from Life”), found that the current euthanasia law’s guidelines and restrictions are not helpful in setting the limits of medical practice. Furthermore, it concluded that Dutch physicians should be allowed to euthanize physically healthy patients who are “suffering through living.” “[It’s] evident to us,” Dr. Dijkhuis told reporters, “that Dutch doctors would not consider euthanasia from a patient who is simply ‘tired of, or through with life,”’ referring to terms used in the Sutorius court case. Instead, he said, the commission prefers the term “suffering through living,” because it could include patients who may have any number of physical and/or mental complaints—in other words, anyone who didn’t want to live.
The report also argued that a doctor could find that a patient’s “suffering through living” constitutes unbearableand hopeless suffering, making that patient qualified for death even under the existing euthanasia law.
But, true to the KNMG’s goal of securing legal immunity for doctors, the commission recommended the creation of more protocols to better evaluate “suffering through living” cases. The KNMG plans to debate the commission’s recommendations sometime this year—no doubt, with wide media coverage. [Expatica.com, 12/16/04; British Medical Journal, 1/8/05; AP, 12/4/04]
According to Kirk Allison, Ph.D., associate director of the Program in Human Rights and Medicine at the University of Minnesota, what is truly remarkable about the Netherlands is that any “extra legal step is carefully coordinated with the Prosecutors Office. This ensures immunity while compromising both the legal and medical cultures simultaneously.” Furthermore, he explained, “…the strictest guidelines (laws) are not strictly followed, and when new protocols are converted to law, under the argument of transparency, they continue to be quite elastic.” [Correspondence with ITF, 12/13/04]
During a Radio Netherlands interview on the Dijkhuis Report, Dr. Rob Jonquiere, director of the Dutch Voluntary Euthanasia Society, said, “I’m afraid that the world will see in this development a kind of slippery slope, and I think that that message is the wrong message.” During the same interview, Dr. Henk Jochemsen, director of the Lindeboom Institute and professor of medical ethics at the Free University of Amsterdam, talked about another conveyed message. “Acceptance of euthanasia for people who are tired of life will further social pressure, to those who feel themselves to be a burden to others, to ask for euthanasia.” [Radio Netherlands, “Boundaries of Euthanasia,” 1/21/05]
Of all the recently proposed expansions to the Dutch euthanasia law, the “Groningen Protocol” elicited the most outrage worldwide. The protocol was drawn up by doctors at the Groningen Academic Hospital—led by Dr. Eduard Verhagen, head of the hospital’s pediatric department—and the Prosecutor’s Office. The primary purpose of the protocol is to change the law so that doctors who kill severely disabled newborns have legal protection. Infanticide is a clear violation of the existing euthanasia law which requires competent patients to voluntarily request death.
In a press release issued by the hospital, Verhagen explained, “It’s time to be honest about the unbearable suffering endured by newborns with no hope of a future.” He added, “[I]t is in the interest of newborns who have to endure unbearable suffering that we draw up a nationwide protocol that allows each pediatrician to treat this delicate question with due care, knowing that he followed the criteria.” Those criteria are: the infant’s suffering is so severe that there is no hope of a future, there is no possibility of a cure or alleviation with drugs or surgery, the parents give their consent for the infant’s death, an independent doctor’s second opinion is obtained, and the infant’s killing must be done in a medically appropriate manner—with due care. Among those babies who would qualify for death are infants with severe brain damage, spina bifida, or hydrocephalus. [Groningen Hospital Press Release, 12/10/04]
Verhagen and fellow pediatrician Pieter Sauer wrote in the New England Journal of Medicine that only 22 infants were reported euthanized from 1997 to 2004, for which there were no prosecutions. But researchers say that the actual number of infanticide cases (reported and unreported) is at least five times what Verhagen and Sauer claim—around 110 total deaths or 15-20 per year. Verhagen and his staff alone have admitted killing four newborns since August 2003. [NEJM, 3/10/05;AP, 3/10/05, 11/30/04]
Dr. Mark Merkens, director of the spina bifida program at Oregon’s Doernbecher Children’s Hospital and clinical ethics consultant at the Oregon Health & Science University, questioned whether doctors should ever be allowed to determine which babies should live or die. He recalled one of his newborn spina bifida patients whose condition seemed hopeless. The infant’s brain looked so deformed that “it was possible the child would not experience interaction with human beings or anything going on in the environment.”
Merkens had to decide whether to provide palliative care and let the baby die naturally or submit the infant to possibly lifesaving surgery that could very likely prove futile. He discussed the case with an experienced colleague “who made a minor point about the anatomy of the brain and the accuracy of our projection.” Merkens opted for the lifesaving surgery.” That infant is now a young teenager who goes to public school and has normal mental abilities. According to Merkens, “We must be humble about our ability to project…outcomes.” [Oregonian, 12/6/04]
The protocol would also endanger all patients with “no free will”— such as dementia patients, older children, the mentally retarded, comatose and PVS patients, etc.—a fact not lost on disability advocates. “We’re horrified,” said Tara Flood, coordinator of Britain’s Disability Awareness in Action Network. “You’re talking about people like me,” she said. “We’re seeing a real growth in a culture of bumping disabled people off, there’s no other way to describe it. It [the protocol] will be for anyone who doesn’t fancy having a disabled child.” [London Times, 12/4/04]
Belgium in lock step with the Netherlands
Belgium, like the Netherlands, is poised to legalize euthanasia and assisted suicide for minors. Two lawmakers belonging to the ruling Flemish Liberal Party introduced a bill for that purpose because, they said, children have as much intolerable pain and suffering as adults and should have the right to choose to die whenever they want. [Reuters, 9/8/04]
The proposed bill would also legalize infanticide. A recent survey of doctors from the Flemish (Dutch) region of Belgium, published in the British medical journal, The Lancet, found that three out of four doctors are willing to bring on an infant’s death either by withholding treatment or by lethal drugs. Seventy-nine percent (79%) felt it was their professional duty to stop newborn suffering by hastening death. The reasons most often given to justify killing a newborn were “no real chance of survival” and “no hope of a ‘bearable future.’” [The Lancet, 4/9/05. 1315-1320]
Regarding induced deaths under the current euthanasia law, a governmental report found an average of 30 cases reported each month—one per day, around 360 per year. [Expatica.com, 4/21/05]
Euthanasia “kits” (for $77) are now available in 250 Belgian pharmacies to help doctors successfully kill patients in their homes. [AFP, 4/17/05]
Terri Schindler Schiavo 1963-2005
In March 31, 2005, as the world watched in utter disbelief, Terri Schiavo, 41, died. It was not your usual kind of death. It was a dehydration death by judicial edict.
It only took one Florida judge, George Greer, at the behest of Terri’s estranged husband, Michael, and his right-to-die lawyer, George Felos, to issue her death warrant by finding her to be in a persistent vegetative state (PVS) with an undocumented wish to die. It was a finding that was never questioned or investigated by the hierarchy of nearly 20 judges presiding at all the appeals filed by Terri’s parents, Robert and Mary Schindler.
In a lengthy Hannity & Colmes, Fox News interview, Mary addressed Greer’s finding that Terri was in PVS. “[The] 50 doctors that we had that said she’s not PVS, and they take the word of [three] doctors that Michael had? That’s pretty amazing.” As to Terri’s wanting to die, Michael only mentioned her alleged “death wish” after he had received a $1 million malpractice award for Terri’s care and rehabilitation and had announced his intention to marry his longtime girlfriend, with whom he has two children. [Transcript, Fox News, Hannity & Colmes, 5/6/05, pp. 6-7; hereafter cited as Transcript. (Also see: Update, Vol. 17, No. 3.)
While Felos told reporters that Terri died a “calm, peaceful and gentle death,” her parents, brother, Bobby, and sister, Suzanne, tell a different story. Bobby called her death “barbaric” and “grotesque.” Suzanne, who along with Bobby was with Terri 10 minutes before she died, said, “I can remember it like it was yesterday. . . how her eyes were sunken in. She looked like a skeleton. She was struggling to breathe.”
Terri’s father described the scene as “gut-wrenching.” “Her cheekbones, at the end, that’s all we could see was her cheekbones. And her eyes were sunken within her head.” [Transcript, p. 2]
When asked why Felos would mislead people by saying that Terri looked beautiful and her death was peaceful and calm, Bobby replied, “I think they’re mischaracterizing the way she died, just as they mischaracterized Terri’s condition prior to the starvation. They have to do this,” he said. “This is a big lie. Because if they described what was really happening, I think, you know, the nation would be outraged with allowing this to take place.” [Transcript, p. 2]
Terri’s father agreed. “I looked in her mouth—because at the very end she was struggling to breathe—and the inside of her mouth looked like. . . a piece of meat in a meat market. . . that had been out for awhile. . . . Her lips and everything [were] cracking from the lack of hydration,” he explained. “And that’s [some]thing that has never been reported. . . this can’t happen again.” [Transcript, p 4]
To that end, the Terri Schindler Schiavo Foundation has a new mission. “We are clear that our focus now and during the very near future is to help others avoid future tragedies that reflect what Terri endured.” [More information on Terri Schiavo case; More information on the Terri Schindler Schiavo Foundation
California, Hawaii & Vermont say “NO”
to assisted-suicide bills this year
California, Hawaii, and Vermont have been targeted by right-to-diers as states most likely to follow in Oregon’s foot steps by legalizing physician-assisted suicide (PAS). These states have had to grapple multiple times with bills that are essentially clones of Oregon’s Death with Dignity Act (ODWDA). PAS organizations like Compassion & Choices (previously Compassion-in-Dying and End-of-Life Choices, aka Hemlock Society) are desperate to get at least one more state to legalize assisted suicide or else risk loss of funding sources. In the ten–plus years since voters passed the ODWDA in 1994, no state has followed Oregon’s lead.
California has been a prime target for the right-to-die movement: a euthanasia ballot initiative in 1992 and several attempts to pass PAS legislation in 1995, 1999, and 2005. The drumbeat for the latest campaign to legalize Oregon-style PAS started in November 2004, when Democratic Assembly members Patty Berg and Lloyd Levine tantalized the media with the news that a PAS bill was “in [the] pipeline.” [Long Beach Press Telegram, 11/9/04]
Both Berg and Levine were media savvy and, with the help of Compassion & Choices’ co-president, Barbara Coombs Lee, and others, quickly learned to spin the message with a vocabulary geared to fool well-meaning legislators and the public—hence the new bill’s title, “California Compassionate Choice Act.”
The PAS measure, AB 654, passed both the Assembly Judiciary and the Assembly Appropriations Committees with more than a little arm twisting by Berg and Levine. But, on June 2, 2005, before it was due to be voted on by the full Assembly, Berg and Levine pulled the bill, acknowledging that they simply did not have the votes to pass it. According to the LA Times, “support for the measure. . .was so weak” that its authors plan to use a “parliamentary maneuver” to gut a bill that has already passed the Assembly and is currently in the Senate, and amend it with the text of the defeated AB 654. Their hope is that the bill would do better in the Senate. But, even if it were to pass the Senate, which is highly unlikely, it would still have to go back to the Assembly for a floor vote. [LA Times, 6/2/05; SF Chronicle, 6/2/05]
Opponents of the PAS bill—professional groups and a broad coalition of disability advocates, health care workers, advocates for the poor, minority groups, religious organizations, hospice groups—called Berg and Levine’s maneuver “a publicity stunt.” “At the end of the day, proponents couldn’t find 20 votes to publicly support this bill,” said Tim Rosales of Californians Against Assisted Suicide. [Press release, 6/2/05]
Three years ago, Hawaii’s legislature hotly debated a PAS bill. The House had actually passed the Hawaii Death with Dignity Act, but the Senate stopped it from becoming law. Encouraged by the fact that the measure had progressed farther than ever before in Hawaii, Compassion & Choices decided to try an Oregon PAS clone again.
During the 2005 legislative session, PAS proponents introduced HB 1454, also titled the Death with Dignity Act. Only this time—after more than nine hours of pro and con testimony—the measure didn’t even survive its first hearing before the House Health Committee.. [Honolulu Advertiser, 2/6/05; Star-Bulletin, 2/6/05]
Much of the credit for the bill’s defeat goes to the work of a broad-based, opposition coalition.
In 2003, PAS proponents introduced the Vermont Death with Dignity Act, but the chairs of both the House and Senate Health & Welfare committees refused to hear the measure. [Rutland Herald, 12/3/03, 1/7/04]
Meanwhile, the Vermont Legislative Council studied PAS practice in both Oregon and the Netherlands, and issued its 43-page report in December 2004. Encouraged by the report’s favorable right-to-die slant, the Vermont chapter of End-of-Life Choices (formerly the Hemlock Society) introduced yet another Vermont Death with Dignity Act (H-168) in 2005. [Rutland Herald, 12/4/04; WCAX-TV, 2/7/05]
On April 12-14, the House Human Services Committee heard 3 hours of public testimony and almost 12 hours of expert testimony for and against the bill. While the majority on that committee favored legalizing PAS, opponents were able to raise enough serious questions and concerns during the hearings for the committee to decide not to vote on the measure this year. [AP, 4/16/05; Burlington Free Press, 4/16/05]
Oregon family leaks PAS failure;
Compassion & Choices’ veracity questioned by newspaper
When David E. Prueitt woke up on February 2, 2005, his first words were: “What the hell happened? Why am I not dead?”
Prueitt, 42, had lung cancer and opted for physician-assisted suicide (PAS) under Oregon’s Death with Dignity law. On January 30, he took the prescribed lethal dose of barbiturates, with his wife, her mother, a friend, and two members of the assisted-suicide advocacy group Compassion & Choices (formally Compassion in Dying & End of Life Choices) close at hand. But he didn’t die. Three days later—after being unconscious for 65 hours—Prueitt awoke. Two days later he told his wife that he had been in God’s presence, and that God had rejected his PAS death, sending him back to live out his life. Prueitt died naturally almost two weeks later on February 15, 2002.
It was only after Prueitt’s family told the media about the botched assisted suicide that Compassion & Choices’ co-president, Barbara Coombs Lee, commented publicly on the case. “He did take a complete dose and slept soundly for 65 hours,” Coombs Lee admitted. “Then he awakened. He suffered no ill effects,” she said. “He was fully capable and competent—and surprised.” She also stated that the Oregon Department of Human Services (ODHS) would be investigating what caused the assisted suicide failure. [Oregonian, 3/4/05; AP, 3/4/05]
Coombs Lee’s statement prompted the ODHS to issue its own press release stating unequivocally that, under the Oregon assisted-suicide law, the ODHS has “no authority to investigate individual Death with Dignity cases.” [ODHS Press Release, 3/4/05] Coombs Lee responded, “If they can’t do it, we’ll convene a panel of experts to investigate this case and publish a report about what happened.” [Oregonian, 3/5/05]
But that poses a major problem, according to the Oregonian, Oregon’s largest newspaper. “As useful as such an investigation could prove to be, Compassion & Choices hardly qualifies as a disinterested party, and seems unlikely to be inclined to offer conclusions that undermine its basic reason for being.” The editorial even questioned the accuracy of the annual state reports on the 208 reported PAS deaths since 1997 because the vast majority—over 75%—of those deaths were Compassion & Choices clients whose deaths were orchestrated by the group’s doctors, staff, and volunteers. “As the Prueitt case shows, the people reporting on the central facts of the [PAS] experiment are not disinterested,” the editorial read. “The results must be considered suspect because they may be shaded by people who, for various reasons, want things to seem fine.” [Oregonian, Editorial, 3/8/05] (For past concerns about official reports, see: Six Years of Assisted Suicide in Oregon.)
Oregon releases 2004 stats on reported PAS deaths
On March 10, 2005, the Oregon Department of Human Services (ODHS) released its annual report on Oregon’s physician-assisted suicide (PAS) law, the Oregon Death with Dignity Act (DWDA), which took effect in 1997. As was the case with all previous reports, this latest “Seventh Annual Report” covers only the assisted-suicide deaths that were reported to the state. The ODHS acknowledges that the data used “do not include patients and physicians who may act outside the provisions of the DWDA.” [“Seventh Annual Report on Oregon’s Death with Dignity Act,” 3/10/05, p. 16; hereafter cited as PAS Report] The ODHS’s data is obtained from physician and pharmacy reports, physician interviews and death certificates. The patients are never interviewed prior to death. [PAS Report, p. 10]
In 2004, a total of 37 patients reportedly ingested prescribed lethal drugs and died under Oregon’s PAS law. Forty (40) doctors wrote 60 lethal doses of barbiturates. Of those who received the 60 prescriptions, 35 took the drugs and died in 2004. Of the remaining 25 patients who did not take the drugs, 13 died naturally of their illnesses, while 12 were still alive on December 31, 2004. Two additional patients, who had been prescribed barbiturate overdoses in 2003, died in 2004—bringing the total number of reported deaths to 37. [PAS Report, p. 12]
Of the 40 lethally-prescribing doctors, 28 wrote one prescription, nine wrote two, one wrote three, one wrote four, and one wrote seven. In only six of the 37 PAS cases (16%) were the prescribing doctors present when their patients ingested the fatal drugs. Moreover, these doctors—mostly family practitioners, oncologists, and internists, not psychiatrists—referred only two (5%) of the 37 patients requesting death for psychological evaluations. [PAS Report, pp. 13-14]
Regarding this low number of referrals, assisted-suicide activist Dr. Peter Rasmussen—an Oregon oncologist who won’t be specific about how many lethal prescriptions he’s written—commented, “…I would say that most oncologists and people who spend a lot of time with the terminally ill are getting good at picking up clinical depression.” He admitted, however, that he saw 75% of his assisted-suicide patients for the first time and that he takes only about three hours with each patient—either in person or over the phone—before he writes the fatal prescription. “I think all involved in the Oregon law,” he said, “must recognize that we are on a slippery slope, and we have to be careful with every step.” [American Medical News, 4/4/05]
Pushing Infanticide: From Holland to New Jersey
Wesley J. Smith
Bureaucracy has trumped morality in the Netherlands. How else can one explain a country where, when doctors admit publicly that they commit eugenic infanticide, the leaders’ response is not to prosecute them for murder, but instead to urge that guidelines be created under which future baby killings can openly take place?
The “Groningen Protocol”—named after a pediatric hospital which admittedly permits doctors to end the lives of babies born with disabilities or terminal conditions — seeks to normalize infanticide by bringing the practice out of the shadows and into the light of day. Under this thinking, it isn’t the killing that is wrong, but the secrecy.
Secrecy? What secrecy? It has been widely known for years that Dutch doctors kill disabled and dying babies. As far back as 1992, the Dutch Royal Society of Medicine published guidelines to be used in deciding whether to kill a baby, including whether the child would ever be able to live independently, experience “self realization” (being able to hear, read, write, labor) and have meaningful interpersonal relations.
By 1993, as documented in PBS’s Choosing Death, three out of eight neonatal intensive care units in the Netherlands had specific policies, endorsed by the Dutch Pediatric Society, that permitted infanticide by lethal injection. Rita Marker’s breakthrough book Deadly Compassion (Marker leads the International Task Force on Euthanasia and Assisted Suicide) raised the warning flag about Dutch infanticide in 1993. In 1996, the Lancet published a study finding that 8 percent of all Dutch infant deaths each year—between 80 and 100—result from lethal injections, many without parental consent. I wrote about the matter extensively in my 1997 book Forced Exit.
No, the publishing of the Groningen Protocol isn’t designed to end the secret that is not a secret. It is intended to legitimize eugenic infanticide and move it from a crime tolerated by the, oh, so tolerant Dutch, to outright legality. In other words, the last vestige of protection left in the Netherlands against infanticide—that is, the technical illegality of killing babies in the Netherlands—is to be stripped away, including the protection against the killing of disabled infants not dependent on intensive care for survival.
Murdering babies because they are disabled or dying is a profound violation of their human rights. At least, it used to be. After all, German doctors who killed disabled infants during World War II faced the business side of the hangman’s noose for their crimes.
This belief appears to be changing, at least among elites. As a consequence, an effort appears to be under way to spread the Dutch cancer to our own shores. The New England Journal of Medicine, for example, recently provided a forum for two Dutch doctors to explain dispassionately how the Groningen Protocol seeks “to develop norms” for infanticide. This was merely the most recent in a series of euthanasia/assisted suicide-promoting articles that have been published in that once august journal in recent years. (Perhaps the NEJM should change its name to The New Euthanasia Journal of Medicine.)
Meanwhile, rather than writing scathing editorials against infanticide, the New York Times instead published “A Crusade Born of a Suffering Infant’s Cry,” a puff profile of one of the leaders of the Dutch infanticide movement, Dr. Eduard Verhagen, “a father of three who spent years tending to sick children in underdeveloped countries.” The article laments, “For his efforts to end what he calls their unbearable and incurable suffering, Dr. Verhagen has been called Dr. Death, a second Hitler and worse—mostly by American opponents of euthanasia.” Poor baby.
Meanwhile, the Los Angeles Times published an apologia for infanticide by Princeton’s notorious Peter Singer, which its subheadline described as “an ethics expert,” in which the world’s most famous proponent of infanticide—he once explicitly compared the killing of a baby to the catching of a mackerel—attempts to conflate removing intensive care and other life support from a dying baby with active killing based on quality of life considerations: “The dispute is no longer about whether it is justifiable to end an infant’s life if it won’t be worth living,” Singer wrote, “but whether that end may be brought about by active means….”
Not mentioned by Singer or the Los Angeles Times is that the “ethics expert” believes that babies who could unquestionably lead happy lives, such as those with Down syndrome and hemophilia, indeed, any infant—not just the dying or disabled—can be killed if their deaths would serve the interests of their families. Indeed, Singer does not consider infants to be “persons,” and hence under his thinking, no infant has the right to life.
The Dutch have fallen into a moral abyss of utter relativism where even the lives of helpless babies are not sacrosanct. But this isn’t a foreign problem: Many of our own molders of professional and public attitudes apparently want to drag us over the same precipice. Whatever the New Euthanasia Journal of Medicine is trying to sell, when it comes to infant euthanasia, this is a time for repulsion not acceptance.
Wesley J. Smith is a senior fellow at the Discovery Institute, an attorney for the International Task Force on Euthanasia and Assisted Suicide, and a special consultant to the Center for Bioethics and Culture. His article, published in the National Review, 3/22/05, is reprinted here with the author’s permission.
Lords: Euthanasia/PAS should be debated in
A British House of Lords select committee called for a whole House debate on its euthanasia/assisted suicide report to be held during Parliament’s session that opened May 17, 2005. The committee was divided over whether euthanasia and assisted suicide should be legalized.
fter studying Lord Joel Joffe’s “Assisted Dying for the Terminally Ill Bill” (ADTI) for a year, the Lords’ select committee issued its report on April 4, 2005. Joffe’s bill would have lifted the existing ban on both practices to “enable a competent adult who is suffering unbearably as a result of a terminal illness to receive medical assistance to die at his/her own considered and persistent request.” [ADTI, Statement of Purpose] The committee called for a debate in the next parliamentary session because time had killed the ADTI when the 2004-2005 session was cut short for the UK’s general election. [BBC, 4/4/05; ABC, 4/4/05]
The Lords’ report contained recommendations for a future “assisted dying” bill, including: assisted suicide and euthanasia should be dealt with separately, allowing a possible change in the law for one and not the other; the term “unbearable suffering” should be changed to “unrelievable suffering”; conditions for “assisted dying” should be specific to clinical practice; and actual procedures doctors should follow must be clearly stated. [Assisted Dying for the Terminally Ill Bill [HL], Vol. I, pp. 7, 87, 91] Lord Joffe has said he will draft a new bill after the full House debate. [British Medical Journal, 4/9/05]
Pressure to legalize assisted suicide, proponents say, comes from the fact that, so far, 30 British patients have traveled to Switzerland where the group Dignitas gives them legal but fatal overdoses of barbiturates. [UPI, 4/4/05]
As the report noted, “It is clear to us from the evidence we have received that the demand for assisted suicide or voluntary euthanasia is particularly strong among determined individuals whose suffering derives more from the fact of their terminal illness than from its symptoms and who are unlikely to be deflected from their wish to end their lives by more or better palliative care.” [Report, p. 7]
The push to legalize euthanasia and/or assisted suicide for this small number of “determined individuals” places other more vulnerable patients at risk. A UK study released in March 2005 found that 1.28 million people over 65 feel lonely, while 250,000 have no family of friends. “The findings of this survey make depressing reading,” explained Paul Cann, director of policy for the charity Help the Aged. “We far too often shunt older people into the sidings of life, leaving them without enough money or activity and above all human warmth.” [Evening News (Edinburgh, Scotland), 3/31/05
Disabled man’s right to life challenged in U.K.
Last year, when British patient Leslie Burke, 45, won his landmark court challenge of the General Medical Council’s (GMC) ethical guidelines regarding tube feeding and hydration, he was relieved. Burke, a wheelchair user with a degenerative nervous system disorder, had feared that, once he could no longer swallow and communicate, doctors would decide that his quality of life was no longer sufficient to warrant his receiving food and fluids through a tube. High Court Judge James Munby agreed with Burke and ordered the GMC to revise its guidelines to indicate that doctors must provide food and fluids to a competent patient who requests them, as well as an incompetent patient with an advance request for such treatment. (Background on Leslie Burke case.)
It didn’t take long, however, for the GMC, backed by the British government, to appeal the High Court’s ruling. The GMC argued that the ruling had broad implications, allowing patients to request treatments “no matter how untested, inappropriate or expensive, regardless of doctors’ views.” Lawyer Philip Sales, representing Health Secretary Patricia Hewitt, told the panel of three appellate judges that doctors, not patients, should have the final say on treatment options like tube feeding, otherwise there would be “inefficient use of resources within the NHS [National Health Service].” It was estimated that providing a patient with artificial nutrition and hydration would cost the NHS £1,500 per day. [London Times, 5/18/05, 5/19/05]
David Wolfe, from the Disability Rights Commission (DRC) told the appeal judges that no one should determine that certain treatment was not in the patient’s best interest based on “resource implications.” “The DRC is concerned that resource allocation issues should not be dressed up as, or confused with, an evaluation of what is in the patients’ best interests,” he said. Wolfe also charged that the health secretary and the GMC demonstrated negative attitudes toward disabled persons. [Guardian, 5/19/05; PA News, 5/19/05]
At the time of the appeal hearing, Leslie Burke explained that he’s not asking for radical treatment to extend his life. “I just do not want to effectively die of starvation and thirst which may take up to two weeks. I want as far as possible to be able to approach the end of my life with dignity.” [Gulf Daily News, 5/17/05]
In a recent editorial, the Daily Telegraph sided with Burke: “The General Medical Council is arguing that doctors should not be forced to provide treatment they consider inappropriate. That seems perverse: a doctor’s medical judgment should come second to the much stronger natural presumption of the right to life.” [Daily Telegraph, 5/17/05] An appellate court ruling is forthcoming.