Update 034: Volume 19, Number 3 (2005)

Dutch studies don’t tell whole story about euthanasia practice

Dutch euthanasia studies, recently published in American medical journals, present new data on end-of-life decision-making as it pertains to the induced deaths of adults and children in the Netherlands.

A Dutch, government-sponsored, euthanasia study—published in the Archives of Internal Medicine—examined patients’ requests for euthanasia and physician-assisted suicide (PAS), and the responses of Dutch doctors to those requests.

Researchers from Amsterdam’s VU University Medical Center sent written questionnaires to general practitioners (GPs) in 18 of the country’s 23 GP districts. A total of 3,614 GPs (60%) filled out the questionnaire and returned it. They were asked about all euthanasia and PAS requests they had received in the previous 12 and 18 months and their subsequent responses. [Jansen-van der Weide et al., “Granted, Undecided, Withdrawn, and Refused Requests for Euthanasia and Physician-Assisted Suicide,” Arch Intern Med 165 (Aug. 8/22, 2005): 1698-1704]

Of the explicit death requests, 44% were granted by GPs. In the other cases, 13% of the patients died before doctors could end their lives; another 13% died before doctors made the final decision to grant or deny their requests; 12% of the requests were refused by the GPs; and 13% of the patients changed their minds and no longer wanted to die. According to the researchers, “pointless suffering,” “loss of dignity,” and “weakness” were the three most frequent and compelling reasons patients gave for wanting to die. Among those denied euthanasia or PAS by the GPs, “not wanting to be a burden,” “tired of living,” and “depression” were reasons most often given by patients to justify their death requests. [p. 1699]

The Dutch researchers concluded, “Physicians report compliance with the official requirements for accepted [euthanasia/PAS] practice.” [p.1704]

Editorial Questions Validity

In an accompanying editorial, however, Susan M. Wolf, J.D., from the University of Minnesota Law School, questioned the validity of the researchers’ conclusion: “Sadly, there are substantial reasons to doubt this reassurance,” she wrote. The surveyed doctors were picked in part because they had “no negative attitude toward euthanasia.”

[A]ll physicians being surveyed were either recently trained in the [euthanasia law] rules as consultants or the target of a project to encourage them to use these consultants and follow the rules. There was no control group, and retrospective self-report was the only data collection method. This is hardly an adequate basis for assessing whether physician practice actually complies with the rules. [Wolf, “Assessing Physician Compliance with the Rules for Euthanasia & Assisted Suicide,” Arch Intern Med 165 (Aug. 8/22, 2005):1677-1679]

Wolf also pointed out that the study’s data were compiled between 2000 and 2002—precisely when the Dutch government was preparing to pass and enact the new euthanasia statute, created, in large part, to solve the huge problem of physician noncompliance. This study, she wrote, “suggests that there was no significant problem to be solved by this statute. This is difficult to believe.” [p. 1678]

Euthanasia for Children

A two-part Dutch study, published in the Archives of Pediatrics & Adolescent Medicine, examined medical end-of-life decisions (ELDs) as they related to children between the ages of 1 and 17. The government-sponsored study defined ELDs as “decisions that, whether intentionally or otherwise, hasten death.” ELDs range from forgoing life-sustaining treatments and alleviating pain using drugs that can cause death, to opting for euthanasia, assisted suicide, or terminal sedation (where all food and fluids are withheld from the patient). [Vrakking et al., “Medical End-of-Life Decisions for Children in the Netherlands,” Arch Pediatr Adolesc Med 159 (Sept. 2005): 802-809]

The Dutch researchers conducted two separate studies; the data from both were included in the published article. The first study obtained data from a written questionnaire sent to 129 Dutch doctors who signed the death certificates of all children age 1 to 17 who died between August and December 2001. The second study involved face-to-face interviews with 63 doctors from pediatric hospital departments. [p.803]

The death certificate study found that 36% of children’s deaths were preceded by an ELD. Of all the deaths, 12% resulted from nontreatment decisions, 21% from the use of potentially death-hastening drugs to control pain and other symptoms; 2.7% involved “physician-assisted dying” (in 0.7% of these cases, death was requested by the child; in 2%, death was requested by others). [p. 804]

The interview study found 20 cases where doctors used drugs to intentionally end children’s lives. In two of those cases, the death request came from the child. Parents requested that their child be killed in 16 cases, while in two other cases the child’s life was terminated without an explicit death request from either the child or the parents. [pp. 804-805]

Researchers acknowledged that “active life ending occurs as frequently in children as in adults, but a patient request is rare in children.” [pp. 806-807]

While the studies’ authors paint a rosy picture of mutual ELDs among doctors, parents, and children, the fact remains that killing a child under 12 is illegal under the Dutch euthanasia law.

Editor’s note: It’s become obvious that seriously ill and disabled infants and children are at risk in the Netherlands. The illegal status of infanticide and child euthanasia is just a minor technicality that can be undermined by conducting government-sponsored studies of the practices and publishing the results in reputable professional journals. The more this is done, the more the illegal act seems desirable and, above all, necessary.
Earlier this year, the ITF Update reported on the “Groningen Protocol,” a series of proposed guidelines which doctors can follow when they terminate the lives of severely disabled newborns. The protocol elicited worldwide outrage, particularly after the New England Journal of Medicine published an article on the issue by the Dutch doctors who helped formulate the guidelines. [See, Update, 2005, no. 1]
Apparently unfazed by all the international criticism, the Dutch Pediatric Society has voted unanimously to adopt the Groningen Protocol as official national guidelines. The vote was called a “confirmation of the acceptability” of a still illegal act. [British Medical Journal, 7/16/05]

Britain & Canada to debate assisted suicide

The battle lines are being set for what promises to be highly emotional, acerbic debates in both the British and Canadian parliaments in October. The topic: legalization of euthanasia and assisted suicide.

In Britain, the euthanasia debate flared earlier this year after a House of Lords select committee issued a favorable report on Lord Joel Joffe’s “Assisted Dying for the Terminally Ill Bill,” a measure that would legalize euthanasia and assisted suicide. The Lords also called for a full House debate on the induced death issues.

Also earlier this year, the British Medical Association (BMA) abandoned it’s long held opposition to euthanasia/assisted suicide, and adopted a neutral stance on both practices. The vote was reportedly staged to be taken after the majority of representatives had left on the meeting’s last day. [Daily Post, 7/14/05] Michael Cook, editor of the international bioethics newsletter, BioEdge, noted, “In short, a rigged vote by a fraction of delegates to the annual representative meeting made what is probably the most momentous decision in the BMA’s history.” [spiked-online.com, 9/05]

Outraged over the BMA’s action, the Royal College of General Practitioners, with the overwhelming support of its members, changed its position from neutral to strongly opposing any change in the law banning euthanasia. [Press Release, Royal College of General Practitioners, 9/21/05]

The Canadian Medical Association (CMA) has no plans to review its opposition to physician-assisted suicide, even though the Canadian Parliament will debate a euthanasia/assisted-suicide bill on October 31. [medicalpost.com, 8/9/05]

The measure, “Bill C-407,” would legalize both induced-death practices, making them available to the terminally ill and those with chronic physical and mental pain. The bill is so badly written that it allows anyone to euthanize or assist the suicide of another, as long as they are aided by a “medical practitioner,” a term not limited to physicians. “This bill seems aimed at legally enabling assisted-suicide advocacy groups to get into the business of hastening deaths,” observed Wesley J. Smith, author and attorney for the ITF. [wesleyjsmith.com web log, “Secondhand Smoke,” 7/18/05]
More on Bill C-407.

Also in October: Oral arguments before the U.S. Supreme Court in Gonzales v. Oregon will be heard on October 5, 2005. For the latest information on this pivotal case involving the use of federally-controlled drugs to assist suicides in Oregon, see: Gonzales v. Oregon.

Marketing death

Belgium: Last April, about 250 Belgian pharmacies began selling easy-to-use euthanasia kits. The kits, purportedly only sold to doctors, cost around $77 and contain all the drugs and materials needed to end life, including instructions on setting up an IV drip. Some pharmacists denounced the kits as a publicity stunt to promote certain pharmacies. Moral theologian Fr. Thierry Lievens, from Brussels, found the “technical logic” manifested in these kits “frightening.” “The death of another becomes a technical act that is equivalent to building a house.” From there,” he said, “it is logical that a technical act will fall into the commercial domain.” [AFP, 4/17/05; Nat’l Catholic Reporter, 9/23/05]

The Netherlands: Meanwhile, in the Netherlands, the influential pro-euthanasia group, NVVE, has developed more euthanasia guidelines—this time for making the “LastWillPill” (aka “Peaceful Pill”) available to all seniors age 75 or older so they can end their lives. The idea of a suicide pill for the elderly was originally conceived in 1991 by Prof. Huib Drion, a former Dutch Supreme Court justice who died last year.

NVVE’s new procedural guidelines would take LastWillPill deaths “out of the medical domain” and place them under a “national authority” appointed by the government to dispense the fatal pills, train volunteers to assist the elderly, and be present when pills are taken. The national authority would have convenient regional locations and would be required to submit annual reports to the government. [Relevant, (NVVE’s monthly publication), 7/05, p. 21]

Comment: The need for NVVE’s guidelines appears premature since no suicide pill is currently available anywhere. [ERGO, Right-to-die News List, 8/9/05] Perhaps the group is positioning itself to be the appointed “national authority” if there ever is such a pill.

Peter Singer: Sanctity of life will be destroyed

Princeton bioethics professor Peter Singer, considered by some the most influential philosopher still breathing, is well-known for his longtime advocacy of infanticide, euthanasia, assisted suicide, and bestiality.

He now predicts that, by 2040, “the traditional view of the sanctity of human life will collapse” under the weight of science and technology, and “only a rump of hard-core, know-nothing religious fundamentalists will defend the view that every human life… is sacrosanct.” “By then,” he says, “an increasing proportion of the population in developed countries will be more than 75 years old and thinking about how their lives will end. The political pressure for allowing terminally or chronically ill patients to choose when to die will be irresistible.” [Singer, “The Sanctity of Life, Foreign Policy, Sept./Oct., 2005]

Singer is, without question, the most internationally protested philosopher alive. In Europe, German parliamentary members have compared him to Nazi henchman Martin Bormann [Washington Times, 3/30/98], and disability right groups around the world have denounced him for, among other things, advocating the killing of disabled newborns. When asked if it is ethical for parents to have a child just so they can kill her and use her organs for their ill, older child, Singer replied, “It’s difficult to warm to parents who can take such a detached view, (but) they’re not doing something really wrong in itself.” [Olasky, “The most influential philosopher alive,” townhall.com, 12/2/04]

For more information on Singer, see: Singer and Not Dead Yet.

Missouri cutbacks target feeding tubes, equipment

Citing a huge deficit in the state’s Medicaid program covering about 1 million low-income patients, Missouri lawmakers have cut 90,000 people from the program, required others to pay some of their medical costs, and dropped payment for most of the “durable medical equipment” for 340,000 poor adults remaining in the program. Included in that category of equipment are feeding tubes and the nutritional formula that flows through them. [St. Louis Post-Dispatch, 8/30/05]

A scathing editorial critical of the equipment cuts appeared in the St. Louis Post-Dispatch. Pointing out that feeding tubes and nutritional formula are not “optional” for the thousands of brain damaged and disabled Missourians who can’t swallow and will die without tube-supplied food and fluids, the editorial went on to describe some of the obstacles facing these patients and their caregivers.

While patients who need feeding tubes can apply for “exceptions,” most were never informed about that option. Furthermore, the patient cannot file for the exception; a letter from his or her doctor is required.

There is also an appeals process. According to the editorial, “Patients who are losing feeding tubes and other equipment have been told they can file appeals. But the results to date are less than encouraging. As of last Wednesday [8/24/05], 1,048 people had filed appeals. Of the 427 appeals hearings held, the patient lost in 396 of them.” [“Missouri’s Medicaid Shame: Feeding tubes optional,” St. Louis Post-Dispatch, 8/31/05]

K. Gary Sherman, director of the MO Dept. of Social Services, defended the equipment cuts: “It simply is not possible to significantly reduce Medicaid spending without affecting the coverage for the elderly and disabled; spending for these categories accounts for nearly 70 percent of the Medicaid budget.” [St. Louis Post-Dispatch, 9/6/05]

Cranford & Schiavo honored at ethics conference

The September 23rd conference, titled “33 Years of Clinical Ethics in Minnesota: Ron Cranford’s Stories of Heroes & Courage,” was essentially a retirement party for neurologist Ronald Cranford and a celebration of his involvement in over 30 years of “right to die” cases in which he testified in favor of death for patients. But the Minneapolis conference also provided invited speaker Michael Schiavo—the latest Cranford right-to-die “hero”—a friendly forum for telling his side of Terri’s story.

“I never, in my entire life, thought I would be thrown into such a national debate,” Michael said. “All I wanted to do was carry out my wife’s wishes.”

“Terri didn’t die an awful death,” he told the audience, wiping away tears. As he held her in his arms, he explained, “I laid a red rose in her hand and said goodbye” [Minneapolis Star Tribune, 9/24/05]

Michael’s portrayal of himself as Terri’s loving, attentive husband, got him a standing ovation. Apparently, no one in the audience of 200 professionals remembered or cared that three of Terri’s former caregivers had testified, before her death, that Michael was anything but loving toward his wife. According to the sworn affidavit by nurse Carla Sauer Iyer, when he came to the nursing facility, Michael said things like: “Has she died yet?” “When is that bitch gonna die?” and “Can’t anything be done to accelerate her death—won’t she ever die?” [Affidavit of Carla Sauer Iver, 8/29/03]
More on Terri Schiavo case.