Non-terminal Cases

Proposed euthanasia and assisted legislation no longer limit it to those who have an imminent terminal illness but include all who are in a distressed state.
  • People who are depressed are un able to make rational decisions as regards choosing treatment or wanting to die.
  • Non-terminal disabled adults and infants are euthanised in Holland, often without consent.
  • Contempt for the disabled that is inherent in laws that would allow assisted suicide on demand.
  • A doctor's decision make be coloured by his/her opinion of a patient's 'quality of life.
  • Depression in cancer patients with an estimated life expectancy of less than 3 months is associated with a higher likelihood to request for euthanasia.
The position held by the World Federation of Right to Die Societies as stated in their 1998 Zurich declaration is that people "suffering severe enduring distress" qualify for an assisted death. They believe that one does not need to be terminally ill in order to qualify for euthanasia or assisted suicide, only "hopelessly ill."

The definition of just what 'unbearable suffering' means is open to interpretation.

According to the Supreme Court in the Netherlands, suffering has been defined as both physical and psychological, while in Belgium the legislation states that "a patient seeking euthanasia must be in a hopeless medical situation and be constantly suffering physically or psychologically."

This has serious ramifications especially for people with depression. The majority of people who commit or attempt suicide are suffering from treatable depression. With the legalisation of euthanasia and assisted suicide (EAS) for conditions that are not terminal, people with depression could demand the right-to-die rather than be treated even though, suffering from depression, their judgment is flawed.

What is seen by some as a right to make an autonomous decision, becomes in practice, a decision by a doctor who may or may not know the person or his/her background and medical history.

Euthanasia of persons who do not have an imminent terminal illness (where they are expected to die within six months) is seen by opponents as having eugenic and economic overtones.

Eugenic Euthanasia
At first, euthanasia in Holland was permitted only if physicians followed strict guidelines. Patients had to be conscious, mentally competent, in unbearable pain and suffering from a terminal disease. A voluntary request for euthanasia was also necessary.

Euthanasia in the Netherlands is not now restricted to voluntary euthanasia for the terminally ill, but includes non-voluntary euthanasia for the `never-competent' adults and minors, non-terminally ill, disabled, depressed and the elderly. Eugenic euthanasia has also become an acceptable practice on disabled newborns in the Netherlands.

The law allows physicians even greater freedom, which opponents believe could compromise the the rights of disabled and older people. 1

Disability-rights advocates around the world have strongly criticised the way doctors in the Netherlands have disregarded the law. The U.S. group Not Dead Yet have denounced the action.

"The Dutch experience with euthanasia is best described as one of increasing carelessness and callousness over the years. The strict guidelines under which euthanasia was decriminalized for many years have been widely ignored, according to published reports in the Netherlands," said Stephen Drake, a research analyst for Not Dead Yet. "In spite of admitted widespread abuses, only a handful of doctors have even been prosecuted for violating guidelines." 2

Not Dead Yet board member Carol Cleigh added, "Holland has shown us how easy it is for euthanasia to become institutionalized and routine. Non-terminal disabled adults and infants are euthanized routinely in Holland, often without consent."

“All they see is the wheelchair”
In 1983 a young woman wanted to die and sought legal help to have force a hospital to keep her comfortable while she starved herself to death. Elizabeth Bouvia had experienced a recent miscarriage, had an impending divorce, the death of a brother, and the cancer diagnosis of her mother. Elizabeth Bouvia, also happened to be “confined” to a wheelchair.

She saw death, she said, as "letting go of all burdens. It is being able to be free of my physical disabilities and mental struggle to live." Instead of recognising the symptoms of the clinical depression Elizabeth was suffering, Richard Scott, an attorney who was a co-founder of the Hemlock Society and involved with the Southern California Chapter of the American Civil Liberties Union, approached Elizabeth in the hope he would be able to push the right to die as a civil liberties issue.

Bouvia lost, and later changed her mind about suicide. Read the story here.

Not Dead Yet President, Diane Coleman, notes the contempt for the disabled that is inherent in laws that would allow assisted suicide on demand.

Depression and emotional pain
In the past, safeguards in the Netherlands purportedly allowed euthanasia only for patients who were terminally ill and suffering untreatable physical pain.

"But a lot of that was broken over time," says Gregor Wolbring, a German biochemist living in Canada, and a leader in the international anti-euthanasia movement. "Now you can also get euthanasia if you are emotionally having a problem, or if you are incurable. The safeguards they had ten or fifteen years ago, don't exist anymore."

Depression in cancer patients with an estimated life expectancy of less than 3 months is associated with a higher likelihood to request for euthanasia. Where EAS is legal, the issue for medical professionals is whether depressed moods should be treated or should they simply grant the request for euthanasia.

As noted before, their decision make be coloured by their opinion of a patient's 'quality of life.'

The majority of elderly suicides die because they are lonely, inadequately supported, or have poor medical care. This is also the case for many of those who request help to die.

Non-voluntary and coerced euthanasia
People with disabilities, the elderly and other vulnerable persons experience abuse and pressure and have a need to be protected.

Professor Raphael Cohen-Almagor of the University of Haifa wrote a paper for Issues in Law & Medicine in 2003, based on his interviews with Dutch doctors about the Remmelink data.

One doctor, Frank Koerselman, told Cohen-Almagor about an 85- year-old patient with pneumonia and depression. The man's family didn't want Dutch doctors to treat him. The patient's doctor was ready to take the easy way out. Koerselman said that he had to order security guards to remove the family so that he could question the patient in private. Then the patient opted for treatment, got it and was discharged from the hospital in very good condition, physically and mentally. 3

EAS could come to be seen as an easy way to cut medical costs, thereby reducing healthcare budgets, financial burdens on taxpayers who pay for government health care programs and families who care for elderly, ill and disabled members.

Safeguards
According to a study in the August 8/22 issue of Archives of Internal Medicine, one of the JAMA/Archives journals, physicians in the Netherlands rely on careful patient evaluations and official practice guidelines when considering patient requests for EAS.

There were more than 2,600 requests in all. In 12% of cases the doctor refused and in another 13% of cases the patient changed his or her mind. The Dutch government says that there were 1,886 cases of euthanasia in total last year. The most frequent reasons for requesting EAS were “pointless suffering,” “loss of dignity” and “weakness.”
specific questions to uncover the possible abuses related to euthanasia.

In a JAMA editorial accompanying the article, Susan M. Wolf, J.D., of the University of Minnesota Law School, writes,
“The ultimate question remains—if you permit physicians to take life deliberately by assisting suicide or performing euthanasia, can you control the practice? … Determining the answers will require detailed study in each health system and culture permitting assisted suicide or euthanasia. The Dutch have struggled mightily for more than two decades to devise a system to oversee physician-assisted suicide and euthanasia and keep both practices within agreed bounds. It is not clear that they have succeeded. Yet even if they were to succeed, that system might not work in the United States. The Dutch have universal health care coverage, long-standing relationships between physician and patient, and a far more homogenous society.”

“Virtually all agree that it is irresponsible to permit assisted suicide and euthanasia without safeguards,” Wolf concludes. “There must be limits and an effective way to police them. Yet it remains unclear that we know how to restrain these practices and assure physician reporting. The Dutch should be commended for wrestling with this problem. But even they may not have the answer to this immensely difficult question.” 4
In the Netherlands euthanasia is very narrowly defined as a voluntary act and any act which is not voluntary does not come under the definition of euthanasia. Previous reports proved that nearly 50% of all euthanasia deaths are not reported.

The study does not address death by deliberate dehydration of patients with dementia or whose disabilities restrict their ability to communicate. A 2004 report proved that intentional dehydration was estimated at between 4 - 10% of all deaths in the Netherlands.

Disabled rights groups point out the bias of the study which was funded by the Royal Dutch Medical Association and the Dutch Ministry of Health, Welfare, and Sports. They say the report is “predictable and self-serving,”

A large part of the problem is for disability activists is that media often use the term “terminal illness” instead of “disability.”

Schadenberg says that the Dutch law refers to “unbearable suffering.” “Unbearable suffering,” he says, for which a person can be killed in the Netherlands, “comprises both physical and mental suffering.”

In Canada, pending legislation to legalize euthanasia and assisted suicide, Bill C-407, employs the ‘suffering’ criterion and does not address the nature of an illness or its prognosis. The bill has already gone though first reading June 15 and allows euthanasia and assisted suicide based on a person suffering “severe physical or mental pain.”

Further, the proposed Canadian legislation says a patient must only “appear to be lucid” and does not have to be legally competent. It also allows the act of killing to be carried out by anyone as long as a doctor is “assisting.”

References:
  1. www.disabilityworld.org
  2. "Physician-Assisted Suicide and Euthanasia in the Netherlands: a Report to the House Judiciary Sub-Committee on the Constitution, Executive Summary," in Issues of Law and Medicine, 01-05-1999
  3. Debra J. Saunders Death trumps choice San Francisco Chronicle, January 6, 2005
  4. Arch Intern Med. 2005; 165:1677-1678