Safe Guards

Although advocates of EAS propose certain 'safeguards' to prevent abuses, opponents point to examples in Oregon and the Netherlands where, they say, safeguards are ineffective in preventing abuse.
  • Involuntary euthanasia has been justified as necessitated by the need to make decisions for patients not competent to choose for themselves.
  • Due to the strict definition in the Netherlands, there are thousands of euthanasia deaths each year that are not counted as euthanasia.
  • If the Netherlands were to report all euthanasia deaths as euthanasia, 10% of all deaths would be caused by an intentional act or omission of an act to cause death, or euthanasia.
  • Oregon officials in charge of formulating annual reports have conceded “there"s no way to know if additional deaths went unreported”.
  • The experience of EAS in the Netherlands and Oregon should be carefully scrutinised before other countries use the same safeguards that have not worked elsewhere.
Advocates of Euthansia and Assisted Suicide (EAS) point out that abuses will be prevented if adequate safeguards are built into legislation.

Those opposed to the legalisation of euthanasia and assisted suicide (EAS) point out that safeguards simply don't work in practice...with the exception of one. The only safeguard that works is the protection of doctors and institutions from prosecution.

A claim by the doctor that he/she acted in 'good faith' and believed that the requirements of the law were satisfied, is virtually impossible to disprove, rendering all other proposed 'safeguards' effectively unenforceable.

Dr. Herbert Hendin is a professor of psychiatry at New York Medical College and medical director of the American Foundation for Suicide Prevention, and was one of a few foreign researchers who had the opportunity to extensively study the situation in the Netherlands, discuss specific cases with leading Dutch practitioners and interview Dutch government-sponsored euthanasia researchers about their work.

 According to Dr. Hendin, in Congressional testimony in 1996, assisted suicide and euthanasia have become not just the exception, but the rule for people with terminal illness. Hendin said:
"Over the past two decades, the Netherlands has moved from assisted suicide to euthanasia, from euthanasia for the terminally ill to euthanasia for the chronically ill, from euthanasia for physical illness to euthanasia for psychological distress and from voluntary euthanasia to non-voluntary and involuntary euthanasia. 

Once the Dutch accepted assisted suicide, it was not possible, legally or morally, to deny more active medical assistance to die (euthanasia) to those who could not effect their own deaths. Nor could they deny assisted suicide or euthanasia to the chronically ill who have longer to suffer than the terminally ill or to those who have psychological pain not associated with physical disease. To do so would be a form of discrimination. 

Involuntary euthanasia has been justified as necessitated by the need to make decisions for patients not competent to choose for themselves."
Adequate Protection Claimed
A study appearing in the August 8, 2005 issue of Archives of Internal Medicine, claims that the "careful patient evaluations and official practice guidelines" followed by physicians in the Netherlands is adequate protection for those disabled people who fear for their lives in Dutch hospitals. 

The study of general practitioners examined the reasons why people ask for euthanasia in relation to the outcome of the requests.

Marijke C. Jansen-van der Weide, M.Sc., of VU University Medical Center, Amsterdam, The Netherlands, and colleagues surveyed all general practitioners in 18 of 22 Dutch general practice districts. Physicians received a written questionnaire in which they were asked about the number of requests for EAS they had received in the last 12 months and how they had dealt with those requests. 1

Physicians were also asked to describe in detail the most explicit request for EAS received in the last 18 months, including patient symptoms, the extent to which the patient"s situation met the official requirements for accepted practice and the decision-making process.

Forty-four percent of all explicit requests for EAS resulted in the granting and performance of EAS, the researchers report. The Dutch government says that there were 1,886 cases of euthanasia in total that year. 

The conclusion of the study is that the safeguards are working well, that doctor compliance is high and that those who ask to be killed by their doctors are doing so "safely."

Specific Questions Not Asked
In the Netherlands the definition of euthanasia is: "the administration of drugs with the explicit intention of ending the patient"s life at the patient"s explicit request". Therefore only acts that are voluntary and involve an act with the intention of killing the patient is considered euthanasia in the Netherlands.

The 2005 study also 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. 

According to Dr Hendin, previous reports have shown that nearly 50% of all euthanasia deaths are not reported. 2

Not all Euthanasia Deaths are Reported as Euthanasia
Due to the strict definition in the Netherlands, there are thousands of euthanasia deaths each year that are not counted as euthanasia. 

Professor Joannes Lelkens from Maastricht Netherlands explained, at the International Federation of Catholic Medical Associations and the Pontifical Academy for Life in March 2004, that in 2002 there were 140,000 deaths of all causes in the Netherlands. 5460 deaths (3.9%) were caused by the removal of food and fluids from a person who has been sedated in order to cause their death. These 5460 euthanasia deaths are not counted among the official numbers of euthanasia deaths in the Netherlands.

Dr. Lelkens explained that if the Netherlands were to report all euthanasia deaths as euthanasia that 10% of all deaths would be caused by an intentional act or omission of an act to cause death, or euthanasia. 3

Accusations of bias
Disabled rights groups are outraged at what they identify as the bias of the study which was funded by the Royal Dutch Medical Association and the Dutch Ministry of Health, Welfare, and Sports. Calling the report “predictable and self-serving,” Stephen Drake of Not Dead Yet, the leading disability rights group in the US, warned that a large part of the problem is that media often conflate the terms, “terminal illness” and “disability.” 

"The second statement, regarding infant euthanasia, is just plain wrong. Earlier this year, the New England Journal of Medicine published an article regarding infant euthanasia in the Netherlands. It was clear that all 22 infants discussed in the article had spina bifida, which is not a terminal condition." 4

Oregon
In November1994, the US State of Oregon in passing Measure 16, became the first to legalise physician-assisted suicide and following legal challenges it came into effect in 1997. Under the law doctors were given the authority to provide (but not administer) a lethal prescription to a terminally ill patient, as long as two physicians agreed that the patient had six months or less to live; had voluntarily chosen to die; and had the mental capacity to make health related decisions.

The official report, released March 10, 2005, states that a total of 208 people have died from physician-assisted suicide in the seven years the law has been in effect. 5

Due to major flaws in the law and the state's reporting system however, there is no way to know for sure exactly how many, or under what circumstances, patients have died from physician-assisted suicide. The International Task Force on EAS maintains that the number of deaths, however, could be far greater, citing reports in newspapers that are not included in the official reports.

The International Task Force on EAS has compiled a list of cases that violate Oregon's law on assisted suicide which can be read in detail here.

The Death with Dignity law contains no penalties for doctors who do not report prescribing lethal doses for the purpose of suicide.

Oregon officials in charge of formulating annual reports have conceded “there"s no way to know if additional deaths went unreported” because Oregon DHS “has no regulatory authority or resources to ensure compliance with the law.” 6

The Oregon Department of Human Services has to rely on the word of doctors who prescribe the lethal drugs. Referring to physicians' reports, the reporting division admitted: "For that matter the entire account [received from doctors] could have been a cock-and bull story. We assume, however, that physicians were their usual careful and accurate selves." 7

Rev Dr Michael McCabe, Director of the New Zealand Catholic Bioethics Centre, points out that "without a proper psychiatric evaluation it is not possible to assess if a patient has impaired judgment and is capable of making an informed decision as required by Oregon Law."

Another difficulty McCabe sees with the Oregon Legislation is that there is no provision for the selection of an independent physician to confirm the "diagnosis prognosis, and voluntariness of the (patient's) choice." 8

He believes we should look carefully at the experience of EAS in the Netherlands and Oregon before writing or passing legislation that proposes those same safeguards that have not worked elsewhere.

References:
  1. "Dutch Physicians" Responses to Requests for Euthanasia, Physician-Assisted Suicide" Archives of Internal Medicine, Aug-2005 http://www.newswise.com/p/articles/view/513616/
  2. Hendin H, M.D. "The Case Against Physician-Assisted Suicide: For the Right to End-of-Life Care" Psychiatric Times February 2004 Vol. XXI Issue 2 
  3. Report from the International Congress: "Life-Sustaining Treatments and Vegetative State"
    http://www.lifesite.net/ldn/2004/apr/040420a.html
  4. Stephen Drake, "Disability Group Charges Associated Press with Inaccurate Reporting "
  5. DHS, "Seventh Annual Report on Oregon"s Death with Dignity Act," March 10, 2005. (http://egov.oregon.gov/DHS/ph/pas/docs/year7.pdf)
  6. Linda Prager, "Details emerge on Oregon"s first assisted suicides, " American Medical News, September 7, 1998
  7. Oregon Health Division, CD Summary, vol. 48, no. 6 (March 16, 1999), p. 2. (http://www.ohd.hr.state.or.us/chs/pas/pascdsm2.htm)
  8. Dr Michael McCabe, "What can we learn from the Netherlands, Oregon and USA experience of legalised Euthanasia"