Euthanasia deaths in the Netherlands continue their relentless rise

According to Dutch media reports today, euthanasia deaths in the Netherlands in 2013 increased by 15% to 4,829. This follows increases of 13% in 2009, 19% in 2010,18% in 2011 and 13% in 2012.

In fact from 2006 to 2013 there has been a steady increase in numbers each year with successive annual deaths at 1923, 2120, 2331, 2636, 3136, 3695, 4,188 and 4,829 – an overall increase of 151% in just seven years.

Almost 3,600 people were helped to die because they had cancer, the report said.

Euthanasia now accounts for over 3% of all Dutch deaths.

In total, there were 42 reports of people who underwent euthanasia because they suffered severe psychiatric problems, compared with 14 in 2012 and 13 in 2011.

Dementia was the reason behind 97 cases, mainly early stage dementia in which patients were able to properly communicate their wish to die.

There were five cases in 2013 where doctors were reprimanded for not properly following the protocol. None of these led to legal action.

But as alarming as these statistics may seem they tell only part of the full story.

On 11 July 2012, The Lancet published a meta-analysis study concerning the practice of euthanasia and end-of-life practices in the Netherlands in 2010 with a comparison to previous studies done in 1990, 1995, 2001 and 2005. 

The Lancet study indicated that in 2010, 23% of all euthanasia deaths were not reported meaning that the total number of deaths last year may not have been 4,829 but rather 5,939. 

The 2001 euthanasia report also indicated that about 5.6% of all deaths in the Netherlands were related to deep-continuous sedation. This rose to 8.2% in 2005 and 12.3% in 2010. 

A significant proportion of these deaths involve doctors deeply sedating patients and then withholding fluids with the explicit intention that they will die. 

As I have reported previously, although official euthanasia deaths are rising year by year in the Netherlands, these deaths represent only a fraction of the total number of deaths resulting from Dutch doctors intentionally ending their patients’ lives through deliberate morphine overdose, withdrawal of hydration and sedation. 

Euthanasia in the Netherlands is way out of control. 

The House of Lords calculated in 2005 that with a Dutch-type law in Britain we would be seeing over 13,000 cases of euthanasia per year. On the basis of how Dutch euthanasia deaths have risen since this may prove to be a gross underestimate. 

What we are seeing in the Netherlands is 'incremental extension', the steady intentional escalation of numbers with a gradual widening of the categories of patients to be included. 

I previously described the similar steep increase of cases of assisted suicide in Oregon (450% since 1998), Switzerland (700% over the same period) and Belgium (509% in ten years from 2003 to 2012).

The lessons are clear. Once you relax the law on euthanasia or assisted suicide steady extension will follow as night follows day. 

Britain needs to take warning as debate on the Falconer bill continues.  

Dutch Ethicist: ‘Assisted Suicide: Don’t Go There’

Professor Theo Boer (pictured) is a Dutch ethicist who was featured in by the Daily Mail last week for changing his mind on assisted suicide. 

He later agreed to send the original article that he had sent to the Daily Mail (who only quoted from it) to Alex Schadenberg, International Chair of the Euthanasia Prevention Coalition.

The article is reproduced here, with permission, from Alex’s blog.

In 2001 The Netherlands was the first country in the world to legalize euthanasia and, along with it, assisted suicide. Various safeguards were put in place to show who should qualify and doctors acting in accordance with these safeguards would not be prosecuted. 

Because each case is unique, five regional review committees were installed to assess every case and to decide whether it complied with the law. For five years after the law became effective, such physician-induced deaths remained level - and even fell in some years. In 2007 I wrote that ‘there doesn’t need to be a slippery slope when it comes to euthanasia. A good euthanasia law, in combination with the euthanasia review procedure, provides the warrants for a stable and relatively low number of euthanasia.’ Most of my colleagues drew the same conclusion.

But we were wrong - terribly wrong, in fact. In hindsight, the stabilization in the numbers was just a temporary pause. Beginning in 2008, the numbers of these deaths show an increase of 15% annually, year after year. The annual report of the committees for 2012 recorded 4,188 cases in 2012 (compared with 1,882 in 2002). 2013 saw a continuation of this trend and I expect the 6,000 line to be crossed this year or the next. Euthanasia is on the way to become a ‘default’ mode of dying for cancer patients.

Alongside this escalation other developments have taken place. Under the name ‘End of Life Clinic,’ the Dutch Right to Die Society NVVE founded a network of travelling euthanizing doctors. Whereas the law presupposes (but does not require) an established doctor-patient relationship, in which death might be the end of a period of treatment and interaction, doctors of the End of Life Clinic have only two options: administer life-ending drugs or sending the patient away. On average, these physicians see a patient three times before administering drugs to end their life. Hundreds of cases were conducted by the End of Life Clinic. The NVVE shows no signs of being satisfied even with these developments. They will not rest until a lethal pill is made available to anyone over 70 years who wishes to die. Some slopes truly are slippery.

Other developments include a shift in the type of patients who receive these treatments. Whereas in the first years after 2002 hardly any patients with psychiatric illnesses or dementia appear in reports, these numbers are now sharply on the rise. Cases have been reported in which a large part of the suffering of those given euthanasia or assisted suicide consisted in being aged, lonely or bereaved. Some of these patients could have lived for years or decades.

Whereas the law sees assisted suicide and euthanasia as an exception, public opinion is shifting towards considering them rights, with corresponding duties on doctors to act. A law that is now in the making obliges doctors who refuse to administer euthanasia to refer their patients to a ‘willing’ colleague. Pressure on doctors to conform to patients’ (or in some cases relatives’) wishes can be intense. Pressure from relatives, in combination with a patient’s concern for the wellbeing of his beloved, is in some cases an important factor behind a euthanasia request. Not even the Review Committees, despite hard and conscientious work, have been able to halt these developments.

I used to be a supporter of legislation. But now, with twelve years of experience, I take a different view. At the very least, wait for an honest and intellectually satisfying analysis of the reasons behind the explosive increase in the numbers. Is it because the law should have had better safeguards? Or is it because the mere existence of such a law is an invitation to see assisted suicide and euthanasia as a normality instead of a last resort? Before those questions are answered, don’t go there. Once the genie is out of the bottle, it is not likely to ever go back in again.

Theo Boer is professor of ethics at the Protestant Theological University at Groningen. For nine years, he was a Member of a Regional Review Committee. For the Dutch Government, five such committees assess whether a euthanasia case was conducted in accordance with the Law. The views expressed here represent his views as a professional ethicist, not of any institution.

Links to important articles: 

• Netherlands 2012 euthanasia statistics. 

• Euthanasia: Incremental extensions are inevitable. 

• Dutch health minister: 45 psychiatric euthanasia deaths in 2013.

• The Netherlands euthanasia law has derailed.

• Blind woman dies by euthanasia in the Netherlands.
• Some Dutch pharmacists refuse to fill prescriptions for euthanasia. 

• Mobile euthanasia deaths begins in the Netherlands.

Euthanasia deaths continue their relentless rise in the Netherlands

According to Dutch media reports today, euthanasia deaths in the Netherlands in 2012 increased by 13% to 4,188. This follows increases of 13% in 2009, 19% in 2010 and 18% in 2011 and comes in the first year after the introduction of 'mobile clinics' which euthanize people in their own homes.

In fact from 2006 to 2012 there has been a steady increase in numbers each year with successive annual deaths at 1923, 2120, 2331, 2636, 3136, 3695 and 4,188 – an overall increase of 118% in just six years.

Euthanasia now accounts for over 3% of all Dutch deaths.

In addition 42 people with early dementia and 14 psychiatric patients were euthanized.

But as alarming as these statistics may seem they tell only part of the full story.

On July 11, 2012, The Lancet published a long awaited meta-analysis study concerning the practice of euthanasia and end-of-life practices in the Netherlands in 2010 with a comparison to previous studies done in 1990, 1995, 2001 and 2005. 

The Lancet study indicated that in 2010, 23% of all euthanasia deaths were not reported meaning that the total number of deaths last year may not have been 4,188 but rather 5,151. 

The 2001 euthanasia report also indicated that about 5.6% of all deaths in the Netherlands were related to deep-continuous sedation. This rose to 8.2% in 2005 and 12.3% in 2010. 

A significant proportion of these deaths involve doctors deeply sedating patients and then withholding fluids with the explicit intention that they will die. 

As I reported previously, although official euthanasia deaths are rising year by year in the Netherlands, these deaths represent only a fraction of the total number of deaths resulting from Dutch doctors intentionally ending their patients’ lives through deliberate morphine overdose, withdrawal of hydration and sedation. 

Euthanasia in the Netherlands is way out of control. 

The House of Lords calculated in 2005 that with a Dutch-type law in Britain we would be seeing over 13,000 cases of euthanasia per year. On the basis of how Dutch euthanasia deaths have risen since this may prove to be a gross underestimate. 

I have never been convinced by the term ‘slippery slope’ which implies passive change over time. What we are seeing in the Netherlands is more accurately termed 'incremental extension', the steady intentional escalation of numbers with a gradual widening of the categories of patients to be included. 

I previously described the similar steep increase of cases of assisted suicide in Oregon (450% since 1998), Switzerland (700% over the same period) and Belgium (509% in ten years from 2003 to 2012).

The lessons are clear. Once you relax the law on euthanasia or assisted suicide steady extension will follow as night follows day. 

Britain needs to take warning as debate on the Falconer and Macdonald bills approaches.

Further reports 

Daily Mail  (Euthanasia now accounts for one in 30 Dutch deaths)

Daily Telegraph  (13% rise in Dutch euthanasia deaths in one year)

Daily Mirror (My case against euthanasia)

Press TV

Washington Times 

Euthanasia and Assisted suicide - more worrying developments in Belgium and the Netherlands

I was recently interviewed by Emily Graves of Crossrhythms Radio about moves to legalise euthanasia and assisted suicide around the world. The following is an extract from the interview focussing on recent developments in Belgium and the Netherlands. The full transcript is available on line.

Emily: Can you tell us a little bit more about what is going on in Belgium at this time?

Peter: Part of the difficulty we have is that it's not been very well reported, or it's been reported in Flemish or French and not been well translated into English media by broadcast or print. What we can gather is that in Belgium euthanasia was legalised back in 2002, but it's only for mentally competent adults, people over 18. What they're wanting to do now is to extend it to children younger than 18 and also to make it available to adults who aren't mentally competent; some of them with Alzheimer's disease or dementia. It's a huge move, which is going to open the boundaries much more.

Emily: When it's specifically speaking about a child, what age range is it referring to? When is the cut-off point?

Peter: They're saying that the child has to be old enough to make a decision. Presumably it applies to older children who are younger than 18. Although it raises a question if a child is not old enough to pick up a drink, to vote, to marry, to drive a car, then why are they giving permission for them to make the most important decision of all about whether they can have their lives ended. It raises real questions; how are they going to determine whether a child's suffering is adequate enough? Is that just going to be subjectively defined depending on the opinion of the doctor? How are they going to work out that they are making a decision free from coercion; a mature decision that's well thought through? It raises all sorts of questions about loopholes and extension.

Emily: Will a child have a full understanding of what this could mean for them?

Peter: We are talking about teenagers aren't we and we all know how often teenagers make quite impulsive decisions that are not well thought through. These are about life style issues; do I have sex, do I drink, do I smoke, do I drive a car in this way and so on and teenagers are notoriously not good because their brains are not yet developed at this stage to properly think through what the consequences of decisions are. Yes, I think it's very dangerous indeed.

Emily: If this is something that does go through do you think it will encourage other countries to go the same way?

Peter: I would hope that other countries seeing this would be horrified and definitely don't want to go down the Belgium route. That's what I hope the reaction will be.

Emily: Since 2005 the Netherlands have not prosecuted doctors who have performed euthanasia on minors as long as the doctor's act is in accordance with a set of medical guidelines dubbed ‘The Groningen Protocol’. Please could you tell us more about that?

Peter: The Groningen Protocol is named after a large town in the Netherlands where it was developed. This is something quite different really. In the Netherlands it is supposedly illegal to offer euthanasia to minors and to babies, but what they have created is a system whereby babies who are disabled or who have severe illnesses, such that they are unlikely to survive, can have euthanasia involuntary. This is obviously long before they are capable of making any decisions for themselves. What happens is that if the doctor can tick a series of boxes, the judiciary basically turns a blind eye and allows them to get on with it. This is hugely controversial.

When it was first written up in a peer-reviewed medical journal in 2005 they reported on 22 cases of babies with spina bifida who'd been given lethal injections over a seven year period and said that there were probably many more. In fact the Dutch Medical Association has just issued a report saying that they think there are around 650 babies every year that could be given lethal injections under this protocol. It seems to have been accepted in the Netherlands now that if you are a baby with special needs then your life is not worth living, so you can effectively be bumped off by doctors, with the consent of your own parents as well. Many parents are giving consent for this and you can imagine the Disability Rights Lobby is absolutely incensed and up in arms about this. They are saying, you are saying my life is not worth living, because this child with the same condition as me has been killed without having any say in it whatsoever. It's a very dangerous and worrying precedent that first of all people are saying that such a life is not worth living and allowing others to make that judgement about people; but secondly, that in the Netherlands one of the main things seeming to be driving this is the supposed suffering that it causes to the family. If you're burdened in the family with someone with an illness then it's alright to kill them.

Emily: Do you think that this protocol has encouraged Belgium to look at the child euthanasia bill?

Peter: Yes. I suppose the difference is that under the Groningen Protocol in the Netherlands we're talking about disabled babies. Whereas in the Belgium situation it's more minors, teenagers younger than 18, so it's a different sort of thing. In Belgium it's going to be legalised, whereas in the Netherlands it's not legal but the judiciary turns a blind eye. There are some differences, but what we've seen is that wherever euthanasia and assisted suicide is legalised, you get what we call incremental extension; a slippery slope. You get more and more cases every year; in fact in Belgium there's been a 5,000% increase in the number of annual cases recorded since the first year in 2002. It goes steadily up every year. In the Netherlands since 2006 there's been a 15%-20% increase every year. In the Netherlands they're now talking about patients with dementia having it and the first ones have already had euthanasia there. There are a large number of people in the Netherlands now, one in eight deaths is due to what we call terminal sedation, where they withhold fluids and food and give huge doses of sedatives, with the deliberate intention that the patient will not come out of it and will not survive. There's a real case of incremental extension and the slippery slope operating in the Netherlands.

Emily: Going back to Belgium, this is a very significant step if this bill is passed, as Belgium would be the first country to legalise child euthanasia. How will this impact the country?

Peter: What we see whenever a new law comes in is the first thing is that people start to practise up to the new law; so there will be child euthanasia. The second thing that happens is that people go beyond the new law; they push the boundaries and you see it being applied in less severe cases. It's not going to be long before someone raises the question about babies as they have in the Netherlands. The third thing, and perhaps the most worrying thing that happens, is that the public conscience begins to change, so that things that would have horrified people in one generation just don't bother people much at all in the next generation. We've seen this in the parallel case of abortion, where 50 or 60 years ago for most people in Britain abortion would have been absolutely unthinkable; but now we have 200,000 cases a year and one in five pregnancies ending in abortion. There is no doubt in my mind that the same thing will happen with euthanasia once it becomes more widely practised. As I say it all starts with the idea that there's a life not worth living, combined with the idea that if someone is creating a burden for us, then we can encourage them to end their life or make that decision for them.

For ten year report on Euthanasia in Belgium see here.

Belgium and the Netherlands escalate their children’s euthanasia programmes

In this last week both Belgium and the Netherlands have taken major steps towards euthanasia for children.

A consensus among members of the Belgian Federal Parliament has reportedly formed in support of legislation to allow children to choose to undergo euthanasia in certain dire cases, according to a report in the Belgian daily newspaper Der Morgen, as translated by the Paris-based news agency Presseurop.

If child euthanasia is legalized in Belgium, the country would become the first in the developed world to have a law on the books formally allowing the practice.

Belgium became the second country in the world after the Netherlands to legalize euthanasia in 2002, but the statute currently extends only to people 18 or older.

The bill, introduced by the Socialist party last December, lays out guidelines for doctors to decide on a case-by-case basis whether or not a child is mature enough to make the decision to end his or her own life, as well as whether a child's health is grave and hopeless enough to warrant euthanasia.

‘The idea is to update the law to take better account of dramatic situations and extremely harrowing cases we must find a response to,’ Socialist party leader Thierry Giet said shortly after the bill was introduced, according to Agence France-Presse.

‘On both sides of the linguistic border, liberals and socialists appear to agree on the fact that age should not be regarded as a decisive criterion in the event of a request for euthanasia,’ Der Morgen wrote last week.

The decision to consider the bill follows months of testimony by medical experts, doctors, clergy members and others, and it marks a turning point in the nation's approach to the rights of young people, some of whom would be able to choose to die if the law were to pass, even while still being legally barred from driving, marrying, voting or drinking liquor until they turned 18.

The bill would also likely allow euthanasia for patients suffering from Alzheimer's and other diseases leading to advanced dementia, who may otherwise be deemed incompetent to make the decision to die. There were 1,133 cases of euthanasia recorded in Belgium in 2011, accounting for about 1 percent of the country's deaths that year, according to AFP.

Peter Deconinck, president of the Belgian medical ethics organization Reflectiegroep Biomedische Ethiek, has come out in support of expanding the practice to minors, as has the head of the intensive care unit of Fabiola Hospital in Brussels, who testified before a Belgian Senate committee.

‘We all know that euthanasia is already practiced on children,’ he told the committee. ‘Yes, active euthanasia.’

A majority of members of the Belgian Parliament are reportedly ready to pass the child euthanasia bill.  

In a separate move the Royal Dutch Medical Association (KNMG), which represents doctors in the Netherlands, has said that distress felt by parents can justify euthanasia of a dying newborn.

The Netherlands has since 2005 not prosecuted doctors who perform euthanasia on some minors as long as the doctors act in accordance with a set of medical guidelines dubbed the Groningen Protocol, drafted by Dr Eduard Verhagen in 2004.

Verhagen reported in the New England Journal of Medicine (NEJM) in 2005 on 22 babies with spina bifida who were given lethal injections under the protocol over a seven year period.

However, in a new policy document, ‘Medical decisions about the lives of newborns with severe abnormalities’ (in Dutch only) the KNMG now explains why it is acceptable, and perhaps even necessary, to euthanase children.

What is new about this statement is that it says that the parents’ suffering may be a reason to kill the newborn.

Amongst other conditions, the policy states that a lethal injection of muscle relaxant is ethically possible when ‘the period of gasping and dying persists and the inevitable death is prolonged, in spite of good preparation, and it causes severe suffering for the parents.’

Dr Verhagen, who is also one of the authors of the recent KNMG report, explained to Volkskrant, a leading Dutch newspaper, why parental anguish is relevant.

Doctors should spare parents the ‘abomination’ of seeing their child die in distress, he argues.  It is part of good palliative care.

The criteria for euthanasing newborns are as follows (from page 54 of the report): if the child is suffering, if it cannot express its own wishes, if death is inevitable and if the dying process is prolonged, then the child may be euthanased and spare the parents further severe suffering.

Of the 175,000 babies born every year in The Netherlands, the KNMG suggests that about 650 might be cases which would be worthy of euthanasia.

‘These babies, despite very intensive treatment, will certainly die in the short term. They have a poor prognosis and a very bleak life perspective. They may not be dependent on intensive care but they face a life of serious and hopeless suffering. Doctors and parents face the exceedingly profound question of whether to start or continue treatment or even whether a good action may actually be a harm, in view of the suffering and disability that may result from the poor health of the child.’ 

These disturbing latest developments in the two countries which were the first to legalise euthanasia in Europe demonstrate graphically the incremental extension that takes place once the door is opened and the public conscience begins to change.

The acceptance of two key concepts is what makes this extension inevitable – first it is accepted that there is such a thing as a life not worth living and second that the active ending of a person’s life is justified in order to lessen the suffering of others.

It was these two principles that were used to justify the killing an infant with limb abnormalities and congenital blindness (named Knauer) with parental consent by Dr Karl Brandt in neighbouring Germany in 1939.

This 'test-case' paved the way for the registration of all children under three years of age with 'serious hereditary diseases'. This information was then used by a panel of 'experts', including three medical professors (who never saw the patients), to authorise death by injection or starvation of some 6,000 children by the end of the Second World War.

The euthanasia programme in Nazi Germany, later headed by the same Karl Brandt, did not begin in prison camps like Auschwitz and Treblinka. It began far more subtly with doctors in hospitals and its very first victims were children who were killed on supposedly compassionate grounds.

It is bitterly ironic that child euthanasia is happening again seventy years later on the very same grounds in two countries that share a common border with Germany. 

This post has been republished on Life News and LifeSite News 

For ten year report on Euthanasia in Belgium see here.

The ‘Groningen protocol’ for euthanasia of disabled babies in the Netherlands

In an interview this morning on BBC Five Live (at 0705) on the Paul Lamb case (listen here) I was asked by the presenter Nicky Campbell about evidence for a slippery slope following the legalisation of euthanasia in other jurisdictions.

In my answer I mentioned the steady escalation in numbers of cases in Belgium and the Netherlands (see here and here) and said that one third of nurses had carried out euthanasia illegally in Belgium and that one third of cases in some parts of Belgium had been involuntary although the law did not allow this.

I also mentioned the ‘Groningen Protocol’ under which disabled babies had been given lethal injections in the Netherlands.

Campbell appeared not to know about this and asked me on air to email him information about it to which I agreed. Another BBC journalist phoned me after the interview to check my sources.

I sent her a link to the original paper on the ‘Groningen Protocol’ from the New England Medical Journal in 2005.

The full reference is ‘Verhagen E, Sauer P. "The Groningen Protocol—Euthenasia in Severely Ill Newborns." New England Journal of Medicine 2005; 352(10):959-62’

It says that ‘Twenty-two cases of euthanasia in newborns have been reported to district attorneys' offices in the Netherlands during the past seven years’ but also highlights underreporting:

‘Given that the national survey indicated that such procedures are performed in 15 to 20 newborns per year, the fact that an average of three cases were reported annually suggests that most cases are simply not being reported.’

The 22 babies killed all had spina bifida and/or hydrocephalus – conditions which many disabled people live with in Britain today (Here is another report on the protocol from CBHD citing the 22 documented cases).

Under the ‘Groningen Protocol’ the termination of a child's life (under age 12) is acceptable if four requirements were properly fulfilled:

1. The presence of hopeless and unbearable suffering
2. The consent of the parents to termination of life
3. Medical consultation having taken place
4. Careful execution of the termination

A more recent report suggests there has been a reduction in cases of direct newborn euthanasia in the Netherlands since 2005 because of 1. More efficient prenatal detection and late abortion 2. More use of ‘terminal sedation’ not recorded officially as euthanasia 3. Continued underreporting

Other issues I mentioned to the BBC in my email included:

1. Almost half of Belgium’s euthanasia nurses have admitted to killing without consent, despite the fact that involuntary euthanasia is illegal in Belgium and that nurses are not allowed to perform even voluntary euthanasia. 

2.  In Belgium, nearly half of all cases of euthanasia are not reported to the Federal Control and Evaluation Committee. Legal requirements were more frequently not met in unreported cases than in reported cases and a written request for euthanasia was absent in 88%.

3. A recent study found that in the Flemish part of Belgium, 66 of 208 cases of ‘euthanasia’ (32%) occurred in the absence of request or consent.

4. According to a recent report Belgium is now the ‘world leader’ in organ removal after euthanasia with at least nine cases since 2005 but suggestions are that there would have been many more had more euthanasia patients had transplantable organs.

5. The stunning 5,000% increase in Belgian euthanasia cases in eleven years since legalisation.

6. Summary of recent developments in Netherlands documenting a 15-20% increase in euthanasia cases per year since 2006 (gives good overview of overall situation).

7. The latest Lancet paper on the subject giving 12.3% as the figure for terminal sedation deaths in the Netherlands and summarising other past papers in NEJM/Lancet

I gather that Nicky Campbell has since agreed on twitter with my opponent in the interview (Andrew Copson of the British Humanist Association) that I was ‘a past master in extreme and irrelevant claims’ (I'd be interested to hear his evidence for that btw) but at least he will be able to verify the truth of my claims about euthanasia in Belgium and the Netherlands from the links given above.

For ten year report on Euthanasia in Belgium see here.

Patients with dementia and psychiatric illnesses included as Dutch euthanasia cases rise steeply

According to Dutch media reports today, euthanasia deaths in the Netherlands in 2011 increased by 18% to 3,695. This follows increases of 13% in 2009 and 19% in 2010.

In fact from 2006 to 2011 there has been a steady increase in numbers each year with successive annual deaths at 1923, 2120, 2331, 2636, 3136 and 3695.

Euthanasia now accounts for 2.8% of all Dutch deaths.

In addition euthanasia for people with early dementia doubled to 49 last year and 13 psychiatric patients were euthanized, an increase of over 500% on the two reported in 2010.

But as alarming as these statistics may seem they tell only part of the full story.

On July 11, 2012, The Lancet published a long awaited meta-analysis study concerning the practice of euthanasia and end-of-life practices in the Netherlands in 2010 with a comparison to previous studies done in 1990, 1995, 2001 and 2005.

The Lancet study indicated that in 2010, 23% of all euthanasia deaths were not reported meaning that the total number of deaths that year was in fact not 3136 but 3859.

The 2001 euthanasia report also indicated that about 5.6% of all deaths in the Netherlands were related to deep-continuous sedation. This rose to 8.2% in 2005 and 12.3% in 2010.

A significant proportion of these deaths involve doctors deeply sedating patients and then withholding fluids with the explicit intention that they will die.

As I reported recently, although official euthanasia deaths are rising year by year in the Netherlands, these deaths represent only a fraction of the total number of deaths resulting from Dutch doctors intentionally ending their patients’ lives through deliberate morphine overdose, withdrawal of hydration and sedation.

Euthanasia in the Netherlands is out of control.

The House of Lords calculated in 2005 that with a Dutch-type law in Britain we would be seeing over 13,000 cases of euthanasia per year. On the basis of how Dutch euthanasia deaths have risen since this may prove to be a gross underestimate.

I have never been convinced by the term ‘slippery slope’ which implies passive change over time. What we are seeing in the Netherlands is more accurately termed 'incremental extension', the steady intentional escalation of numbers with a gradual widening of the categories of patients to be included.

I recently described the similar steep increase of cases of assisted suicide in Oregon (450% since 1998) and Switzerland (700% over the same period).

The lessons are clear. Once you relax the law on euthanasia or assisted suicide steady extension will follow as night follows day.

There is more analysis of the latest Dutch figures on Alex Schadenberg’s blog.

Lancet Study proves significant growth in euthanasia deaths in the Netherlands

Alex Schadenberg, Chair of the International Euthanasia Prevention Coalition, has today published a full analysis of the Lancet review of euthanasia deaths in the Netherlands. I have reproduced this in full below.

The long awaited 2010 nationwide examination of the euthanasia law in the Netherlands was published in the Lancet on 11 July, 2012. The study found that:

* the number of euthanasia deaths has grown significantly since 2005 (4050 in 2010, 2425 in 2005),

* the under-reporting of euthanasia in the Netherlands has grown since 2005 (23% in 2010, 20% in 2005),

* there is a growth in deaths by terminal sedation (12.3% in 2010, 8.2% in 2005),

* the percentage of requests for euthanasia being fulfilled has increased (45% in 2010, 37% in 2005).

* the number of deaths without request or consent has decreased (300 in 2010, 550 in 2005).

The media decided to ignore the significant growth in the number of euthanasia deaths since 2005, by reporting that the current percentage of euthanasia deaths in the Netherlands is similar to the percentage of euthanasia deaths in 2001, before it was officially legalized.

Historical facts

Euthanasia in the Netherlands was first legalized through court decisions in the Netherlands. In 1984, the Supreme Court in the Netherlands established a set-of-criteria that should be followed for a physician to cause the death of a person by euthanasia without fear of prosecution.

From 1984 to 2002 a series of legal decisions led to a widening application of euthanasia.  The courts allowed euthanasia for people living chronic depression (mental pain), to children who were born with disabilities, and other vulnerable groups.

In 2001, the Netherlands parliament official legalized euthanasia along the guidelines that were approved by the successive court decisions. The law officially came into effect in April 2002. Therefore euthanasia and assisted suicide were common before being legalized in the Netherlands.

Significant growth in Euthanasia

In 2003, the first full-year of legal euthanasia in the Netherlands, there were 1,815 reported cases of euthanasia in the Netherlands. In 2010, there were 3,136 reported cases of euthanasia. There is an approximate (20 – 23%) rate of under-reporting, nonetheless, based on the reported number of euthanasia deaths there has been a 73% increase in euthanasia deaths since 2003.

The rate of increase of reported euthanasia deaths has accelerated over the past few years with a 19% increase in 2010 and a 13% increase in 2009.

The continued increase in the number of euthanasia deaths may be partly explained by the increase in the number euthanasia deaths that are carried out after request. In 2005 37% of requests for euthanasia were fulfilled while in 2010 45% of requests were fulfilled.

There has also been a 50% increase in the number of deaths by terminal sedation since 2005. Terminal sedation is usually done by sedating a person and withdrawing fluids and food. Palliative sedation is different than terminal sedation because with palliative sedation the intention is to allow natural death to occur. Terminal Sedation is viewed by some people as an alternative to euthanasia. When a person is not otherwise dying, the act of terminal sedation is more accurately a form of euthanasia and should be referred to as “slow euthanasia.”

The media reports

The medical daily reported that: Rates of Euthanasia are steady since 2002 legalization, Fox news reported: Little change in Dutch euthanasia post-legality, and ABC.net.au reported: Euthanasia number remain the same after legalization – study.

Clearly, the media bought into a common position based on the press release from the Lancet, rather than reading the study to uncover significant concerns.

A thorough response was written by Dr. PeterSaunders, Campaign Director for the Care Not Killing Alliance in the UK. Saunders article focused on the incredible shift towards the use of Deep Continuous Sedation (Terminal Sedation) in order to keep the number of euthanasia deaths officially low.

Euthanasia in the Netherlands

The rate of euthanasia in the Netherlands has increased by 73% in the last 8 years (1,815 reported deaths in 2003, 3,136 reported deaths in 2010) and even more important, the rate of euthanasia has increased by almost 35% in the past two years (2,331 reported deaths in 2008, 3,136 reported deaths in 2010).

Combined with the growth in the use of terminal sedation for people who are not otherwise dying “slow euthanasia” and the slight increase in the number of unreported euthanasia deaths, one must conclude that there are abuses occurring in the Netherlands.

On 1 March, a euthanasia clinic in the Netherlands launched six mobile euthanasia teams in the Netherlands. The NVVE, euthanasia lobby in the Netherlands, announced that they anticipate that the mobile euthanasia teams would complete 1000 euthanasia deaths per year.

The mobile euthanasia teams plan to fill unmet demand for euthanasia for people with chronic depression (mental pain), people with disabilities, people with dementia/Alzheimer, loneliness, and those whose request for euthanasia is declined by their physician. In 2010 45% of all euthanasia requests resulted in death by euthanasia.

Similar to the previous euthanasia reports (1990, 1995, 2001, 2005) the 2010 report uncovers significant concerns related to the practice of euthanasia in the Netherlands.

Legalizing euthanasia and assisted suicide is not safe and the safeguards that are devised to control euthanasia do not protect the dying, but rather they protect the doctor.

Dutch doctors turn to ‘continuous deep sedation’ to keep official euthanasia figures low

The Lancet has just published an article purporting to show that euthanasia rates have not increased in the Netherlands since legalisation in 2002.

This news will probably be seized upon by enthusiasts for decriminalisation in the UK and elsewhere but the figures are not at all what they seem at first sight and the press release sent out by the journal is selective and misleading in its reporting of the facts.

If you read the press release sent by the Lancet (reproduced by Medical Xpress) it all seems cut and dried. There were about 4,050 cases of euthanasia or assisted suicide in 2010 (2.8% of all deaths) and this was only slightly up from the 2001 figure of 3,800 (2.6%).

But if you read the abstract along with the full article and accompanying comment you get a very different picture altogether.

Most news outlets will do neither but will simply propagate the press release which is why it is important to look at the original sources.

Thus far, the Daily Telegraph is the only national newspaper to cover the story.

The key fact which should alert people to something odd going on is the reference to ‘continuous deep sedation’ in the Netherlands which appears in the article’s abstract but tellingly (and perhaps even disingenuously) not in the Lancet press release.

The abstract states, ‘Continuous deep sedation until death occurred more frequently in 2010 (12.3% [11.6—13.1; 789 of 6861]) than in 2005 (8.2% [7.8—8.6; 521 of 9965]).’

But what was the rate of ‘continuous deep sedation until death’ in 2001 and previously?

On examining the article we learn from table 1 that it was not measured in 1990 and 1995 and was 5.6% in 2001. In other words there has been a steady increase in this category of cases which in 2010 accounted for 16,700 deaths.

Over the same period the number of deaths after ‘intensified alleviation of symptoms’ has also increased from 20.1% to 36.4% and now accounts for over 49,500 deaths annually.

There is nothing new about any of these figures. They have all been published in reviews of Netherlands practice before in peer-reviewed medical journals (in total five studies covering 1990, 1995, 2001, 2005 and 2010).

But the accompanying comment piece in the Lancet by Brendan Lo raises some very interesting questions indeed.

It acknowledges that the line between euthanasia and ‘the less controversial, much more common practice’ of ‘continuous deep sedation’ ‘can be blurred in clinical practice’ and noted that in other studies ‘physicians also misclassify some cases of euthanasia’.

In other words, it says, ‘physicians who say they are undertaking palliative sedation sometimes cross the line to euthanasia’.

Whilst the paper claims that the level of involuntary euthanasia has decreased since 1991 from 0.7% to 0.2% of all deaths (ie. deliberate killing with lethal drugs without consent), it also acknowledges that ‘in 42% of cases classified by the investigators as intensified alleviation of symptoms, the physician did not discuss the decision with the patient, relatives or another physician’.

The Lancet comment concludes by saying that ‘an in-depth analysis of these cases might reveal more widespread conceptual confusions or flaws in practice’ and recommends that ‘additional information from in-depth interviews in ethically problematic cases is needed’.

In other words it is not at all clear how many of these two categories of ‘continuous deep sedation’ and ‘intensified alleviation of symptoms’ involved the explicit intention to end life.

But the huge increase in number of patients dying in each of these categories since legalisation in 2002 is very suspicious indeed.

It appears that Dutch doctors have kept the euthanasia figures low simply by choosing to end patients’ lives in ways other than administering paralysing drugs (muscle relaxants) or barbiturates.

In other words they are making more decisions to end life than before legalisation but are just carrying it out and recording it differently.

The practice of ‘continuous deep sedation’ has been questioned before. A 2010 Mayo Clinic article drew the following stark conclusions:

‘Published literature has not discerned end-of-life palliative versus life-shortening effects of pharmacologically maintaining continuous deep sedation until death (i.e., dying in deep sleep) compared with common sedation practices relieving distress in the final conscious phase of dying. Continuous deep sedation predictably suppresses brainstem vital centers and shortens life. Continuous deep sedation remains controversial as palliation for existential suffering and in elective death requests by discontinuation of chronic ventilation or circulatory support with mechanical devices. Continuous deep sedation contravenes the double-effect principle because: (1) it induces permanent coma (intent of action) for the contingency relief of suffering and for social isolation (desired outcomes) and (2) because of its predictable and proportional life-shortening effect. Continuous deep sedation should be distinguished from common sedation practices for palliation and characterized instead as physician-assisted death.’

Other authors have proposed the term 'early terminal sedation' for the particularly contentious practice of giving deep, continuous sedation to patients who are not imminently dying without provision of hydration or nutrition, with the end result that death is hastened. This is in reality a form of euthanasia and seems to be increasingly common in the Netherlands despite not being labelled as such.

The UK should take warning. At present it appears that palliative sedation as practised in the UK, which is aimed primarily at reducing anxiety at the end of life, is very different from that practised in the Netherlands, which seems to be aimed at producing deep sedation and shortening life.

But the Dutch figures seem to reveal incremental extension after legalisation which is being carefully and skilfully disguised by the way the figures are being presented.

The Lancet report, far from providing reassurance, actually raises more questions than it gives answers and it is very difficult indeed to extract the substance from the spin.

The lesson is clear. Don’t rely on the Lancet’s specious press release or superficial reports in newspapers and medical magazines. Read the original paper and ask serious questions!

(See also Alex Schadenberg's analysis of these figures. He argues quite correctly that by comparing euthanasia deaths before and after legalisation the Lancet has also conveniently masked the steady increase in euthanasia deaths which have occurred since 2005)