Boer: I was wrong — Euthanasia has a slippery slope

[Dion]

Whereas the law sees assisted suicide and euthanasia as an exception, public opinion is shifting toward considering them rights, with corresponding duties on doctors to act.

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 per cent annually, year after year. The annual report of the committees for 2012 recorded 4,188 cases (compared with 1,882 in 2002). Last year 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 becoming a default mode of dying for cancer patients.

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 of being aged, lonely or bereaved. Some of these patients could have lived for years or decades.

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 well-being 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 12 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?

http://www.calgaryherald.com/opinion...178/story.html

[GreenLantern2814]

We live too long. If you're losing/have lost what made you an actual person, you should be allowed to gracefully exit into the good night.

[Street Pharmacist]

Originally Posted by GreenLantern2814

We live too long. If you're losing/have lost what made you an actual person, you should be allowed to gracefully exit into the good night.

Most people would agree. The trouble, and what the above article explains, is that it's not a black and white line.
What if someone's wealth was what they felt made their life worth living?
Treatment resistant depression?
Chronic pain? What types of chronic pain?
Loneliness?

[Daradon]

Exactly. I'm a proponant of euthanasia, but I do think we still need a higher level of debate than we have had thus far before we start changing the rules because there is so much grey even in the cases where everyone is being honest with each other. Then of course, depending on how you shape the rules, there are possibilities for cases where people may be speaking for a person who cannot fully communicate what they want and doing it for their own reasons.

In a perfect world people would have this right and it would give everyone (the sick, those that love them and remain behind, and the world in general) more dignity, happiness, and comfort in our lives. But we don't live in a perfect world and sometimes you need blanket rules to protect people from themselves and each other.

I do think we could draft a good system and rules and laws to allow euthanasia sometime, and sometime soon, but I don't think we have talked about it honestly enough yet as a society yet. I would like to see more ideas and debate.

Great article Dion.

[Thor]

Of course its not black and white, you could start simply with terminally ill or people in extreme pain that cannot be cured, but we need to do this and be grown ups about it, avoiding dealing with this because its difficult and hard to do is no excuse for letting good people suffer and die painful deaths because there are difficult questions and decisions to be made.

Doctors are already doing euthanasia, its well known, lets not hold back on this any longer, its sickening to see us letting our loved ones suffer and die horribly because of people who are healthy feeling uneasy about it.

[Dion]

Originally Posted by Thor

Of course its not black and white, you could start simply with terminally ill or people in extreme pain that cannot be cured, but we need to do this and be grown ups about it, avoiding dealing with this because its difficult and hard to do is no excuse for letting good people suffer and die painful deaths because there are difficult questions and decisions to be made.

Doctors are already doing euthanasia, its well known, lets not hold back on this any longer, its sickening to see us letting our loved ones suffer and die horribly because of people who are healthy feeling uneasy about it.

It's that slippery slope Boer talks about that scares me. The rules keep changing where now they have a law in the making where GP's who refuse to administer euthanasia "must" refer their patients to a “willing” colleague. What's next? GP's being "forced" to administer euthanasia?

There's a time and a place for euthanasia but I think there needs to be more discussion and better safe guards put in place to protect the vulnerable. It disturbes when relatives are reported to be putting pressure on the doctors to grant these things. Do we progress to a point where the vulnerable don't have a say and friends and family get to decide for us?

[Dion]

Most troubling to Boer is the latest development in which the Dutch Right to Die Society, NVVE, has established a network of mobile euthanasia clinics, with the sole purpose of killing people who ask to die. “Doctors of the End of Life Clinic have only two options: administer life-ending drugs or send the patient away,” writes Boer.

In other words, don’t bother to seek anti-depressants or receive some grief counselling. It’s death or nothing. Nice. The new face of compassion.

Other longtime proponents of euthanasia and physician-assisted suicide are starting to speak out about the mobile death squad free-for-all in the Netherlands.

Boer says another reason for his conversion away from euthanasia is how it is affecting doctors.'

“Whereas the law sees assisted suicide and euthanasia as an exception, public opinion is shifting toward considering them rights, with corresponding duties on doctors to act,” writes Boer.

Dr. Boudewijn Chabot, a Dutch psychiatrist, has been quoted as saying on the Dutch TV program Nieuwsuur that the law “has gone off the rails.”
This from the very man who was convicted in 1991 for killing a healthy, sane 50-year-old woman who was depressed because one of her sons committed suicide, another died from illness and her husband left her.

Most parents would acknowledge that losing a child constitutes unbearable suffering and would lead to depression, but this woman needed counselling and compassion, not a lethal injection.

Alex Schadenberg, executive director of the Euthanasia Prevention Coalition, says Quebec’s Bill 52 would force that province’s doctors to refer patients who wanted to be killed to their superior despite their objection on moral or professional grounds.

In his column, Boer wonders if the law either wasn’t properly crafted in Holland, or whether “the mere existence of such a law is an invitation to see assisted suicide and euthanasia as a normality instead of a last resort?”

Schadenberg believes it’s the latter. So do I.

“Once the genie is out of the bottle,” concludes Boer, “it is not likely to ever go back in again.”

http://www.calgaryherald.com/opinion...027/story.html

[Ashartus]

Personally I think euthanasia and assisted suicide should not be viewed as the same thing. I don't see any issues with assisted suicide, where the person involved is clearly participating (so long as the are mentally capable of making and understanding the decision). Euthanasia I can see having a slippery slope and I'd want us to be a bit more careful with that; if we're going to legalize euthanasia then we need to look at the experiences in other jurisdictions and have really tight laws.

[Street Pharmacist]

"Assisted suicide" as you describe it though is where the slippery slope is worst.
Mother depressed because her son killed himself. Is that a good enough reason if she wants to?
Guy has chronic back pain that has been unresponsive to therapy. What if he's got 3 kids?
Lonely widower who's kids have passed on but is otherwise healthy?
Teenager with severe treatment resistant depression?


I think it can and should be done (euthanasia that is), for simple economics if nothing else. At thousands of dollars a day to keep some people alive that are getting no enjoyment out of life will eventually break the bank so to speak. The trouble is, it's not an easy law to write. Whether people want to admit it, the choice is between prolonging suffering and helping people commit suicide who may be saved. We all will have a different view of what that looks like, but it isn't as simple as some believe.

[Thor]

Originally Posted by Dion

It's that slippery slope Boer talks about that scares me. The rules keep changing where now they have a law in the making where GP's who refuse to administer euthanasia "must" refer their patients to a “willing” colleague. What's next? GP's being "forced" to administer euthanasia?

No doctor will be forced against their will, if they have objections there should be a strict set of rules and a committee to go over these objections.

There's a time and a place for euthanasia but I think there needs to be more discussion and better safe guards put in place to protect the vulnerable. It disturbes when relatives are reported to be putting pressure on the doctors to grant these things. Do we progress to a point where the vulnerable don't have a say and friends and family get to decide for us?

Safeguards like you are of course mentally sound that you decide, no one can ever force you, if you want put in your will conditions where if your no longer mentally sound that you wish or do not wish for conditions that would come up. Again there is lots of ways to go about this, ideally strict rules and a committee to go over a case.

I just feel like people are bringing up scenarios that are highly unlikely and things like sad teenagers, back problems, etc.. Akin to the anti gay marriage people suggesting we marry our pets.

We need to move forward and make this happen, our humanist group in Iceland is working on bringing this to the forefront in Iceland, the will is there here but I see some ludicrous objections here as well for those against it, mostly its unfounded as there is an easy way to go about setting clear cut guildelines and rules as to how to go about all this.

We have a few experts working on drafting such recommendations on how to proceed that includes a top doctor at our main hospital, lawyers, psychiatrists, etc.. I'll share what we come up with when the time comes, our goal is to have a paper out on this by end of summer next year at the latest.

[Dion]

Originally Posted by Thor

No doctor will be forced against their will, if they have objections there should be a strict set of rules and a committee to go over these objections.

Public opinion in the Netherlands is shifting towards euthanasia being a right and doctors being forced to do the procedure. Laws are being drafted to force doctors who are against the proceudre to refer their patients to an associate that will. What happened to doctors rights the law said would protect them?

Safeguards like you are of course mentally sound that you decide, no one can ever force you, if you want put in your will conditions where if your no longer mentally sound that you wish or do not wish for conditions that would come up. Again there is lots of ways to go about this, ideally strict rules and a committee to go over a case.

I just feel like people are bringing up scenarios that are highly unlikely and things like sad teenagers, back problems, etc.. Akin to the anti gay marriage people suggesting we marry our pets.

When you see a sudden sharp increase in cases with those given euthanasia or assisted suicide because of people being aged, lonely or bereaved, Boer is correct when he says we need to discuss this more. The suggestion or fear is that it is drifting away from a last resort to a normaility.

You also have doctors and others in the medical field who were once for euthanasia but are now raising concerns sfter seeing what is happening.

We need to move forward and make this happen, our humanist group in Iceland is working on bringing this to the forefront in Iceland, the will is there here but I see some ludicrous objections here as well for those against it, mostly its unfounded as there is an easy way to go about setting clear cut guildelines and rules as to how to go about all this.

We have a few experts working on drafting such recommendations on how to proceed that includes a top doctor at our main hospital, lawyers, psychiatrists, etc.. I'll share what we come up with when the time comes, our goal is to have a paper out on this by end of summer next year at the latest,

I look forward to hearing what they have to say

[edslunch]

Originally Posted by Street Pharmacist

"Assisted suicide" as you describe it though is where the slippery slope is worst.
Mother depressed because her son killed himself. Is that a good enough reason if she wants to?
Guy has chronic back pain that has been unresponsive to therapy. What if he's got 3 kids?
Lonely widower who's kids have passed on but is otherwise healthy?
Teenager with severe treatment resistant depression?


I think it can and should be done (euthanasia that is), for simple economics if nothing else. At thousands of dollars a day to keep some people alive that are getting no enjoyment out of life will eventually break the bank so to speak. The trouble is, it's not an easy law to write. Whether people want to admit it, the choice is between prolonging suffering and helping people commit suicide who may be saved. We all will have a different view of what that looks like, but it isn't as simple as some believe.

Economics should not enter the equation at all otherwise we're putting a dollar value on human life. Granted in Canada we don't see those costs directly (apart from drugs) but imagine in the US being forced to choose between euthanasia and bankruptcy.

[GGG]

Of Boers complaints it becoming the default mode of death for cancer pairients shouldnt be a concern. The big risks I see is the increase in patients with psychiatric conditions and dimentia and the doctors reporting pressure coming from relatives.

The risk with assisted suicide is that instead of putting grandma, when she gets altzimers, in a home you take her to the glue factory. You need strict guidelines to prevent this from hapoening that work. So Holland should be looked at a guide to determine how to prevent these things.

My general rule would be if you dont have a living will then no assisted suicide for dimentia or any other psychiatric condition.

[PsYcNeT]

It's only a slippery slope if you don't believe that a person has every right to do as they wish with their own body.

[Coach]

I have a problem with the last quote in the OP. It seems to frame the problem as a no-win scenario. Is does the law need better safeguards? Or is it being seen as a normality not a last resort.

It leaves out an important option. Maybe there actually are that many people living in enough pain that they want this.

I do agree that it should be monitored closely, but I also agree with a few posters that we do live too long and it is a burden on our healthcare system to be keeping 80 year old cancer patients alive. I don't really look at it as a slipperly slope as much as it is a difficult decision and really up to no one but the person, as even the doctors can't know what type of pain they are feeling.

[GreenLantern2814]

Originally Posted by GGG

Of Boers complaints it becoming the default mode of death for cancer pairients shouldnt be a concern. The big risks I see is the increase in patients with psychiatric conditions and dimentia and the doctors reporting pressure coming from relatives.

The risk with assisted suicide is that instead of putting grandma, when she gets altzimers, in a home you take her to the glue factory. You need strict guidelines to prevent this from hapoening that work. So Holland should be looked at a guide to determine how to prevent these things.

My general rule would be if you dont have a living will then no assisted suicide for dimentia or any other psychiatric condition.

The bolded is callous - .1% of the population thinks like that. People delay putting down their pets for six months because they can't handle it, they aren't 'sending grandma to the glue factory'.

I'll agree, you can't kill someone who hasn't requested it in a living will. I would guess that when the practice becomes legal, everyone who's been to a nursing home and thinks it seems like a special kind of Hell will be signing up for the early Alzheimer's exit plan.

Both my grandparents have dementia/Alzheimer's. They live in the same facility in Sherwood Park, and see each other for six hours a day. They're safe, they seem as happy as their situation would allow, but the people that I knew growing up are gone. So it's fair to say I'm certainly biased in one direction, but certainly would never advocate putting them down.

My grandparents never wrote wills. They seemed to think it was a bad omen. But if they'd written it in that they wished for assistance ending their lives when the people they were before vanished, I'd be on their side.

As human beings, we deserve this option.

[PeteMoss]

Originally Posted by GGG

Of Boers complaints it becoming the default mode of death for cancer pairients shouldnt be a concern. The big risks I see is the increase in patients with psychiatric conditions and dimentia and the doctors reporting pressure coming from relatives.

The risk with assisted suicide is that instead of putting grandma, when she gets altzimers, in a home you take her to the glue factory. You need strict guidelines to prevent this from hapoening that work. So Holland should be looked at a guide to determine how to prevent these things.

My general rule would be if you dont have a living will then no assisted suicide for dimentia or any other psychiatric condition.

That would rule out pretty well everyone, particularly people who are sick/terminally ill who are probably dealing with depression and/or anxiety.

[Street Pharmacist]

Originally Posted by edslunch

Economics should not enter the equation at all otherwise we're putting a dollar value on human life. Granted in Canada we don't see those costs directly (apart from drugs) but imagine in the US being forced to choose between euthanasia and bankruptcy.

Economics will come in to play and already does. We are already denying people medication that may save their life because it costs too much. This is already happening. Our healthcare is unsustainable

[GGG]

Originally Posted by GreenLantern2814

The bolded is callous - .1% of the population thinks like that. People delay putting down their pets for six months because they can't handle it, they aren't 'sending grandma to the glue factory'.

I'll agree, you can't kill someone who hasn't requested it in a living will. I would guess that when the practice becomes legal, everyone who's been to a nursing home and thinks it seems like a special kind of Hell will be signing up for the early Alzheimer's exit plan.

Both my grandparents have dementia/Alzheimer's. They live in the same facility in Sherwood Park, and see each other for six hours a day. They're safe, they seem as happy as their situation would allow, but the people that I knew growing up are gone. So it's fair to say I'm certainly biased in one direction, but certainly would never advocate putting them down.

My grandparents never wrote wills. They seemed to think it was a bad omen. But if they'd written it in that they wished for assistance ending their lives when the people they were before vanished, I'd be on their side.

As human beings, we deserve this option.

I agree that my phrasing was callous. But the article above states that families are putting pressure on doctors to end people's lives. Now the reasons may be altruistic most of the time but if you go to a nursing home there are plenty of people who have been dumped and forgotten by their families. I don't see it as that much of a stretch to see people justifying to themselves that it is for the persons own good when really it is for there own convenience.

I am in general in favour of assisted suicide but I am aprehensive of how it would be implemented.

I have a different view of nursing homes I guess. Mostly because both of my great grandparents died within a year of needing a high level of assistance. Before that they were in the assisted living section of their nursing home where meals were cooked for them and there laundry and rooms cleans but they were still highly mobile. There metal capacity wasn't what it used to be and it is those types of elderly people that I am afraid would be pushed into ending their lives.

[GGG]

Originally Posted by PeteMoss

That would rule out pretty well everyone, particularly people who are sick/terminally ill who are probably dealing with depression and/or anxiety.

It sure does, You should make the choice to kill yourself before you are depressed and your judgement is clouded. A high level of anxiety, fear of being a burden and clinically depressed is not the kind of person who should be making a live or death decision for themselves.