Marlowe's Shade

Thursday, May 12, 2005

Why Assisted Suicide Laws Lead to Involuntary Euthanasia: Part 1

Yesterday I took a brief look at California bill AB 654 which is modeled on Oregon's infamous Death with Dignity law. The purpose is to make physician assisted suicide legal.

It would be useful as an object lesson to examine the history of physician assisted suicide in the Netherlands, where it has been practiced the longest. In the course of two decades, Dutch physicians have gone from assisted suicide to the euthanasia of the elderly and disabled children. During that time 2 reports were released that concluded that the guidelines that were established were working and the program remained true to it's original intent. But in this article the investigating physicians demonstrate that the data from the reports suggests the opposite:

From our point of view there has been an erosion of medical standards in the care of terminally ill patients in the Netherlands. The 1990 and 1995 studies document that 59% of Dutch physicians do not report their cases of assisted suicide and euthanasia, more than 50% feel free to suggest euthanasia to their patients, and about 25% admit to ending patients’ lives without their consent. How is it that the Dutch researchers are so sanguine about their data?

Political considerations have admittedly influenced the studies and their conclusions. Why were physicians not challenged when they offered implausible explanations for ending fully competent patients’ lives without consulting them? The investigators have explained that securing and retaining the cooperation of the Royal Dutch Medical Association and the participating physicians demanded that the physicians and policies not be challenged (8[p77-78]). In addition, the researchers draw conclusions that exceed their evidence. The 1990 and 1995 studies accepted physicians’ assertions that their patients had received the best possible care and that there was no alternative to euthanasia. These statements are not supported by any objective data. Indeed, studies have demonstrated the inadequacy of training of physicians in palliative care in the Netherlands (18,19). Since the statements of the responding physicians were accepted by the investigators without challenge, there was no exploration of possible alternatives to euthanasia (20).

Both the 1990 and 1995 studies are flawed for all of the above reasons. When cases are classified and counted so as to minimize disturbing findings, when implausible explanations are accepted without challenge, and when conclusions that might offend are not stated, there is need for more objective and inclusive exploration and analysis. That exploration and analysis will have to include a realization that notification by physicians of all euthanasia cases would not by itself diminish euthanasia abuse in the Netherlands. Nor could better counting and classifying cases do the job without exploring the interactive decision-making process that is at the heart of euthanasia and is not addressed in the Dutch research.

Dutch efforts at regulating assisted suicide and euthanasia have served as a model for proposed statutes in the United States and other countries (21). Yet, the Dutch experience indicates that these practices defy adequate regulation. Given legal sanction, euthanasia, intended originally for the exceptional case, has become an accepted way of dealing with serious or terminal illness in the Netherlands. In the process, palliative care is one of the casualties, while hospice care lags behind that of other countries (18,19,22). For the Dutch, accepting the option of euthanasia seems to be costing them the opportunity to take advantage of the developments in palliative care of the past decade. For other countries, knowledge of these developments still remains to be disseminated and implemented. We should accept that challenge and avoid making the Dutch mistake.

The impact of these errors can be seen in this sad tale from the Netherlands:

[Henk Reitsema’s] grandfather had contracted non-Hodgkin’s lymphoma, which would have naturally taken his life within a few years. He also had developed a painful thrombosis in his leg, so he asked the nursing-home physician for help with the pain.

Instead, the doctor quietly ordered nurses to administer overdoses of morphine and withhold food and water. Rather than providing healing or comfort, and without consulting Grandfather Reitsema or his loved ones, this doctor aimed to kill.

Henk’s soft-spoken wife, Riana, had been regularly visiting Grandfather Reitsema. She relates that one of Henk’s aunts stumbled upon the plan—but too late. The day before he died, she tried to give him water, but the nurse didn’t allow it.

Horrified, the family realized the nursing home was euthanizing Grandfather Reitsema. Henk explains, “My family tried to reverse it, but he died from pneumonia”—a common result of heavy morphine dosing.

This family learned the hard way what can happen when the right-to-die agenda is given free rein:

One day outside the nursing home, Henk’s aunt waited for the physician who had killed her brother. When she confronted him, Henk recalls, “[The doctor’s] response was, ‘But he was sick! Don’t you understand? I was just helping him out.’”

Henk points to that conversation as an illustration of the philosophical chasm between the Christian view of the intrinsic, sacred value of human life and the utilitarian secular view.

“The framework is radically different,” Henk explains. “The whole connectedness with other people was totally absent from his mind. The doctor thinks, ‘This guy’s standard of life isn’t worth living, so let’s just save them all the effort.’”

The family considered legal action against the doctor.

“But it proved to be a no-win situation,” Henk explains. “Only the most extremely harsh cases ever come to court, and even then, the court always favors the doctors.”

What was intended in Holland as a voluntary choice in exceptional cases has become a policy reminiscent of the Nazi euthanasia programs:

Not long after the incident with Henk’s grandfather, Dutch media began to uncover the tragedy at the nursing home.

Henk recalls, “The newspaper reported that they practiced ‘bed-rooming’—making space in the beds from time to time—by putting in what the Dutch call versterving. It’s a sort of humanistic Dutch word for letting somebody starve. It’s an official term that makes active killing of people sound like a treatment.

“When they needed beds for new patients, they would ‘clean out’ some beds. Make a checklist, and in a week, ten people would die. The records showed that this kind of administrative pressure had started to play a role in the diagnosis of the doctors. They become little lords over life and death.”

It's little wonder that the elderly in the Netherlands reportedly avoid going to hospitals for care, out of fear that they will become victims of these policies.

Right-to-die advocates consistently scoff at their opponent's "slippery slope" arguments against physician assisted suicide legislation, and confidently claim that the sage architects of these laws have built in guidelines that will prevent abuses. But the Dutch experiment illustrates how useless these self-imposed guidelines can be. And this is not merely a case of the guidelines not being properly implemented. Rather it reveals this fundamental flaw of physician assisted suicide and euthanasia legislation. Because it seeks to shield doctors from the traditional consequences or assisting suicide in the form of judicial penalties, it also renders the guidelines impossible to enforce. This, combined with the intrinsic secrecy and deceptiveness of these programs, make the slippery slope an undeniable feature of the ethical terrain in this debate.

In the next post we'll look at how these same issues plague the Oregon Death with Dignity law and similar legislation.
papijoe 6:06 AM