Euthanasia Takes On a Life of Its Own

But Studies Show the Big Impact of Palliative Care

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THE HAGUE, Netherlands, APR. 21, 2001 ( The recent approval of doctor-assisted euthanasia by the Dutch upper house has sparked debate and added to pressure in other countries to follow suit.

With the vote April 10 the Netherlands became the first democratic country to legalize euthanasia. Although the practice has been tolerated for more than two decades, doctors have always risked criminal prosecution for murder unless they followed certain guidelines.

The bill, already passed last year by the lower house, was approved 46-28, Reuters reported the day of the vote. Even though a majority of Dutch citizens were in favor of the measure, thousands of protesters organized meetings during the vote to express their opposition.

There are about 3,000 cases of euthanasia a year in the Netherlands, the Telegraph of London reported April 10. This number may well increase since patients who want assisted suicide no longer have to be terminally ill. The test now is that they are “suffering unbearably.” A court case several years ago established that a woman in mental despair after the deaths of her two children was justified in requesting euthanasia.

Christians for Truth (CFT) protested against the new law, noting that the reporting of doctor-assisted suicides has proven faulty. Government research, the group said, indicates that more than half of all doctors do not notify the authorities about their participation in euthanasia. CFT observed that the government hopes the removal of euthanasia from the penal code will motivate the doctors to report more cases. Yet, after the relaxation of the law in 1998 the number of cases reported decreased, CFT said.

CFT also mentioned the recent court case in which a doctor killed a patient without his assent. The doctor had consulted the family, who could not bear to see the suffering any longer. The doctor was found guilty of murder, but not punished.

Reaction to the vote

The decision to legalize euthanasia was criticized in many quarters. Russian Health Minister Yuri Shevchenko said the law would be wide open to abuse. “Imagine an ill, old man induced to die, with his belongings and small apartment taken from him,” he said. “This is a great sin and we must not allow it.”

In the United States, the Illinois-based disability-rights group Not Dead Yet also condemned the action. “The Dutch experience with euthanasia is best described as one of increasing carelessness and callousness over the years,” it said in a statement.

Bishop Tadeusz Pieronek, former secretary-general of Poland´s episcopate, observed, “Euthanasia allowed in one sphere … can slip out of control and embrace other groups of people — those unwanted and disabled.”

And in Germany, Cardinal Karl Lehmann, the chairman of the Catholic bishops´ conference, accused the Netherlands of adopting a “culture of death” by becoming the first country to legalize mercy killing and assisted suicide, the New York Times reported April 12. He said it was “inconceivable” that Dutch doctors would “deliver sick patients to their deaths rather than help them through a difficult situation.”

The cardinal´s statement formed part of a fierce German reaction to the euthanasia law. Front-page newspaper editorials, statements from ministers and criticism from doctors all took the view that the Dutch had “breached a dike” with dangerous consequences.

Other countries follow

After the vote, Dutch Health Minister Els Borst commented, “I hope other governments will find the courage to enter into similar debate,” according to an April 10 Reuters article. Days later, on April 13, the Associated Press announced that a South Korean medical group was pushing to give doctors the right to terminate treatment of incurable patients.

Mercy killings are illegal in South Korea. But the Korean Medical Association, a lobby for 70,000 doctors, has drafted an ethics code that would give doctors more discretion in determining the fate of patients suffering from unbearable pain with no hope of living. The ethics code, the first of its kind in South Korea, would become formal if approved by the association´s annual general meeting later this month.

If adopted, the new ethics code would allow doctors to discontinue treatment on terminally ill patients on their own judgment or when they are asked to do so in writing by the patients´ families. It would also enable doctors to refuse demands for treatment by patients´ families if they believe it´s medically needless.

In France, Health Minister Bernard Kouchner announced he plans to press for the legalization of euthanasia, Reuters reported April 16. Kouchner cited favorable opinion polls and told the newspaper Le Monde: “It´s time to debate the issue openly, without arrogance, preconceived ideas or ideological rhetoric.”

Kouchner, co-founder of the charity Médecins Sans Frontières (Doctors Without Borders), returned to the French government in February after a stint as U.N. administrator in Kosovo.

For Dutch Health Minister Borst, the legalization of euthanasia is not the end of the road. According to a report April 15 in the Spanish paper El Mundo, Borst is in favor of a type of “suicide pill” that could be readily available for use by older people and for others who are simply “tired of living.”

This differs from the euthanasia law, explained Borst, because the new law is limited to those suffering from a serious illness; a suicide pill, on the other hand, would be available to those who are simply older or have no desire to keep on living.

The need for palliative care

Countering the pro-death sentiments are proposals to improve pain treatment and to make life more bearable for patients. The Italian newspaper La Repubblica reported March 18 that if terminally ill patients are well cared for, the demand for euthanasia disappears.

A study of 900 patients by Dr. Carla Ripamonti showed that those who wish to quicken their death are not being adequately treated. In fact, of the 900, only one asked for help in committing suicide, and this person, after receiving additional palliative care, changed his mind.

Moreover, the average rate of suicides among those suffering from cancer in Italy is 0.027% — less than the rest of the population. The study showed that the desire for suicide is normally present in the first six months after the diagnosis of cancer. The desire diminishes if afterward the patient receives sufficient pain treatment.

Similar conclusions were reached by a Canadian medical expert, Balfour Mount, a Montreal physician and expert in palliative care, the National Post reported March 19. Mount published an article in the March issue of the journal of the Royal College of Physicians and Surgeons of Canada arguing that the country must dramatically improve its palliative care system for dying patients, if euthanasia and assisted suicide are to be avoided.

Mount argued that palliative care in the Netherlands has lagged behind that of other countries, and that assisted suicide has been adopted as the solution before ensuring optimal care for the terminally ill.

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