Is the Dutch Euthanasia law working as intended?

The Daily Mail reported recently on a number of euthanasia cases in the Netherlands which are being investigated over concerns that the correct procedures may not have been followed, leading to euthanasia of people who possibly did not meet the strict criteria set out in the Dutch legislation. See Daily Mail articles “Dutch police investigate four euthanasia cases…” and “Police probe five suspicious killings by lethal injection carried out by Dutch doctors…

This demonstrates an important process to check that the intended limits of their law are followed. The cases involve some patients who do not have the mental capacity at the time of their assisted death. This will always be a particularly difficult area of judgement – especially when there is disagreement between the family, doctors, and a patient who has lost the ability to understand their situation, even if they have previously given written consent to a medically assisted death under the circumstances they are now in.

Unfortunately, stories like this get sensationalised too easily, although one of the articles does also report a finding that “In 98 percent of the cases the strict rules had been properly applied.” We should not lose sight of the fact that virtually all doctors are trusted, well-meaning, and act in what they believe to be their patient’s best interests. The law is there to deal with the very rare exceptions, like Harold Shipman. The risk of an errant doctor exists whether or not doctors are legally allowed to help someone to die. Whatever laws a country has, the medical authorities need procedures and cross-checks to ensure that safety procedures are both adequate, and followed in practice. A few instances of cases where procedures may not have been followed correctly in difficult cases, but which are being investigated, leading to possible process improvements, demonstrates a working law, not a failing one.

MDMD campaigns for a law that is restricted to those who have mental capacity to make a life ending decision at the time of their assisted death. Under these outline proposals dementia sufferers would need to be aware that they will eventually lose mental capacity. If they do not wish to let their illness progress this far, they should be allowed medical assistance to end their life beforehand, while they still clearly have sufficient mental capacity, but when there is a high probability that this will be lost before long. This is exactly the case in Switzerland – and is the situation Alex Pandolfo finds himself in (see his Mail on Sunday interview, and a recent follow up interview by MDMD). It avoids some of the difficult scenarios faced by Dutch doctors.

Euthanasia was legalised in the Netherlands in 2002. In 2017 4.4% of deaths were by euthanasia. In 2016 the Journal of Pain and Symptom Management reports that the Netherlands has one of the leading palliative care systems in the EU. The combination of leading palliative care and legalised medical assistance to die gives Dutch citizens a much higher probability of having the “good death” they choose, than those dying in the UK. Here, although we have good palliative care, requests for medically assisted deaths currently have to be denied. This leaves people like Omid, Joan Cheatle, and many others for whom even the best palliative care is not sufficient, to suffer for much longer than they would choose. How many exactly? There are no clear statistics, but judging from the choices Dutch people are making, perhaps around 4% or 5% (1 in 20 to 25) – a small but significant minority.

Update 12/9/2019: Refering to one of the cases that prompted this piece the BBC report that “A doctor accused of failing to verify consent before performing euthanasia on a dementia patient has been cleared of any wrongdoing by a Dutch court. … Judges said the doctor acted lawfully as not carrying out the process would have undermined the patient’s wish.” The article goes on to discuss some of the implications of this ruling regarding patients who have lost mental capacity.