Around one in five patients who choose euthanasia in the Netherlands may be influenced by family circumstances, according to a leading expert on the ethics of assisted dying.
Professor Theo Boer said doctors come under pressure for a variety of reasons, sometimes from family members concerned for the patient’s well-being, while in other cases the patients themselves wanted to ease the burden on their relatives.
Boer based his estimate on his experience of nine years as a member of one of five review committees that assess every euthanasia case, helping to judge around 4,000 case files.
Boer also voiced concern about the steady rise in the number of people who choose euthanasia and assisted suicide, which has trebled from around 1,800 in the early years to 4,829 in 2013. Although the vast majority of requests still come from terminally ill cancer patients, the parameters have gradually widened to take in growing numbers of people with conditions such as Alzheimer’s disease and psychiatric illness.
Last month the paediatric association NVK called for the minimum age of 12 to be scrapped, arguing that some terminally ill children of 10 and 11 are capable of deciding that they want to die. (The NVK’s comments were made after Boer spoke to DutchNews.nl.)
‘What surprises me is that nobody is making any serious attempt to treat this as a problem,’ said Boer, who teaches ethics at Groningen’s Protestant Theological University. ‘It seems inarguable to me that the law has led to a rise in incidences.’
Asked how often he saw evidence of pressure from the family, he said: ‘It’s hard to say, but at a rough estimate I would say the family is a factor with one in five patients. The doctor doesn’t want to put it in the dossier; you need to read between the lines.
‘Sometimes it’s the family who go to the doctor. Other times it’s the patient saying they don’t want their family to suffer. And you hear anecdotally of families saying: “Mum, there’s always euthanasia”.’
The Netherlands’ euthanasia law, which dates from 2001, gives doctors who help their patients to die protection from prosecution as long as they meet specific criteria. The patient must request euthanasia in person and convince the doctor that they have considered their decision thoroughly. The doctor must be satisfied that the patient’s suffering is unbearable and without prospect of relief, and that there is no alternative treatment to alleviate their pain.
The Dutch medics’ federation KNMG published a survey last December which found that 70% of doctors had experienced pressure, while 64% felt it had increased in recent years. The survey did not ask where the pressure came from.
KNMG policy officer Erik van Wijlick said: ‘We’ve been aware since the early 1990s that pressure is an issue. It would be helpful to do some research into what kind of pressure there is and where it comes from.’
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