The pro-euthanasia lobby, by contrast, has attempted to reassure people that legalising euthanasia would not increase pressure on vulnerable people and has therefore campaigned to give prominence to the latest article purporting to demonstrate this, published in the Journal of Medical Ethics today (Thursday 27 September 2007).
About every five years, statistics on Dutch euthanasia are released. The figures for 2005, published in May this year and highlighted today, show that the number of euthanasia cases in the Netherlands fell from 3,500 in 2001 to 2,325 in 2005. The drop, from 2.6% to 1.7% for euthanasia cases as a percentage of all deaths, may appear reassuring on the surface and this is indeed how it is being spun.
However, these figures, which were set out in a detailed report in the New England Journal of Medicine by a group of Dutch doctors, including some of the country's leading advocates of euthanasia, on deeper scrutiny reveal a very different picture. They show that a small decrease in voluntary euthanasia has been more than offset by a hefty increase in what is called "terminal sedation". Patients are given drugs which sedate them "continuously and deeply" until death, in 8.2% of all deaths! To put it more starkly, voluntary euthanasia (1.7%), non-voluntary euthanasia (0.4%) and terminal sedation accompanied by withdrawal of nutrition and hydration, now account for nearly one in ten Dutch deaths. Even if we were to disregard the increasing use of "terminal sedation" by Dutch doctors the argument that legalising euthanasia in the Netherlands has not led to an increase in people having their lives ended without giving consent is deeply flawed for the very simple reason that euthanasia has been legally sanctioned in the Netherlands for over 20 years.
In 1984 the Dutch Medical Association (KNMG) ruled that performing euthanasia was ethically permissible provided certain criteria were met and the Ministry of Justice confirmed in 1985 that physicians who performed euthanasia using the KNMG's criteria and reported it to the coroner would not be prosecuted. In other words the legalisation of VAE and PAS occurred in 1984 not 2002, and notably before any of the official surveys were carried out.
Furthermore, the courts have interpreted the law extremely liberally underlined by the paucity of convictions of doctors for non-voluntary euthanasia (which has never been legalised) and the leniency of sentences imposed on doctors found guilty of breaking the law.
It is therefore quite disingenuous to argue that the official surveys have revealed no significant increase in non-voluntary euthanasia as a result of legalisation. The law, indeed the whole legal climate, had changed seven years before the first official survey was published in 1991. As early as 1990 over 1,000 Dutch citizens per year were having their lives ended by doctors without their consent. Non-voluntary euthanasia was rampant in 1990 and is equally rampant now. Dutch doctors who practise euthanasia are not on the slippery slope. From the very beginning, they have been at the bottom. These concerns were further heightened in 2005 when Dutch doctors instituted the Groningen protocol, enabling the killing of severely disabled children.
Britain should not be going down the Dutch road. Instead, we need the excellent palliative care already available in this country to be made much more widely accessible. There are no full time palliative care posts in the Netherlands at all. This, together with the fact that patients with the worst symptoms are most likely to request euthanasia, makes a strong case for making good palliative care more widely accessible. Requests for euthanasia are extremely rare when the needs of dying patients are properly met.
