A changing pattern of death.

The Latest News from The Netherlands Offers No Reassurance

In 2001 The Netherlands enacted its ‘Termination of Life on Request and Assisted Suicide’ law, legalising physician-administered euthanasia (PAE) and physician-assisted suicide (PAS) under certain conditions.  In the year following the law’s enactment there were 1,882 cases of PAS and PAE reported by Dutch doctors to the Regional Euthanasia Review Committees created under the terms of the 2001 Act.  By 2006 the number had shown only a small increase – to 1,923 – and there were those who argued that legalisation did not, as others had warned, lead to rising numbers of deaths.

They spoke too soon.  From 2007 onwards there have been year-on-year rises in reported deaths from PAS and PAE – to the point where the latest report reveals that 6,091 deaths from this source were reported in The Netherlands in 2016.  That represents 4 per of cent of all deaths in that year.  To put that figure into perspective, it’s the equivalent of around 20,000 such premature deaths annually in Britain if we were to have a such a law here.

There has also been in recent years a changing pattern in the reasons given for administering euthanasia or supplying lethal drugs for assisted suicide.  In 2004 87 per cent of deaths from PAS and PAE in The Netherlands were of people who had had cancer.  By 2013 that proportion had fallen to 74 per cent and in 2016 it had fallen further to 68 per cent.  So what conditions are on the increase?  Cardiovascular disease, disorders of the nervous system and lung disease accounted for 15.4 per cent of cases in 2016, as against 6.4 per cent in 2004.  Other conditions are also on the rise.  In 2016 age-related illnesses accounted for 4 per cent of reported cases of PAS and PAE.  Dementia and mental health conditions accounted for another 3.3 per cent.  Between 2015 and 2016 alone the number of deaths of patients who had had dementia rose from 109 to 141.

Is this what the Dutch Government had in mind when it changed the law in 2001?  It is impossible to say.  However, it is fair to ask whether it was foreseen or intended that legalisation would lead to one death in every twenty five (a proportion which is continuing to grow year by year) being the result of deliberate action by doctors to end a patient’s life and whether it was foreseen that euthanasia and assisted suicide would migrate from physiological illness into mental health conditions.  One person who has expressed doubts is Dr Theo Boer, who was a member of one of the five Regional Euthanasia Review Committees since 2005.  Writing in the British press in 2014, he suggested that euthanasia was on the way to becoming ‘the default mode of dying for cancer patients’ in The Netherlands and he referred to cases where euthanasia was being approved for people who were not ill but ‘aged, lonely or bereaved’.  Whatever view one takes of the controversial issue of ‘assisted dying’ (as it is euphemistically called by its advocates in Britain), the experience of The Netherlands provides a cautionary tale.