Dutch court rules doctors can euthanise dementia patients who change mind

Doctors in the Netherlands can no longer be prosecuted for carrying out euthanasia on dementia patients who have previously given written consent.

Previously, those with dementia would need to reconfirm their earlier request.

But the Dutch Supreme Court ruled earlier this month this was no longer necessary.

“A doctor can carry out an (earlier) written request for euthanasia from people with advanced dementia,” the Supreme Court said in a summary of its decision.

The ruling means another legal safeguard has been removed.

The devastating move comes after a Dutch doctor was taken to court for carrying out an assisted suicide on a patient with Alzheimer’s.

The vulnerable patient had earlier written a directive asking for euthanasia in the event that she had been admitted to a nursing home due to dementia, but indicated she wanted to determine when “the time was right.” 

Once in the nursing home, she gave “mixed signals” about wanting to die.

And in the days leading up to the killing, the patient affirmed her desire to live, saying “I don’t want to die” on several occasions. 

Despite her requests, a doctor in “close consultation” with her family decided that she should receive an assisted suicide because of her prior statement.

The doctor slipped a sedative into the woman’s coffee to relax her before administering the lethal injection. 

During the assisted suicide, the patient awoke and resisted the doctor causing the physician to ask the family for help in holding down the patient down while he finished the procedure.

In the court case that followed, prosecutors argued the doctor did not properly consult with the 74-year-old patient.

“As long as the woman was able to communicate, the nursing home doctor should have kept talking to her about her desire to live or to die,” reads a statement from the prosecutor’s office.

“And as long as that conversation gave cause for doubt, the nursing home doctor should have refrained from euthanasia.”

However, the doctor has since been acquitted of any wrongdoing by a Dutch court that ruled “all requirements of the euthanasia legislation” had been met.

The law change announced earlier this month means cases such as these likely won’t even reach the courtroom.

In the Netherlands, euthanasia is legal if the person is deemed to be experiencing “hopeless and unbearable suffering” and chooses to end their life.

The country’s only euthanasia clinic recently revealed that it had seen a 22% increase in requests from people seeking assistance to end their lives last year compared to 2018.

There was also a 37% rise in requests from dementia patients, from 70 in 2018 to 96 in 2019.

UN official criticises ‘liberal eugenics’ of disability abortion

A United Nations human rights expert has brought fresh attention to some of the many negative consequences of disability-selective abortion and assisted suicide in a wide-ranging report on disability rights to the Human Rights Council on people with disabilities.

Special rapporteur Catalina Devandas-Aguilar is a Costa Rican lawyer who has spina bifida and has three children with the condition.

Unfortunately, Catalina Devandas Aguilar’s report has been overlooked because of the current focus on the coronavirus pandemic. 

Beginning of life: Prenatal screening

In the report, Catalina shares how technological advances in prenatal screening has resulted in a steady rise of prospective parents choosing to abort children like her own. 

She revealed how “in some high-income countries, high uptake rates for screening have already been associated with significant reductions in the number of children born with some congenital disabilities.”

Evidence of this can be seen across the UK, which recently reported a 150% rise in disability-selective abortions relating to cleft lip. Additionally, figures show 90% of babies with Down’s syndrome are aborted and estimates show the figure is around 80% for babies with spina bifida.

Catalina, who herself has spina bifida, suggests the use of prenatal screening is a cost-saving measure – as it is often cheaper to abort a baby than offer life-affirming treatment. She says: “Genetic screening must never be considered to be a cost-effective alternative to providing the highest attainable standard of care or service for persons with disabilities.”

In 2013, it was revealed a staggering £30 million had been spent in the UK on prenatally screening babies for Down’s syndrome. In comparison, less than £2 million was spent on research that would improve the lives of those who survive the eugenic screening process. 

Catalina rightly points out that such practices “may reinforce and socially validate the message that persons with disabilities ought not to have been born,” a concern shared by disability rights activists.

“Legislative frameworks that extend the time frame for a lawful abortion or,

exceptionally, permit abortion in the presence of fetal impairment aggravate this message,” she adds. 

“In addition, as the consequence is a smaller number of persons with disabilities being born, some fear a reduction in disability advocacy and social support for persons with disabilities.” 

End of life: Assisted suicide

Catalina is even stronger on the issue of assisted suicide saying “an impairment should never be a reason for assisted dying to be permitted.”

The Costa Rican lawyer, highlights how legalising assisted suicide will place at risk the lives of persons with disabilities.

“If assisted dying is made available for all persons with a health condition or impairment, regardless of whether they are terminally ill or not, a social assumption might follow that it is better to be dead than to live with a disability,” she says. 

“Generally, when life-ending interventions are normalized outside the end stage of terminal illness, persons with disabilities and older people may increasingly feel the need to end their lives.”

The report states how those with disabilities are vulnerable to explicit and implicit pressures to undergo an assisted suicide ‘procedure’, including expectations from family members, financial pressures, cultural messages and even coercion.

During life: ‘Futile treatment’?

In addition to highlighting the discrimination disabled people face at the beginning of life and at the end of life, Catalina reveals how disabled people are discriminated during their life.

“It has been reported that physicians may exert pressure on critically ill patients and their families to withhold or withdraw life-sustaining treatment based on the belief that further treatment would be futile, non-beneficial or potentially inappropriate, particularly for patients with severe impairments.

“That subjective assessment, based on the physician’s opinion and values, includes an assumption on the resulting quality of life of the individual and thus involves a risk that it is influenced by ableist views of living with a disability.”

She adds: “Similarly, cost-effectiveness considerations may also result in the denial of life-sustaining treatments to some persons with disabilities.” 

Catalina concludes her report by suggesting countries who are member states of the UN should: “Conduct a comprehensive legislative and policy review to abolish all laws, regulations, customs and practices that discriminate against persons with disabilities, including in the context of medical or scientific procedures, research and experimentation.”

Before the publication of Catalina’s report, a campaign was launched in the UK to stop abortion being available up to birth for disabilities such as cleft lip, club foot and Down’s syndrome. 

Heidi Crowter, a 24-year-old woman who has Down’s syndrome, has launched a landmark case against the UK Government over the current discriminatory abortion law that singles out babies with disabilities allowing abortion right through to birth.

Cheryl Bilsborrow, whose two-year-old son Hector has Down’s syndrome, has also joined Heidi in bringing forward the case.

The UN Committee on the Rights of Persons with Disabilities’ concluding observations on the initial report of the United Kingdom of Great Britain and Northern Ireland made a key recommendation that the UK change its abortion law on disability so that it does not single out babies with disabilities. However, the Government has decided to ignore this recommendation.

Additionally, a 2013 Parliamentary Inquiry into Abortion for Disability found the vast majority of those who gave evidence believed allowing abortion up to birth on the grounds of disability is discriminatory, contrary to the spirit of the Equality Act 2010 and that it affects wider public attitudes towards discrimination. 

The Inquiry recommended Parliament reviews the question of allowing abortion on the grounds of disability and should consider repealing section 1(1)(d) of the Abortion Act which allows for it.

Disabled peer Lord Shinkwin has previously had a Bill in the House of Lords that would have repealed section 1(1)(d) of the Abortion Act – the Bill was undefeated but unfortunately ran out of time. Lord Shinkwin’s Bill was supported by Disability Rights UK.

Royal College of Physicians clarifies it does not support assisted suicide

In a move welcomed by pro-life groups, The Royal College of Physicians (RCP) has released a statement on its website clarifying that it does not support a change in the law on assisted suicide.

The RCP, which represents more than 35,000 doctors, dropped its long-standing opposition to assisted dying in favour of neutrality following a controversial survey of its members last year.

In a highly contentious move criticised by over 1,500 doctors, the RCP’s Council said ahead of the vote that the College would go neutral unless 60% of its members voted either in favour or against assisted suicide.

The resulting survey revealed 43.4% said the organisation should be opposed to a change in the law to allow assisted dying, while nearly a third (31.6%) said it should support a change in the law and a quarter (25%) said it should be neutral.

Despite continued opposition to assisted suicide being the most favoured position among those surveyed, the RCP adopted a neutral position to assisted suicide.

The change in stance and the irregular framing of the poll prompted a legal challenge.

Professor John Saunders, a Fellow of the RCP and the former chair of its Ethics Committee labelled the survey as a “sham with a rigged outcome”.

Peer and Former Paralympian Baroness Grey-Thompson had warned that the RCP’s survey was: ‘A travesty of a consultation and… it risks bringing the college into disrepute as professional body’.

Now, in a statement on its website this week, the RCP has clarified that it does not support a change to the law.

“Neutrality was defined as neither supporting nor opposing a change in the law, to try to represent the breadth of views within its membership,” it said.

“Regrettably, this position has been interpreted by some as suggesting that the College is either indifferent to legal change or is supportive of a change in the law.

“So that there can be no doubt, the RCP clarifies that it does not support a change in the law to permit assisted dying at the present time.”

The clarification was welcomed by Dr Gordon Macdonald, Chief Executive of Care Not Killing.

He said: “This extensive and unusually frank statement from the UK’s oldest medical organisation, rightly puts a sword to the lie that RCP supports a change in the law – it does not. 

“The current laws on assisted suicide and euthanasia exist to protect those who are sick, elderly, depressed or disabled from feeling obliged to end their lives. This is not an imagined risk.

“As we have seen in places like Oregon and Washington, a majority of those ending their lives cite the fear of being a burden on their families and carers as a reason for the decision to end their life.”

Earlier this year, The Royal College of General Practitioners (RCGP) announced it will continue to oppose a change in law on assisted suicide following a consultation of its members.  

The RCGP’s consultation, conducted independently by Savanta ComRes, was sent to almost 50,000 members, who were asked whether RCGP should change its current position of opposing a change in the law on assisted dying.

Just under half (47%) of those surveyed said the College should not change its position, while 40% said it should support a law change providing there is a regulatory framework and appropriate safeguarding processes in place. 11% of respondents said the RCGPs should be neutral, while 2% abstained.

The British Medical Association (BMA) recently polled its member’s views on assisted suicide. The results of the first-ever BMA survey on assisted dying, which closed on 27 February, were due to be discussed at this year’s annual representatives meeting in June and could see the professional body changing its current policy on assisted suicide.

However, due to the coronavirus crisis all BMA events have been cancelled for the foreseeable future meaning any announcement is likely to be postponed.

Activists have been attempting to introduce assisted suicide legislation to the UK through the courts, through parliament and through pressuring medical bodies but continue to face obstacles.

Last year, the High Court rejected to hold a judicial review of the current law on assisted suicide, with judges stating the court was “not an appropriate forum for the discussion of the sanctity of life”. The Court of Appeal rejected an attempt to challenge this decision last month.

Similarly, in 2018, the Court of Appeal ruled that Parliament was a “better forum” than the courts for determining the issue of legalising assisted suicide.

Parliament has consistently rejected attempts by the assisted suicide lobby to introduce assisted suicide, with 330 to 118 voting against introducing assisted suicide in 2015. 

In January, strong opposition from MPs resulted in the Government rejecting a call for review on assisted suicide, despite the best efforts from large pressure groups in favour of assisted suicide.

Additionally, the Lord Chancellor Robert Buckland QC has recently confirmed the Government has “no plans” to introduce assisted suicide legislation, saying: “Personally, I have grave doubts about the ability of legislation to be watertight when it comes to the potential for abuse.”Assisted suicide pressure groups cite a poll that shows there is widespread support for legislation of assisted suicide, yet experts have heavily criticised the polling as deeply flawed. In fact, when asked questions that drill down into the merits of the debate, the percentage of those in support drops dramatically.

Assisted suicide will save NHS money and provide organs, researchers argue

Legalising assisted suicide would save the NHS money and potentially release higher quality organs for transplant argue researchers at the University of Strathclyde, raising ethical concerns.

The highly controversial paper by Dr David Shaw, an ethicist at the Universities of Basel and Maastricht, and Professor Alec Morton, a health economist and analyst, has been criticised by palliative care and pro-life groups. 

The pair say they do not intend their arguments to be used as the basis on which to change present legislation but claim that permitting assisted suicide would substantially benefit both the small population that seeks it and the larger general population.

Additionally, lead author, Dr Shaw, has dismissed criticisms from individuals – who have suggested it is callous to consider assisted suicide from the perspective of resource management – by labelling this criticism as “misplaced”.

He adds: “We are simply arguing that the economic costs of denying assisted dying should not be ignored; they should not be the key driver of any legal change, but it would be irresponsible not to consider them.”

The researchers argue that up to £74m could be saved if just one-third of the costs involved in caring for those with cancer were cut by vulnerable cancer patients opting for an assisted suicide.

In the paper, the authors write: “Organ donation could also benefit because there are several reasons why donation, after assisted dying, is better from a clinical and economic perspective.

“First, if patients are denied assisted dying, organ function will gradually deteriorate until they die naturally, meaning that transplantation is less likely to be successful. Second, patients who choose assisted dying have to go through a lengthy process, and organ donation can be easily integrated into that process…”

This year it was revealed that the legalisation of assisted suicide in Canada has led to a surge in organ donations and the open solicitation of those considering medically assisted death. In one case, a chronically ill man was denied healthcare at his home and instead offered an assisted suicide. 

Dr Moira McQueen, executive director of the Canadian Catholic Bioethics Institute, told CNA such practices appear “rather horrifying.”

Given that a person who is approved for euthanasia may not be terminally ill, McQueen added it is not out of the realm of possibility that a primary physician “might well suggest organ donation as, if not an incentive, a kind of ‘consolation’ for the person’s own loss of life.”

The UK parliament has consistently rejected attempts by the assisted suicide lobby to introduce assisted suicide, with 330 to 118 voting against introducing assisted suicide in 2015.

A new Assisted Dying Bill by Lord Falconer has recently received its first reading in the House of Lords. Due to the busy parliamentary timetable, it is unlikely that this bill will be debated further, but it demonstrates the clear intent from the pro-assisted suicide lobby to try and change the law.  

Dr Gordon Macdonald, chief executive of Care Not Killing, which resists any change in the law, said: “This report is highly disturbing. It highlights the dangers of legalising euthanasia. Very quickly the argument moves from that of personal autonomy to doctors and nurses making value judgments about the quality of other people’s lives while seeking to save money and tackle so-called ‘bed blocking’ in health services.” 

A spokesperson for Right To Life, Catherine Robinson said:

“You can learn a lot from paying close attention to countries and other places where assisted suicide and euthanasia has been legalised. Recent evidence from the United States demonstrates how the so-called ‘right to die’ could become the ‘duty to die’. Feelings of being a burden were cited in 55% of Oregon and 56% of Washington assisted-suicide requests in 2017.

“This is especially the case when families and health budgets are placed under financial pressure, which makes the Canadian study which found that the legalisation of assisted suicide could save the health care system up to $138 million per year so alarming. 

“Legalising assisted dying would likely lead to pressure on vulnerable people to choose the quicker, cheaper option of death over palliative care.

“This is further compounded when one considers how the legalisation of assisted dying has led to a surge in organ donations and the open solicitation of those considering medical assistance in dying (known as MAiD) in the country. 

“Rather than assist vulnerable people to end their lives, we should be looking to improve the UK’s palliative care provision and affirm their right to life.”