Doctor defends euthanasia on vulnerable patient who said ‘no’ three times

A doctor cleared of murder for euthanising a vulnerable woman with dementia has waived her anonymity to declare she did the “right thing”, even though her patient said “no” three times. 

In an interview with Dutch current affairs programme Nieuwsuur, Marinou Arends attempted to justify her actions saying they were “for the best”.

On April 22, 2016, the now-retired doctor euthanised a 74-year-old woman with Alzheimer’s who had been admitted to Mariahoeve care home in The Hague seven weeks before.

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

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

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

Arends asked the woman three times if she wanted euthanasia, but on each occasion, she answered that she did not.

“I couldn’t get this confirmation, and without it I had to take this step,” said Arends.

“If you asked her: ‘What would you think if I were to help you to die?’, she looked bewildered and said: ‘That’s going a bit far!’ I saw in her eyes that she didn’t understand it anymore.”

She added: “It was tremendously difficult, but for the best. I believed I was working within the boundaries of the law.”

Despite her requests, Arends judged her mentally incompetent and in “close consultation” with her family decided that she should be euthanised because of her prior directives – a decision that the Dutch courts eventually ruled was legal.

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 started to resist the procedure causing the doctor to ask the family for help in holding down the vulnerable woman while she finished the procedure.

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

However, in 2019, a district court in The Hague ruled that 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.

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

The ruling, which was upheld earlier this year, not only exonerated Arends’ actions but means another legal safeguard protecting vulnerable people from euthanasia has been removed.

The case attracted critical attention when details were reported to the Regional Euthanasia Review Committees, which assesses all of the Netherlands’ roughly 6000 annual cases.

Over 200 Dutch doctors took out a newspaper advert saying they would not perform euthanasia for a patient with dementia without their confirmation.

However, Arends mantains she did the “right thing”, saying: “This was [a] unanimous [decision], a choice between an average residency of seven years, seven years of suffering, or – on the basis of the fundamental message in her living will – giving her the euthanasia she longed for.”

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.

(Image credit: The Dutch Broadcasting Foundation (Nederlandse Omroep Stichting – NOS))

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 started to to resist the procedure causing the doctor to ask the family for help in holding down the vulnerable woman down while they 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.

UK Government has no intention of reviewing assisted suicide law – Lord Chancellor

The Lord Chancellor Robert Buckland QC has confirmed that the UK Government has no intention of reviewing the UK’s assisted suicide law.

He also shared that personal “grave doubts” he has over the ability of any assisted suicide legislation to protect vulnerable people from unintended consequences and abuse stemming from a change in law.

The comments were made in response to a question asked by Congleton MP and member of the Joint Committee on Human Rights, Fiona Bruce, during a remote meeting of the Joint Committee on Human Rights.

Fiona Bruce MP, who is also chair of the All-Party Parliamentary Pro-Life Group, had sought assurances from the Lord Chancellor that there would be no change in law after noting that people had “become more aware during this crisis of how precious every human life is.”

In his response, Mr Buckland said: “we [the Government] don’t currently have any plans to initiate a review of the law in this area or to indeed publish a call for evidence.”

Alluding to the attempts by activists to introduce assisted suicide legislation through the UK courts, he stated the issue of assisted suicide is a conscience issue for Parliament to decide rather than one for Court or Government.

In November, the High Court rejected 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 earlier this year.

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. 

Earlier this year, strong opposition from MPs resulted in the Government rejecting an earlier call for review on assisted suicide, despite the best efforts from large pressure groups in favour of assisted suicide.

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.

In addition to lobbying the Government and parliament, activists have been seeking to lobby medical bodies in the UK.

Despite this, not a single doctors’ group or major disability rights organisation in the UK supports changing the law, including the British Medical Association (BMA), the Royal College of General Practitioners, the Royal College of Physicians, the British Geriatric Society and the Association for Palliative Medicine. 

In a move welcomed by pro-life groups, the Royal College of Physicians recently released a statement on its website clarifying that it does not support a change in the law on assisted suicide. The clarification comes after the medical body changed its official stance on the matter to neutral last year.

The Royal College of General Practitioners announced in February that it will continue to oppose a change in law on assisted suicide, following a consultation of its 50,000 members.  

The BMA, which is currently opposed to assisted suicide, has launched its first-ever survey on the issue. The poll will ask their 160,000 members for their views “on whether the BMA should adopt a neutral position with respect to a change in the law on assisted dying”. The results of the British Medical Association survey will be revealed later this year.

Assisted suicide pressure group Dignity in Dying (formerly the Voluntary Euthanasia Society), which spent over £1,600,000 last year, said in an email to supporters “that the poll is happening is a significant win” for their campaign. Meanwhile, a large group of palliative care doctors have written to The Times calling on the BMA to continue opposing the involvement of doctors and ensuring that assisted dying will not become a medical intervention in the UK.

A spokesperson for Right To Life UK, Catherine Robinson said: 

“Despite the best efforts of well-resourced assisted suicide activists, the Lord Chancellor’s statement is very clear and is particularly welcome during this current crisis.

“The concerns raised by a large number of MPs earlier this year highlighted just a small number of the reasons why the Government should look away from assisted suicide and instead fund better hospice and palliative care. 

“Any legislative change could place many vulnerable people at risk of abuse and put pressure on those with terminal and chronic illnesses and on the disabled to end their lives prematurely.

“Evidence from Oregon demonstrates how a so-called ‘right to die’ may 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 under financial pressure, which makes the Canadian study which found that the legalisation of assisted suicide could save the health care system more than $138 million per year so alarming.

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

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.