Euthanasia legislation expands to cover terminally ill children under-12 in Netherlands

Doctors will be able to euthanise children between the ages of one and 12 in the Netherlands under the country’s ever-expanding assisted suicide regime.

Deputy Prime Minister Hugo de Jonge, who also serves as the Health Minister, wrote to Dutch politicians this week outlining his plans to amend regulations to allow ‘active life termination’ for terminally ill children ages between one and 12.

Current law

Under the current law, non-voluntary euthanasia is available for Dutch babies who haven’t yet reached their first birthday.

Children between 12 and 15 can be euthanised with the approval of their parents, while those aged over 16 are eligible for euthanasia if they make a considered, voluntary request for it and if their suffering is “unbearable.”

As it stands, there is no euthanasia provision for children between the ages of 1 and 12.

‘Necessary’?

However, that looks set to change with de Jonge claiming a change in regulations is necessary to help prevent children from suffering.  

Despite months of debate and strong opposition from political parties, including his own – the Christian Democratic Appeal party – de Jonge noted in his letter that a parliamentary Bill wouldn’t be needed to introduce euthanasia for one 12 year-olds.

Instead, doctors will be exempt from prosecution if they carry euthanasia on someone in this age range if they do so to end “unbearable suffering”.

In their apparent attempt to circumvent parliamentary procedure, de Jonge says health bosses are working on policy updates alongside the Public Prosecution Service.

Euthanasia on the increase as safeguards are eroded

The Netherlands was the first country in the world to legalise euthanasia when its Termination of Life on Request and Assisted Suicide (Review Procedures) Act came into effect in 2002.

Since its introduction, the legislation has become more extreme and safeguards have been eroded.

Last year, 6,361 individuals lost their lives to euthanasia in the Netherlands – equating to 4% of the country’s total deaths. In addition, the Netherlands’ only euthanasia clinic revealed that it had seen a 22% increase in requests from people seeking assistance to end their lives in 2019, compared to 2018.

In June, a Dutch doctor, who was cleared of murder for euthanising a vulnerable woman with dementia, 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”.

Her comments come after a 2019 district court ruling in the Hague stating 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.

Expanding euthanasia law

In July, a Dutch MP introduced a controversial Bill that would allow healthy people to have an assisted suicide if they feel their life is ‘complete’.

Pia Dijkstra, Foreign Minister for the four-party coalition Government and medical ethics lead for coalition party D66, submitted a Bill that would allow healthy individuals over the age of 75 to seek euthanasia if they have had “a strong death wish” for at least two months.

Outlining their opposition to similar proposals in 2017, the KNMG Royal Dutch Medical Association believes it could have the undesirable effect of stigmatising the aged population.

The medical association said that the government should invest in measures to make sure the elderly do not feel their lives are pointless, over the option of an early death.

Palliative care doctors overwhelmingly oppose assisted suicide, new poll reveals

Seven out of ten palliative care doctors surveyed believe the British Medical Association (BMA) should remain opposed to assisted suicide, a new survey has revealed.

The largest poll to date of British medics’ views also showed that only 30% of doctors surveyed supported the BMA actively supporting attempts to change the law to allow euthanasia. Whereas 63% of doctors opposed the BMA supporting a law change or be neutral on the matter, with 40% expressing the view that the BMA should stay with it’s current position opposing a law change and 23% holding the position that is should be neutral on the matter.

When asked whether the BMA support a change in law which would permit physician-assisted suicide, 40% of doctors said it should actively support a law change, 33% said it should stick with its present policy of opposing a law change, and 21% backed a neutral stance.

However, 70% of palliative care doctors opposed a change in the medical bodies stance, whilst just 7% were in favour.

Some 44% of geriatricians were opposed to the BMA changing their stance on assisted suicide, whilst only 27% were in favour.

General Practitioners, too, seem less keen on seeing a change in the law, a result echoing the findings of their own Royal College earlier this year.

In comparison, calls for changing the BMA’s stance on assisted suicide came largely from doctors who rarely deal face-to-face with patients, such as histopathologists.

Support was also bolstered by those who have never practised medicine because they are students or do not hold a license to practice, and retired doctors.

Conscientious objection could become an issue

If the law regarding assisted suicide were to change in the future, the right to conscientiously object and opt-out of administering life-ending drugs could become an issue.

Despite doctors narrowly being in favour of a change of law, 54% of doctors revealed in the poll that they would not be willing to participate actively in the process of administering life-ending drugs. Only 26% said they would be willing, and 20% were undecided.

So, while there appears to be an appetite for allowing patients to end lives, it seems there is much less enthusiasm for providing such assistance. In Canada, the Superior Court of Justice Division Court of Ontario ruled in 2018 that if doctors are unwilling to perform legal actions, such as assisted suicide, they should find another job.

What happens next

Currently, the BMA believes that “the ongoing improvement in palliative care allows patients to die with dignity … [and] insists that physician-assisted suicide … voluntary euthanasia … [and] non-voluntary euthanasia should not be made legal in the UK.” 

The doctors’ union has had a policy opposing assisted suicide since the 1950s, but very briefly became neutral on the issue in 2005.

Since then, the BMA has been opposed to all forms of assisted suicide – a position they reaffirmed in 2016 at the organisation’s annual representative meeting.

While the BMA emphasised that the poll was not a vote and did not commit them to any change in its formal opposition to assisted suicide, it is possible doctors will call for a formal change in the medical bodies stance on assisted suicide during its next annual meeting due to take place next summer.

The results had been due for release and debate this summer, but the BMA’s annual meeting was postponed because of the coronavirus pandemic.

Duty of care

Earlier this year, as the BMA was collecting responses on its survey, a large group of prominent palliative care doctors called on the BMA to uphold their duty of care and remain opposed to assisted suicide.

In a letter published in The Times, over fifty palliative care doctors and healthcare professionals said the existing law, which prohibits any form of assisted suicide or euthanasia, “ensures that doctors continue to uphold their duty of care, avoiding the inherent risks to sick and vulnerable patients that physician assisted suicide would bring”.

The doctors also used the letter to highlight how safeguards are ignored and eligibility criteria is soon expanded in countries that allow assisted suicide. Referencing Canada, the doctors say: 

“Canada’s Federal government has consulted on expanding assisted dying laws to the mentally ill, to ‘mature minors’ and individuals whose deaths are not imminent. Meanwhile Canadian hospices are facing pressure to provide assisted death or risk losing their funding.”

‘Mendacious claims’

Commenting on the poll, Dr Gordon Macdonald, Chief Executive of Care Not Killing said

“We welcome the fact that many active medics have repeatedly rejected the mendacious claims made by those pushing for this change, namely that legalising assisted suicide and euthanasia can be done with safeguards and would not put pressure, real or perceived, on vulnerable people to end their lives prematurely.

“They have seen what happens in the small number of jurisdictions that have gone down this dangerous path – places like Oregon and Washington. These two US states are held up as the model to copy, but in both, a majority of those opting to end their lives cite fear of being a burden as among their key reasons, and others talk about financial concerns. While the list of conditions that qualify for the lethal cocktail of barbiturates continues to grow, some experts have warned that allowing assisted dying might also be normalising suicide in the general population. Suicide rates are, after all, a third higher in Oregon than the US average.

“In Canada, last year a Court struck down the requirement that a person be terminally ill before they qualify for euthanasia. This followed the case of Alan Nichols, a former school caretaker who was physically healthy, but struggled with depression. His life was ended by lethal injection in July. Roger Foley, meanwhile, was repeatedly offered the drugs to kill himself, while being denied the social care to live a dignified life, due to the cost.

“Closer to home, we see how laws introduced in the Netherlands or Belgium, which were supposed to be limited to mentally competent terminally ill adults, have been extended to non-mentally competent adults and children, profoundly disabled people, and even those with treatable psychiatric problems such as depression and anorexia.”

Current laws protect

Dr Macdonald concluded: “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. They protect those who have no voice against exploitation and coercion and those who care for them who might come under pressure to conserve scarce resources. They do not need changing.”

Ireland advances assisted suicide Bill after rejecting opportunity to further scrutinise it

Politicians in the Republic of Ireland have rejected an opportunity to refer a radical assisted suicide Bill to a special committee which would assess the legislation’s impact and report back within 12 months, by 86 to 65 votes.

Instead, the so-called ‘Dying with Dignity’ Bill was voted through to committee stage by 81 votes to 71. The Justice Committee now has the chance to amend the proposed legislation to be more or less severe.

Seven of the coalition Government’s Cabinet ministers were among those who voted in favour of the Bill, including the Tánaiste Leo Varadkar, Justice Minister Helen McEntee, Health Minister Stephen Donnelly and Higher Education Minister Simon Harris.

Voices against assisted suicide silenced

In response to the votes, Aontu leader Peadar Toibin decried the lack of scrutiny and said the manner in which the bill was passed was shocking.

The Meath West TD noted that out of 75 minutes of debate, only 4 minutes were given to those who opposed the bill.

In an apparent departure from the established norm, all speaking slots were filled before the bill reached the floor of the chamber, with deputies in favour of the radical proposals having taken them all.

Ten minutes from the end, Mr Toibin called a point of order and appealed for more time, noting the irony of the one-sided debate: “I welcome that all the speakers so far have said we need a proper discussion about this very serious issue. It would be a shame to go through the Second Stage debate without anybody with an opposing view on the Bill getting a chance to speak, and with all the views exactly the same”.

Deputy Mattie McGrath also questioned the distribution of speaking slots and called the debate “shambolic”.

Despite the protests, the Chair refused a request to extend the 75-minute debate by 20 minutes to allow more contributions.

However, 4 minutes were afforded to Independent TD Peter Fitzpatrick to make the case against assisted suicide.

The TD for Louth said: “The Bill before us this evening would open up the door to one of the most extreme regimes anywhere in the world…

“The amount of correspondence I have received in recent days from healthcare professionals is unbelievable. They all raise serious concerns about the impact a change in the law in this area would have on the very vulnerable people in the area. Away from the soft-focus interviews that many in the media have been conducting on this issue in recent weeks, there are people all around Ireland who have been listening to this debate and are disconcerted and upset by what they have heard.

“The message the medical professions have been sending to Deputies in recent days is loud and clear. The impact of what is said in debates like this and the changes to the law in the area can be devastating for the most vulnerable and fragile members of our community who oftentimes start to see themselves as a burden on society with a duty to end their lives. We must listen to what the experts are saying in this regard.”

‘Wrong in principle’

The latest proposal to allow assisted suicide has been criticised by palliative care doctors, geriatricians, politicians and pro-life campaigners.

Columnist and head of the Dublin-based Iona Institute, David Quinn, condemned the Bill for being both “wrong in principle” and for having “incredibly far-reaching” proposals which go further than other countries that allow assisted suicide.

“For example, the definition of ‘terminal illness’ is so broad it could include dementia. It does not require that a person be within a set period of death such as six months. Therefore, the person could be in the early stages of a terminal illness with years of life remaining and still ask a doctor for a lethal drug. They only have to make the request once,” he told Crux.

‘A better option’

Professor Anthony O’Brien, a Clinical Professor of Palliative Medicine at University College Cork with over 35 years of experience in hospice care, has spoken out against the Bill, telling The Irish Times: “I have met very many patients who in desperation asked to have their life ended, believing that they had no other option. With good palliative care, the overwhelming majority had occasion to change their minds. With suicide, there is no going back.

“Surely a compassionate society can be more creative in its response to human suffering than premature, self-inflicted death. Good care is always a better option.”

‘Regressive step’

Hope Ireland, a coalition of healthcare professionals and disability rights advocates, says the introduction of assisted suicide and euthanasia is a “regressive step for vulnerable people – particularly the elderly and those with disabilities”.

In their briefing document, which was sent to all of Ireland’s TDs, they highlight how the operation of similar laws in other countries have shown the consequences of legalisation are “catastrophic” for older people and people with disabilities.

For example, they state:  “In 2019, a woman with dementia who revoked her consent to be euthanised had to be held down by her family whilst the doctor ended her life. A Dutch court approved this practice, and acquitted the doctor of any wrongdoing.”

Analysis by Naoise Graham, Public Affairs Officer at Right To Life UK

There is an abundance of alarming aspects to the radical Bill, which goes far beyond the demands of Dignity in Dying, the assisted suicide campaigners in the United Kingdom, and the supposedly exemplary legislation of Oregon, USA, which this campaign claims to emulate.

Most notably, Gino Kenny’s Bill allows for euthanasia in cases where “it is not possible” for the patient to self administer lethal drugs. 

Such actions are expressly forbidden under both the Death with Dignity Act implemented in Oregon in 1997 and the similar proposals from Dignity in Dying.

A host of other provisions illustrate the extremity of the Dying with Dignity Bill, even among the radical company of Oregon and Dignity in Dying.

The Oregon law defines terminal illness as expected to “within reasonable medical judgement, produce death within six months”. 

In contrast, the Bill before the Irish Parliament lacks any time limit for terminal illness, only requiring that the patient be ‘likely to die as a result of that illness or complications’ at an unspecified stage.

Whereas Oregon patients supply both written and oral requests for lethal drugs, Kenny’s Bill reduces the procedure to only a single written declaration. 

Similarly, only one witness would be needed to sign off on patient declarations under the radical Irish proposal, as opposed to two witnesses under the American legislation of much longer experience. 

Unlike in Oregon, Kenny’s Bill does not stipulate that the patient be recommended to inform their next of kin of their decision.

Under the ‘Dying with Dignity’ Bill, the waiting period between a patient’s declaration to end their own life and the prescription of lethal drugs reduces from fourteen to six days in cases where death from a terminal illness is deemed likely to occur within a month. 

In contrast, the Oregon system of assisted suicide only collapses the 15-day waiting period if death from a terminal illness is likely to occur within that period.

Whereas the Death with Dignity Act in Oregon insists that any informed decision must involve consideration of “feasible alternatives, including, but not limited to, comfort care, hospice care and pain control”, Gino Kenny’s ‘Dying with Dignity’ Bill fails to detail the mandatory information for patients beyond the simple mention of “the available choices”. 

Perhaps most strikingly, the ‘Dying with Dignity’ Bill makes no reference to the possibility of psychological or psychiatric evaluation in case of potentially impaired judgement on the part of the patient. This represents a disturbing distinction with Oregon where the physicians are obliged to refer such patients for counselling.

Assisted suicide Bill launched in Ireland

A radical Private Members’ Bill attempting to legalise assisted suicide in the Republic of Ireland has been introduced in the lower house of Ireland’s parliament.

The so-called ‘Dying with Dignity Bill’ was tabled in the Dáil Éireann by People Before Profit TD Gino Kenny on Tuesday 15 September.

Although Kenny’s party only has five members, other parties have indicated they could support the proposed law, with any vote likely to be an issue of conscience.

The ‘Dying with Dignity’ bill was first introduced by TD John Halligan in 2015 but ran out of time when the Irish government was dissolved in 2016.

Analysis by Naoise Grenham, Public Affairs Officer at Right To Life UK

There is an abundance of alarming aspects to a radical Bill which lurches far beyond the demands of the assisted suicide campaigners Dignity in Dying in the United Kingdom and the supposedly exemplary legislation of Oregon, USA, which this neighbouring campaign claims to emulate.

Most notably, Gino Kenny’s Bill allows for euthanasia in cases where “it is not possible” for the patient to administer themselves lethal drugs. 

Such actions are expressly forbidden under both the Death with Dignity Act implemented in Oregon in 1997 and the similar proposals of Dignity in Dying.

A host of other provisions illustrate the extremity of the Dying with Dignity Bill even among the radical company of Oregon and Dignity in Dying.

The Oregon law defines terminal illness as expected “within reasonable medical judgement, produce death within six months”. 

In contrast, the Bill before the Irish Parliament lacks any time limit for terminal illness, only requiring that the patient be ‘likely to die as a result of that illness or complications’ at an unspecified stage.

Whereas Oregon patients supply both written and oral requests for lethal drugs, Kenny’s Bill reduces the procedure to only a single written declaration. 

Similarly, only one witness would be needed to sign off on patient declarations under the radical Irish proposal as opposed to two witnesses under the American legislation of much longer experience. 

Unlike in Oregon, Kenny’s Bill does not stipulate that the patient be recommended to inform their next of kin of their decision.

Under the ‘Dying with Dignity’ Bill, the waiting period between a patient’s declaration to end their own life and the prescription of lethal drugs reduces from fourteen to six days in cases where death from a terminal illness is deemed likely to occur within a month. 

In contrast, the Oregon system of assisted suicide only collapses the 15-day waiting period if death from a terminal illness is likely to occur within that period.

Whereas the Death with Dignity Act in Oregon insists that any informed decision must involve consideration of “feasible alternatives, including, but not limited to, comfort care, hospice care and pain control”, Gino Kenny’s ‘Dying with Dignity’ Bill fails to detail the mandatory information for patients beyond the simple mention of “the available choices”. 

Perhaps most strikingly, the ‘Dying with Dignity’ Bill makes no reference to the possibility of psychological or psychiatric evaluation in case of potentially impaired judgement on the part of the patient. This represents a disturbing distinction with Oregon where the physicians are obliged to refer such patients for counselling.

‘Wrong in principle’

The latest proposal to allow assisted suicide has been criticised by palliative care doctors, geriatricians, politicians and pro-life campaigners.

Columnist and head of the Dublin-based Ioana Institute, David Quinn, condemned the Bill for being both “wrong in principle” and for having “incredibly far-reaching” proposals which go further than other countries that allow assisted suicide.

“For example, the definition of ‘terminal illness’ is so broad it could include dementia. It does not require that a person be within a set period of death such as six months. Therefore, the person could be in the early stages of a terminal illness with years of life remaining and still ask a doctor for a lethal drug. They only have to make the request once,” he told Crux.

No proper protection for conscience rights

In addition to David’s concerns, the bill would force healthcare professionals who have a conscientious objection to assisted suicide to make “arrangements for the transfer of care of the qualifying person”, a form of participation that goes against an individual’s conscience rights.

This is especially worrying for the hospice movement, which cares for patients near the end of their lives and is philosophically opposed to euthanasia.

In stark contrast, the archetypal Death with Dignity Act in Oregon does not require healthcare professionals to transfer such patients but only to transfer their records once the patients have themselves located a new provider.

‘A better option’

Professor Anthony O’Brien, a Clinical Professor of Palliative Medicine at University College Cork with over 35 years of experience in hospice care, has spoken out against the Bill, telling The Irish Times:

“I have met very many patients who in desperation asked to have their life ended, believing that they had no other option. With good palliative care, the overwhelming majority had occasion to change their minds. With suicide, there is no going back.

“Surely a compassionate society can be more creative in its response to human suffering than premature, self-inflicted death. Good care is always a better option.”

‘Regressive step’

Hope Ireland, a coalition of healthcare professionals and disability rights advocates, says the introduction of assisted suicide and euthanasia is a “regressive step for vulnerable people – particularly the elderly and those with disabilities”.

In their briefing document, which was sent to all of Ireland’s TDs, they highlight how the operation of similar laws in other countries have shown the consequences of legalisation are “catastrophic” for older people and people with disabilities.

For example, they state:  “In 2019, a woman with dementia who revoked her consent to be euthanised had to be held down by her family whilst the doctor ended her life. A Dutch court approved this practice, and acquitted the doctor of any wrongdoing.”

Negative culture change

Peadar Tóibín, the leader of the pro-life Aontú party, has warned that in countries that have introduced physician-assisted suicide or euthanasia, “pressure starts to grow on older people and people with severe disabilities.”

So much so that countries such as Canada, Netherlands and Belgium have seen the number avail of assisted suicide radically increase,” he told News Letter.

“These countries initially introduced assisted suicide for a small number of really difficult cases but have now seen the numbers increase nine and ten-fold. Requests for euthanasia are extremely rare before it’s made legal but radically increase when the culture changes,” Tóibín continued.

He also said the bill could “radically change” the direction of the medical profession from the saving of life to ending it.

“We urge the government to assist people with living. To invest the necessary resources to ensure that people who are faced with difficult death have all the supports that they need to make for final journey as comfortable and pain free as humanly possible. We need to improve our palliative care and our health service but euthanasia is not the solution to the failings in our health system,” he said.