Legal euthanasia in the Netherlands has “turned the whole landscape of dying upside down,” a Dutch ethicist has warned the Oireachtas Committee on Assisted Dying, highlighting the quadrupling of such deaths in the country in the space of the last two decades.
During a Joint Committee hearing on Tuesday, Professor of Healthcare Ethics, Theo Boer said that the numbers of deaths by euthanasia are “rising significantly year after year” in his home country, as he warned Ireland of his concerns around legalising the practise here. The bioethics professor helped review euthanasia cases in the country from 2005 to 2014.
He said that assisted deaths as part of an increasingly “permissive, cynical and sometimes desperate system of end-of-life decisions.”
The committee, formed in January, is currently in the process of considering legislative and policy change relating to the right to assist a person to end his or her life legally in Ireland.
Speaking to the committee on Tuesday, Professor Boer said that the legalisation of euthanasia in the Netherlands has “turned the whole landscape of dying, including our view of illness, suffering, ageing and care dependence, upside down.”
“Ageing and dying increasingly become a life project, a task to be managed,” the euthanasia expert added.
Euthanasia was legalised by the passing of the “Termination of Life on Request and Assisted Suicide (Review Procedures) Act” in 2001, with the law coming into force in 2002. Since the passing of the legislation, euthanasia has become a more common way to die; In 2020, one in every 25 people died by euthanasia in the European country, with an rising number of requests coming from those who are not terminally ill.
In 2022, the numbers dying by euthanasia increased by almost 14 per cent, and included 29 couples who died together.
There were 8,720 such deaths last year – over 5 per cent of all mortality in the country. 115 cases involved those with severe psychiatric illness, a number which remained the same as 2021.
Speaking before the Oireachtas Committee, which is being chaired by Michael Healy-Rae TD, Prof Boer pointed out that the Netherlands has spent half a century debating and regulating assisted death. He told TDs and Senators that he personally has switched from being moderately supportive of the Dutch euthanasia law to being “increasingly critical” over time.
From 2005 through 2014, the ethicist was a member of a Dutch euthanasia review committee and on behalf of the Dutch Government, reviewed a total of 4,000 cases.
“The numbers I refer to in this contribution are not contested,” he stated, adding that they are accepted as being “empirically right.”
The professor, who denied that he is categorically opposed to the practise – and says he can see euthanasia as “reasonable” in some cases – said that when the practise was first legalised, the Netherlands experienced years of “relative stability and increasing transparency” in the early 2000s. This, he said, “made us all very happy.”
However, he warned, “The numbers are now rising significantly year after year.”
“In the past 20 years, the numbers have quadrupled and […] the increase seems to accelerate rather than slow down. In some neighbourhoods assisted deaths account for between 15% and 20% of all deaths. The reason the average is still at a relatively low 5.2% nationally is that in some predominantly rural areas the percentage is well under 2%, but here too we see it catching up,” the Protestant theologian said.
He said the country has seen an expansion of the pathologies – the reasons underlying a request to die.
“From patients who dread spending the last days or weeks of their lives in pain and agony and afraid of choking, the category of patients that once was the most important reason for assisted dying advocacy in my country in the first place, and which I think still is in Ireland and Great Britain, we see a shift to patients who fear years or decades of loneliness, alienation and care dependency.
“In the Netherlands, as in other countries that have legalised assisted dying, this expansion is motivated – this is important for the committee, as Members of Parliament, to take into account – by a logic of justice, the question as to why euthanasia is provided only for terminal patients, for example? That is the question that was asked in Canada, which expanded euthanasia to patients with chronic illnesses too.
“Why only permit assisted dying for those suffering from a physical illness or people suffering from an illness rather than anyone in unbearable and irremediable suffering? After all, a person can suffer very much for non-medical reasons as well.”
He said that is why the Netherlands now has a law in parliament that legalises euthanasia for all people over 74 years, with or without an illness.
“Their age is the only reason they can have assisted dying,” he continued, while highlighting new regulations that will broaden euthanasia rules to cover children of all ages:
He also referenced the country’s decision to expand euthanasia to children of all ages. The broadening of the law, announced in April, would apply to children of all ages who “suffer unbearably” and “have no hope of improvement,” the government said.
“That in turn is why we now have a regulation that allows parents to request euthanasia for their young children aged from zero to 11 years old. I am convinced it is only a matter of time before we take the next hurdle, namely, allowing children of dementia patients to request euthanasia for their demented parents,” Prof Boer told the committee.
He pointed out that his own church had supported introducing euthanasia, and that his opposition, rather, stems from what he has seen happen since the practise became legal.
“A third misunderstanding is that my scepticism stems from my Protestant background. Interestingly, it does not,” he told TDs.
“My church, the Dutch Reformed Church, is a liberal church and it was the first worldwide to support assisted dying back in the 1970s. In the 1980s, about 80% of all its vocal supporters were Reformed ethics professors, politicians and physicians. My critique arises from what I have seen happen in practice.”
Prof Boer also told politicians that there are legal concerns around the practise, saying it is something which is “impossible to police” when it comes to law-breaking.
He referenced a Dutch case where the legitimacy of a signature requesting euthanasia was questioned, and from which saw ethics committee take a step back as it did not have the power to criminally investigate its concerns.
“When the doctor was asked ‘are you sure that this signature is the signature of the patient’, the doctor said ‘I was told that it was’.
“So, in the end, we backed off,” Prof Boer said.
He added: “Once you have a law […] it is absolutely impossible to put a police officer in every hospital room or in every bedroom […] and look [for] some silent pressure,” he said.
“That is impossible, because that will infringe very much on the privacy of their patient-doctor relationship so there is no solution,” Prof Boer said.
He concluded by warning that the legalisation of euthanasia has done “much more than just providing some citizens the liberty of taking a way out.”
“It has turned the whole landscape of dying, including our view of illness, suffering, ageing and care dependence, upside down. Ageing and dying increasingly become a life project, a task to be managed.
“As members can see, in the slipstream of legal euthanasia the percentage of people dying through terminal sedation has skyrocketed in the past 20 years. It was up to 25% of all deaths last year, whereas in most other developed countries that proportion is well below 2%. The committee’s considerations and upcoming decisions are among the most consequential a parliament can ever make.”
He added: “I sincerely hope the Irish Parliament seriously weighs all these experiences.”