Don't get depressed in Oregon

By Susan Martinuk

(3 March 1999) — This article is reprinted from the National Post, March 1, 1999

Two basic tenets that underlie arguments to legalize euthanasia and physician-assisted suicide are an individual's right to self-determination and the easy establishment of safeguards to regulate these practices.

Such arguments give rise to idealistic notions that death can come in a neat package at the time and place of an individual's choice and that the legalization of these practices would not threaten the lives of others. But a recently published study suggests such thinking is not only false, but naive. A survey of Dutch doctors, published in the Journal of Medical Ethics, shows the strict safeguards that govern the practice of euthanasia in the Netherlands are routinely ignored and patient autonomy is often cast aside.

In 1995, a full 20% of euthanasia cases occurred without the patient's explicit request.

Almost two-thirds of all cases went unreported and other therapies were available in 17% of cases. Each of these findings contravenes the guidelines that supposedly control euthanasia and led the report's authors to conclude, "Dutch claims of effective regulation ring hollow."

This comes as no surprise. The study confirms data from an earlier investigation, The Remmelink Report, which found more than half of euthanasia cases go unreported and that at least 1000 cases of euthanasia occur each year without a formal request from the patient.

So much for the idea that euthanasia is an expression of individual autonomy and that its practice can be effectively controlled by strict regulations. Instead, it appears doctors, not patients, are the ones who gain the power to make the final determinations about if, and when, a life is ended — and they then shuffle the paperwork to cover up their actions.

Voluntary euthanasia has been available in Holland since 1984, and while it is not technically legal, the courts have agreed to "look the other way" as long as doctors follow the established guidelines. Doctors who don't follow the rules can face criminal charges.

But the very nature of guidelines requires that doctors be willing to submit to them, and that apparently isn't the case in Holland. According to Dutch regulations, euthanasia is only to be used in cases of "unbearable suffering." But the study states that pain is rarely the cause for the request. Fifty-six percent of doctors said the main reason was "loss of dignity" and 47% said they wanted "to prevent further suffering." This led the researchers to state, "it must surely be doubted whether either of these reasons, by itself, satisfies the requirement of unbearable human suffering."

Recent events in Oregon provide us with further evidence that strict guidelines to control euthanasia are virtually meaningless in practice. According to the media, one of the first people to undergo an assisted suicide under that state's new law experienced a "peaceful" death and advocates were quick to express their admiration for Oregon's "progressive" euthanasia law.

But evidence now suggests the guidelines were also broken in the pursuit of this dignified death.

According to Oregon law, patients can be legally granted their death wish only if they are within six months of death, mentally competent, and have the approval of two physicians. The first two physicians whom the woman consulted refused her request, with one doctor stating she was suffering from depression, not pain. But a suicide advocacy group leaped to her rescue and quickly referred her to a physician who was willing to make her death wish come true.

So much for the safeguards that were supposed to prevent doctors from helping "depressed" patients take their lives. So much for the airtight regulations that were supposed to protect patients from being easily manipulated by others in their quest for an easy death. And so much for the stringent controls that were to protect patients from overzealous doctors. Having to obtain the consent of two physicians doesn't amount to much protection when a patient is able to keep shopping around until they find a doctor who is willing to grant their request.

A regulatory board exists, but it only hears about cases after the fact — which obviously limits its capacity to "regulate."

The above evidence clearly casts doubt on the idea that euthanasia and assisted suicide can be controlled with carefully thought-out guidelines. In Holland, and now in Oregon, the process has been shown to be seriously flawed. Canadians are fools if we think that we can do any better.