Half do not agree to die, June 11, 2010

The following article from The Telegraph appeared in The Age, commenting on research on the Belgian assisted dying bill. The article reflects the view from the UK anti-euthanasia group, Care Not Killing.

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ALMOST half of deaths by euthanasia in Belgium have involved patients who did not explicitly request that their lives be ended by a doctor, a study has suggested.

A fifth of nurses interviewed by researchers admitted they had been involved in the euthanasia of a patient based on the ''assumption'' they would want to die.

Nearly half of the nurses - 120 of 248 - admitted they had taken part in ''terminations without request or consent''.

Euthanasia has been legal in Belgium since 2002. It accounts for 2 per cent a year of deaths. The law states that the patient must consent and that doctors must carry out the procedure.

But the study, published in the Canadian Medical Association Journal, shows that rules are routinely flouted and doctors often delegate the administering of fatal drugs to nurses.

The study states: ''By administering the life-ending drugs in some of the cases of euthanasia, and in almost half of the cases without an explicit request from the patient, the nurses in our study operated beyond the legal margins of their profession.''

Dr Peter Saunders, of anti-euthanasia charity Care Not Killing, said: ''We should take warning from this that wherever you draw the line people will go up to it and beyond it.''

Reported in The Age

Just a note on the Canadian Medical Association Journal article on euthanasia without explicit request in Belgium. There are several things that The Age article does not note, and concentrates on the sensational. It is important to note that the article is not a criticism of Belgium's euthanasia laws. In fact, there is no sign in the report that, in the opinion of those doing the research, the euthanasia laws should not continue in force. Indeed, the research was in fact a process of monitoring how effectively the law regarding euthanasia was being followed. The main recommendation is that advance planning should in most cases take place to avoid situations where assisted death without request may seem the humane thing to do.

The number of assisted deaths without request in Belgium has actually declined. They occur mainly in the Flemish speaking parts of Belgium, and (the report suggests) have to do with the traditional patriarchal nature of Flemish society, and the patriarchal practice of Flemish doctors. The cases involved patients who were either comatose or suffering from serious dementia, and most were over 80 years old. Discussion was usually held with relatives, and in a number of cases with patients before their unexpected and rapid decline. The shortening of life was very limited, usually less than 2 days. The patients concerned were usually admitted to hospital for diseases other than cancer, the trajectory of whose diseases was not as predictable (as known types of cancer, for example). At the start most of the treatment was aimed at cure, and the decline was often rapid and unexpected. In many cases, according to the study, the assisted death was carried out by means of opioids, in many cases at dosages which did not, in the opinion of the research team, actually contribute to the death of the patient.

In its conclusions the research team suggests that these cases point out the importance of advanced planning with regard to people's last days, but it would be fair to say that in the cases noted the report does not suggest serious misdoing. The actions proceeded on the basis of humane concern, and the headline in The Age is entirely misleading. It is not that "Half do not agree to die", for these patients were in no condition to agree or disagree. The headline suggests that involuntary euthanasia took place, that is, euthanasia against the wishes of the patient. This is not the case. These were cases of non-voluntary euthanasia, and in most cases family members were consulted before proceeding with assistance. In many cases, because the effects of opioids is often not well understood by some medical practitioners , dosage was not higher than was necessary to relieve the patients' pain, and the assistance did not really amount of euthanasia at all. Indeed, the report states: "This suggests that the practice of using life-ending drugs without an explicit patient request in reality resembles more intensified pain alleviation with a 'double effect,' and death was in many cases not hastened."

The response of the spokesperson for Care Not Killing in the UK is completely at variance with the findings of the report. It is not that people will go beyond the line. It is probably that doctors in Belgium were doing this long before the euthanasia laws came into force, and it is only now that this general practice is declining, not increasing, as the newspaper report falsely suggests.

By Eric S. MacDonald.