Dutch doctors feel pressure to euthanise

We know that laws allowing euthanasia and assisted suicide fundamentally change the therapeutic relationship between doctors and their patients. You cannot remove the prohibition on doctors killing their patients without serious consequences.

A new study has looked into the impact of legalised euthanasia on doctors in the Netherlands, where the practice has been legal for almost 20 years. The study has uncovered some alarming results.

The authors looked into the question of what kind of pressure GPs experience when it comes to requests for euthanasia. The fact that they do experience is not disputed: a previous 2014 survey had found that 70% of doctors experienced pressure to grant a request for euthanasia and 64% of them felt an increase in this pressure over the years.

There were 6 categories of pressure identified as having been experienced by the GPs who were interviewed for the study.  The study excluded those doctors who have a principled objection to euthanasia, and also those doctors who have had no experience with euthanasia.

The categories included:

  • Emotional blackmail (where the patient threatened to commit suicide themselves if the doctor wouldn’t agree to the request, or a family member threatened to kill them instead);
  • Where the patient takes control and won’t take no for an answer (an example given by one of the doctors was where the patient declared “I have made up my mind I want it [euthanasia] after my birthday, because I still want to celebrate my birthday”)
  • Where the doctor had doubts about whether the patient fulfils the criteria, and needed multiple meetings with the patient to satisfy themselves that the patient’s complaints of “increasing dependency and loss of control” was enough to fulfil the criteria, but felt forced by the patient to make it “too soon”;
  • Counterpressure by the patient’s relatives; the difficulty experienced by doctors when the patient’s family members have conflicting views about whether euthanasia should be provided or not;
  • Time pressure around referred patients (where the doctor has not had time to develop a trusting relationship but feels pressured to continue with processes already begun with other doctors); and
  • Organisational pressure, where doctors described the difficulty of combining euthanasia cases with their day to day work, and the toll it takes on them personally.

The stories relayed by the GPs are disturbing:

“If you do not help me this week I will have to jump.”

“Even after the decision to grant the euthanasia request a GP may feel herself ‘entering a theatre play’ on the day of the euthanasia. ‘The whole table was surrounded with friends who were smoking and drinking. On the table lay all sorts of jewelry that were to be divided; whether K [trainee GP] and I [GP] would want to select a nice necklace as well?”

“Another GP described his unpleasant feeling when the patient who was about to receive euthanasia opened the door himself and led the GP into the living room which was full of people as if it was a birthday party: ‘Everybody had a glass of wine in his hands, while I was preparing the euthanatica’”

There are good reasons that the medical profession is overwhelmingly opposed to euthanasia. Around the world, 107 of the 109 World Medical Association’s constituent medical associations are opposed. They know that euthanasia and assisted suicide should never be incorporated into the practice of medicine.  This latest study provides further data on the negative impact the practice is having on the profession, and what happens when euthanasia is framed as a patient’s ‘right to die’. Autonomy becomes king and the doctor’s role is reduced to that of legal and practical enabler of their patient’s suicide.