Euthanasia: What could possibly go wrong?

The following article was written by Margaret Wente and published in  on February 20, 2014.The Globe and Mail

Margaret Wente

Stop Québec's euthanasia Bill 52

Margaret Wente

On April 19, 2012, an attractive 64-year-old woman named Godelieva De Troyer checked herself into a hospital in Brussels, where she was killed, at her own request, by lethal injection. The retired schoolteacher did not have an incurable disease, nor was she in chronic pain. She wanted to die because she suffered from chronic depression. She found a psychiatrist who agreed. Her family was not informed in advance. Her son, Tom Mortier, found out about her death the next day when he was summoned to deal with the paperwork.

Mr. Mortier is now a passionate opponent of Belgium's euthanasia law, which has been gradually broadened since it was introduced in 2002. He has a warning for Canadians: Beware the slippery slope. What happened to his mother "has nothing to do with humanism," he said recently in Quebec, where he held a press conference. "This has nothing to do with taking care of a human being. 

Bill-52-GrandmaRight now, though, not many of us are listening. In Canada, support for right-to-die laws is very strong, especially among the enlightened elites. Quebec's Parti Québécois government is trying hard to pass its own law this week, before an expected provincial election. It would be by far the most liberal in North America, because it would legalize not just physician-assisted suicide (which is already legal in several U.S. states) but also voluntary euthanasia. 

How can reasonable people possibly oppose laws that offer death with dignity? Who can forget the tragic case of Sue Rodriguez, trapped in a failing body but unable to relieve her own suffering? Or the impassioned plea of SARS doctor Donald Low, who was diagnosed with an incurable brain tumour? "I wish they could live in my body for 24 hours," he said in a video statement a few days before he died. Such people cry out for our compassion. Most of us have witnessed suffering that went on too long, and we want no part of it. 

But what has happened in Belgium and the Netherlands (two of the most liberal, progressive countries in the world) might make you want to think again. 

When those countries introduced right-to-die laws, everybody had a clear idea what they meant - or thought they did. The laws were meant for cases of unbearable suffering from incurable illnesses, such as terminal cancer. Euthanasia would be permitted only under tightly controlled circumstances, with careful oversight and close consultation with the patient and family doctor over a long period of time. 

It hasn't quite worked out that way. Physicians are now killing people they have barely met. Some of these people have psychological and psychiatric disorders, such as anorexia or depression. 

In 2012, 42 people with dementia and 13 people with psychiatric problems were medically killed in the Netherlands. A service launched by a right-to-die group has 30 mobile teams that make house calls to people who want to die but whose family doctors may be unwilling to participate. One of the people its staff put to death was a 63-year-old man who had no friends or family and couldn't face the prospect of retirement. Another was a 54-year-old woman with a pathological fear of germs. "I couldn't understand it at first," Gerty Casteelen, one of the clinic's psychiatrists, told the media. "It was a long process. I came to understand that her fears completely controlled her life. All she could do was clean. It was impossible for the patient to maintain a relationship. Her whole development stalled." 

Clinic director Steven Pleiter told the Daily Beast, offering psychiatric patients the option of assisted suicide is important. The group also believes that assisted death should be available to anybody over 70. 

Even Boudewijn Chabot, a pioneer of the Dutch euthanasia movement, thinks things have gone too far. "The legislation is off the rails," he told a Dutch TV program last month. 

Last week, Belgium passed a law extending the right to die to children who meet the criteria and request it. Advocates insist that the criteria are very strict, and that the law will never be abused. Still, a number of Belgium's pediatric doctors are opposed. How can we know if a child understands what's at stake? How can we know if they are making a decision based on what they think their families want? 

In fact, a minority of people who request death do so because of unbearable pain, says bioethicist Ezekiel Emanuel in a blog post. They request it because they're afraid of what the future may hold, or of losing control. They may be sick and tired of living with illness. They think they're a burden on their families. Or they are seriously depressed. 

Are these reasons really compelling enough to help them die? If so, then several people I love dearly might be dead before their time. As Balfour Mount, the pioneer of Canadian palliative care, has said, "Legalizing euthanasia places at risk the most vulnerable among us, the elderly, the handicapped, those unable to speak for themselves, those who feel they're a burden to their loved ones." 

Of course, maybe we won't turn out like the Belgians or the Dutch. Maybe we will act with incredible humanity and restraint. Or maybe not. Personally, my hunch is that our ethical dilemmas are only beginning.