'Unthinkable in the beginning' the dynamics of euthanasia laws

by Paul Russell:

In a recent interview for a Portuguese television network, Dutch Professor Theo Boer gave, for mine, the clearest explanation yet of the situation in both Belgium and The Netherlands.

The interview opens with Boer giving an overview: "For a considerable number of people, euthanasia has become part of their lifestyle; it has to do with controlling your destiny. In the beginning euthanasia was seen as a last resort in a situation of extreme physical suffering. Now, increasingly, euthanasia is considered to be a patient's right and is considered by some even to be a fashionable death."

This from a man who not only once supported the Dutch euthanasia laws and who, for many years until 2014, was also a member of one of the Dutch Regional Euthanasia Evaluation Committees overseeing the practice of the law. "I was also relieved that I could quit because, in the last couple of years (I quit in 2014) I had considerable problems with my conscience because I saw that people were being euthanized in cases where, in my opinion, it was not necessary."


Earlier in the interview Boer laid out some of his observations: "Not only the numbers have gone up considerably but also the reasons why people want to have euthanasia. For example: two people - lovers - where one person dies of cancer, the other person (who is care dependent) also wants to die. Or people who have autism; people who have blindness, or people who have dementia, or psychiatric problems - those were unthinkable in the beginning."

Boer summarises: "Once a law has been established it will create its own demand, it will create its own dynamics; which means that, in The Netherlands, at this moment, there is still an enormous pressure to liberalise further. For example: to have euthanasia for old people over 70 who want to have their lives ended."

Juxtaposed to Professor Boer in the documentary is Dr Marc Van Hoey; a Belgian doctor and leading euthanasia activist.

 The vision is taken from the documentary by the Australian SBS network, Allow Me to Die first screened in September 2015 where, amongst other stories, we see Van Hoey assisting in the death of an 85 year old woman via assisted suicide. Simona de Moor was physically well and on no medication but was grieving at the unexpected death of her favourite daughter only months previous.

As Van Hoey himself acknowledges, the de Moor case has been referred by the Belgian Euthanasia Evaluation Commission to the judiciary for further possible action against him. This is the first such referral since the law came into effect in 2002. The first in something like 8000 reported deaths.


Van Hoey discusses his treatment of Simona de Moor with SBS journalist, Brett Mason (note: this is prior to de Moor's death):

Van Hoey: "I started with the medication; with the treatment. She took it for a few weeks or months; but here request (for euthanasia) is still going on. So, she doesn't want to die because she is depressed, no. She wants to die because she has had it. See the difference?"

Brett Mason: "In medical terms what is the official cause of Simona's unbearable suffering?"

Van Hoey: "Reactive depression, certainly."

Mason: "As a result of her daughter's death?"

Van Hoey: "Yes, and I will mark that on her death certificate, it's a natural death; euthanasia IS a natural death. And then the second step will be, untreatable depression; the next line will be the death of her only daughter."

Van Hoey is playing games with Mason and with the audience. He responds instantly and even keenly to Mason's question about de Moor's unbearable suffering saying defining it as arising from, 'reactive depression.'

Reactive Depression is described as: 'a subtype of clinical depression or major depressive disorder. It is also sometimes called an adjustment disorder with depressed mood, and is characterized by a depressed state in direct response to an external event. The subsequent depression tends to be mild to moderate, and typically will not persist beyond several months after the stressful event.'

Psyweb adds that stressful events can include, 'everything from the death of a family member, loss of a job, children moving out, or any of life's other constantly shifting events. These are distinct from grief events, although certain stressors, like the loss of a loved one, will overlap.'

Symptoms can be, 'characterized by feelings of hopelessness, worthlessness, and sadness. Additional symptoms might include anxiety, weight fluctuations and eating disorders, irritability, memory problems and difficulty concentrating. In extreme cases, it may be accompanied by somatic symptoms like pain, headaches, and digestive problems. Serious warning signs include drug and alcohol abuse, and suicidal thoughts or behaviours.'

A significant problem, clearly, but as this descriptor and every other I read online makes abundantly clear such depression, typically will not persist beyond several months after the stressful event; in this case, the death of de Moor's daughter. Even if de Moor's reactive depression was severe and persistent there were clearly other options available such as continuing treatment and seeking a reconciliation for de Moor with her other, estranged daughter. And, given the diagnosis, there should have been every reason to expect that this fit and capable 85 year old lady would have made a full recovery.

That brings me to the question of the official cause of death - what doctors are charged to write on the deceased's death certificate. In a number of bills in Australia in recent history and also, I believe, in Oregon, doctors were directed not to note the cause of death as being euthanasia or assisted suicide.

The Belgian law says: Any person who dies as a result of euthanasia performed in accordance with the conditions established by this Act is deemed to have died by natural causes for the purposes of contracts he/she had entered into, particularly insurance contracts. (Section 15)

'Natural Causes', but only in relation to 'the purposes of contracts' such as insurance. If the reverse were the case; that is to say, if euthanasia or assisted suicide were listed as the cause of death and if insurance companies, in particular, were not required to pay on a claim in those circumstances, I could accept such a clause as an attempt at a 'safeguard'. I am not advocating that, by the way. But the reference to 'natural causes' in the Belgian law cannot be taken to mean that 'euthanasia is a natural death'. Far from it.

Van Hoey is fudging here. Although, with the broad acceptance of doctors killing patients in Belgium and The Netherlands to the point where, as Professor Boer suggests, it is now seen as a 'right', it may well be that citizens in those places are becoming so blasé about such practices that what becomes common becomes, perversely, natural.

Regardless, Van Hoey does seems to be in a little hot water over Simona de Moor's death. The Belgian euthanasia establishment has been growing increasingly annoyed at the negative attention of the international media in recent years. The referral to justice of the de Moor case by the Belgian Euthanasia Evaluation Commission seems to be a response to this negative media and unwelcome scrutiny. It is certainly not about the commission considering that her death was outside the law. There have been many other deaths over the past few years that, if that were the case, should have been referred in a similar manner.

Whether making Van Hoey an example in the face of exposure by the Australian SBS Network is or is not the primary consideration, Van Hoey's strongest criticism, it seems, was that he did not conduct the euthanasia 'carefully'. He did not get an additional opinion as required by the law where the illness or condition is not terminal. As Tom Mortier observed:
'Although the Belgian euthanasia law states that a psychiatrist should give advice (not necessarily approval) in the case of a non-terminal illness and a third doctor should be involved in the euthanasia procedure, Van Hoey said that these other doctors were not needed.'

So, even the fact that any opinion provided by another doctor need not agree to the euthanasia request, Van Hoey did not comply. 'Careful' euthanasia is not so much about whether the person should or should not be killed, rather, it is principally about ticking all the boxes. And while, potentially, Van Hoey could face a homicide charge, I think it highly unlikely. As Van Hoey himself observes, such an action would send shock waves through the Belgian medical profession.

So, why are the Belgian's so concerned with being 'careful'? Simple: doing it 'carefully' provides immunity from prosecution for the doctor. Whether the person could have benefitted from further treatment of any kind and whether or not they were suffering from a depression is not really considered. As Van Hoey confirms elsewhere in the video, it really is the person's choice; little else seems to matter other than having something to put on the death certificate in addition to noting a 'natural death'.

When people think of euthanasia, more often than not they will be imagining that the law is for some very hard case, where the person has tried every remedy and where desperation drives them to ask to be killed. Even if that was how people thought in Belgium and The Netherlands when the law was debated nearly 15 years ago, it is clearly now not the case. What was 'unthinkable' was, in hindsight, perhaps inevitable.