August 5th, 2017

The slippery euthanasia slope in the Netherlands

Euthanasia has been legal in the Netherlands since 2002, and since then the incidence of such deaths has risen to become 4.5 percent of all deaths. What’s more, the number of people availing themselves of this form of death who are not otherwise terminal has increased, as well.

Unsurprising. Disturbing.

The vast majority – 92 percent – had serious illness and the rest had health problems from old age, early-stage dementia or psychiatric problems or a combination. More than a third of those who died were over 80.

Requests from those who aren’t terminally ill still represent a small share, but have been increasing, Van der Heide said.

“When assisted dying is becoming the more normal option at the end of life, there is a risk people will feel more inclined to ask for it,” she said.

About 8 percent of the people who died in 2015 asked for help dying, the review showed. Van der Heide said about half of all requests are approved now, compared with about a third in previous years.

Not only is it a slippery slope, but it’s an exceptionally difficult issue involving liberty. Should people be allowed to choose to die, and to have medical assistance in carrying out their wishes? A strict libertarian would probably say “yes.” Most religious people and most religions would probably say “no.”

It troubles me that many of the people doing this in the Netherlands seem to merely be depressed (although depression can be so bad that “merely” really doesn’t seem to be the correct word). We have a situation in which some depressed people are committing suicide with the help of doctors. This seems so clearly wrong to me that I would think it beyond argument, and yet it’s been going on in that country for quite some time.

[NOTE: I know a number of elderly people who had said for years that if they ever came to the point of being very compromised, either in body or mind or both, they would kill themselves. Several owned the book Final Exit and praised it highly (I believe that one even belonged to the Hemlock Society), and at least two had access to enough medication to perform the act without assistance. And yet, when both of them failed (in body more than mind, although there was a moderate amount of memory loss for both) at very advanced ages, neither did a thing to end their lives. Their everyday existence was very diminished, and there was even a fair amount of pain, but both of them elected to let fate determine the hour of their deaths.]

39 Responses to “The slippery euthanasia slope in the Netherlands”

  1. charles Says:

    “We have a situation in which some depressed people are committing suicide with the help of doctors.”

    Thank you! Thank you Neo for saying that.

    I’ve been having that exact argument with both those on the left and the right (on the right is mainly those who claim to be libertarian, so, technically, one might say that they aren’t on the “right”)

    And, they have always looked at me as if I’m stupid and claimed “well, people have the right to do as they please with their own body”

    But, your one sentence says it all – we ARE helping depressed people kill themselves with the aid of doctors. And, THAT does not speak well of any society that condones such behavior.

  2. Big Maq Says:

    “It troubles me that many of the people doing this in the Netherlands seem to merely be depressed” – Neo

    Seen some loved ones who changed dramatically near their end.

    It might well be that the elderly have a much higher incidence of depression than the rest of us? IDK.
    .

    There doesn’t seem to be a good way to take one’s imminent demise, and if mental and physical frailty significantly hinders (or makes near impossible) a “good quality of life”, it seems all the more understandable a collapse into depression, if not a desire for suicide (to die on their own terms, as they may see it).

    If one thinks it right to put down an animal because of its suffering, there is not much of a leap from there to the end of life issues people may face and their own desire to end suffering.
    .

    The serious problem seems to be in manipulating such people into a depression and desiring assisted suicide, or in taking advantage of such people (unable to fend for themselves) in some way to advance one’s own goals, rather than to advance the patient’s best interest.

    How one draws a line between those circumstances and the individual’s own choice, IDK.

    Looks like it could get messy and blurred rather quickly.

  3. huxley Says:

    A college friend who became a doctor told me it’s a dirty little secret that most MDs have helped someone die. She didn’t go into details and I didn’t ask.

    I once flew out with my girlfriend to her family’s for Thanksgiving and also to comfort her sister who was dying of colon cancer in the hospital. She was in great pain, then she died.

    My girlfriend sold medical infusion pumps for a living so she was chummy with doctors and nurses. She said the staff made sure her sister had lots and lots of morphine. Not enough to kill her but enough to make it easy for her to die, as well as alleviate pain.

    These are hearsay stories yet I suspect there is some truth to them.

  4. neo-neocon Says:

    huxley:

    My understanding of what usually happens is that, when a patient isn’t just “terminal” in the sense that he or she has something like six months to live, but when a patient is so bad that death is imminent within a few days or at most a couple of weeks, and pain relief or relief from a breathing struggle is needed, doctors prescribe morphine for pain relief or to ease breathing. This sometimes can have the effect of hastening death, but the goal is pain relief or breathing-struggle relief. It is very rare for a physician to euthanize a patient like these European patients—patients who are not that close to death, or who are not terminal at all—and to administer drugs like morphine with the sole purpose of killing them.

  5. huxley Says:

    neo: I understand the distinction.

  6. neo-neocon Says:

    huxley:

    But did she?

    I doubt most physicians have helped someone not terminal to commit suicide.

  7. miklos000rosza Says:

    I think long life-spans and bein a :survivor” has been pushed way past the point where it males very much sense. I’m not sure we’re designed to live to be truly elderly — and this may be true especially of those who have grown old without issue, that is, childless,,, often estranged or rather distant from any family that remains.

    I, for instance, have MS, which is, as they say, an “incurable, progressive disease.” I don’t have any children — the great sorrow of my life. My ex-wife and niece are both hardcore political lesbians who by now have noting to dp with heteronormative white males. They too are childless and determined to remain so.

    I can bear the MS, but the trend in care makes dealing with the medical much more demeaning and difficult than it was even just five years. I was hospitalized three times last year (each time because of a misadventure unlikely to ever recur — such as a fall off a porch down onto cement wherein I suffered non-displaced fractures of eye-orbit and cheekbone, on another occasion an accidental overdose of a prescription med I’ve been taking for fifteen years) and each hospital stay was so hellish compared to others in the past that I now feel like I understand the sheer awfulness of third-world hospital conditions up-close-and-personal more vividly than I would ever wish on any reader of this post. I went into “survival mode”… and I survived.

    For one instance, pain medicine was ordered down in ER, and a young doctor down there put her hand on my arm and “We’ll take care care of you,” but then up on the ward the order had been received somehow and wen I finally asked about something for pain the nurse treated me as though I was a drug-seeking addict. This was with my broken face swelling like a balloon. An obese nurse’s came and sat in my room, turned on an NBA playoff game, volume cranked up, and watched it for 45 minutes while commenting on all the action. I asked a new nurse about something and had to overcome her disbelief that I had not already received an injection of Dilaudid. Finally a resident who looked about 19 came in, apologized profusely, and I was given some pain-medicine into my IV. It almost didn’t matter by then.

    I won’t continue to play the violin with such minutiae.

    In any case, I can well understand reaching a point of “Enough!” even if I don’t have Stage 4 Esophageal Cancer diagnosed. I have a project I’f like to finish, and one of my books is possibly being made into an HBO tv series, but what will either of those really mean? And either or both could definitely be subect to the kind of misfortune that I’ve experienced over and over in the artistic (no — entertainment!) world in the past.

    Sometimes to exit, Stage Left, is neither dishonorable nor the result of anything but realistic, objective appraisal by the subject who goes away. It’s not even nihilistic. Life is beautiful. It’s unfair, but who other than a teenager believes it has ever been fair?

  8. Ann Says:

    It all starts with “luv”. Never did “the road to Hell is paved with good intentions” seem more apt.

  9. Griffin Says:

    Neo:

    What you describe is almost exactly what happened with my father at the end. Was sort of strange as a lot of words like make him ‘comfortable’ were used when everybody knew what was going on. And nobody in our family thought of it as euthanasia either.

  10. F Says:

    Both of my sisters were diagnosed with incurable/terminal health issues, one massive cancer, the other liver failure.

    The cancer patient went home to her physician husband and family, where she was put on a morphine drip. I arrived after medication had reached the level where she was no longer conscious, and that progressed over the space of several days to the point where she could no longer breathe. She went peacefully, in the sense that she was not agitated — merely heavily sedated.

    The liver failure patient was in ICU when the family called. I arrived after she was no longer conscious either, but given the state of American medical care today it appeared she could survive a long time sedated but on a ventilator. The hospital staff said the family had to decide what to do — she could no longer “tie up” an ICU bed in a vegetative state. Her children decided they should disconnect the ventilator. They did so after giving her a massive dose of morphine, and we sat with her as she breathed her last. It was the morphine that suppressed her breathing reflex, not the liver failure that killed her.

    Those were sad passings, but in both cases it was obvious their physical being could not continue to survive. And in both cases, it was morphine that led to respiratory failure. These were “physician-assisted” passings, I guess, but not suicide and not an alternative to living a few more months or years, which neither one of them could have done.

    As I progress in years I feel ever less troubled by physician-assisted suicide. It’s trite to say, but death waits us all and we don’t know when it will speak our name. Are we wrong to welcome it’s cold embrace? Hmmm. Twenty years ago I would have said yes. Now I’m less sure.

  11. neo-neocon Says:

    F:

    Sorry for your losses

    However, you write, “It was the morphine that suppressed her breathing reflex, not the liver failure that killed her… in both cases, it was morphine that led to respiratory failure.”

    I don’t know whether you are a doctor or not. If so, perhaps you know more about it than I do. But I learned a while back that, although patients and their families often perceive that’s what is happening (morphine causes the breathing stoppage), that is not usually the case.

    Please see this. I’ve read more or less the same thing elsewhere. I can’t find it right now and I’m in somewhat of a hurry at the moment, but a while back I read a lengthy and detailed explanation of the whole thing that convinced me that the morphine itself is calibrated in a way that death does not come from the morphine, although it’s understandable that families perceive it that way.

    I’m assuming that the relative you describe who was in liver failure and on a respirator was on a respirator for a reason, and that reason was that it was necessary in order for her to continue to remain alive a while longer. When she was removed from the respirator it is highly likely that that is what killed her (the lack of a respirator), and the morphine was administered to ease that passage.

  12. Tim Turner Says:

    “It might well be that the elderly have a much higher incidence of depression than the rest of us”

    Isn’t all medical suicide depression-based? If I were 90 years old, with no good years left, with aches and pains in every movement, and each hour was a toil, and there were no adventures or joys left in life… wouldn’t I be depressed? Isn’t that the reason the elderly kill themselves?

    It seems to me the difference is that some depression can be cured. That a doctor would prescribe cutting off my leg when a topical cream would do is a travesty of medicine. When a doctor prescribes death instead of a lifestyle change and a support group, that is also a travesty.

    I think this understanding is the critical distinction. Not that it is wrong for people to end it all, but that it is wrong to resort to it as a first option when there are better solutions available.

  13. neo-neocon Says:

    Griffin:

    Please see the comment I just wrote, addressed to “F.” And please read the link I gave there. It may change your mind. “Comfort” is not just a euphemism, and if administered properly the morphine is not the killer, although most families perceive it that way.

  14. neo-neocon Says:

    miklos:

    So sorry to hear how rough it’s been for you in recent years! I sincerely hope things improve.

    I think, though, that suicide and physicians helping suicide are two separate issues—both complex, but different.

  15. Griffin Says:

    Neo:

    It was the cancer that killed my dad not the morphine that is for sure. What I was referring to was the morphine definitely relieved the breathing difficulties that he experienced at the end and once that happened the end came shortly thereafter.

    My main point is I don’t think most people consider this euthanasia at all nor should they in most cases.

  16. F Says:

    Neo:

    Thank you for the link to the Canadian site. I am not a doctor, but my brother-in-law is. He was the one who said the morphine brought about death in the case of the sister with cancer. I will admit he is not in a specialty that would have seen a lot of death, but he is well read and certainly prepared for her death by reading specifically on that subject and talking to colleagues who would know.

    I trust his analysis.

    The other sister was being kept alive on a ventilator, with, we were told, no chance she could survive without the ventilator. The nurse who came in to remove the ventilator gave her what I would consider a massive dose of morphine just before removing the tube — about 5 ccs directly into her IV, IIRC. Which is not to say she could have continued without the ventilator, of course, merely that they wanted to ease any pain caused by the removal of the tube.

    “The last dose is the same as the doses the patient has previously received and tolerated,” according to the Canadian hospice site. I thought her last dose was significantly more, but I don’t know for sure. This was a decade or so ago, so there is no way I’ll ever know more. She just stopped breathing. She didn’t gasp, just took one last breath.

    They do make one good point: morphine is the last medication given, so families assume it was the cause of death. That is probably often the case. Perhaps I’m being uncharitable in my memory of her last minutes.

    Thanks again for your reply.

  17. Griffin Says:

    One last thing, I would say that in our case at least we all new when they started with the morphine they weren’t doing it so he would get better and that is what I meant when I said we all knew what was going on.

  18. neo-neocon Says:

    Griffin:

    I see what you’re saying.

  19. neo-neocon Says:

    F:

    You’re welcome.

    I will add that if your brother-in-law, although a doctor, doesn’t know much about this particular area of medicine, than his opinion may not be particularly well-informed.

    Also, when death from morphine overdose occurs, breathing does NOT typically end suddenly, boom. It typically slows down a lot for quite some time before it ceases.

    You might want to take a look at this article, too.

  20. Ed Bonderenka Says:

    “Don’t Go To The Doctor”
    http://wmbriggs.com/post/22358/

    Scary Stuff.
    “For those who might not have been paying sufficient attention, let me repeat that. Terminations of life without request.

    “Doc, this hangnail has really been bothering me. Can you do anything about it?”

    “Hmm. When you say ‘bothering’, do you mean mental distress?”

    “Well, I guess—hey! What’d you do!”

    “Just relax, Mr De Jong. I’ve treated you with the latest method. Nurse? Could you get me another form for termination of life without request?””

  21. sre Says:

    Due to medications and level of health and all that the elderly people numbers rises and people living longer this make some or many of the elderly people asking or seeking to die.

    If people live their life which all those medical health product which may causing long living if they stop taking these products the will die sooner rather later with some problem with their body of mind.

    Its one life will end with death, enjoy your days do look to extended your life, enjoy Your Day Today Not Look for Tomorrow.

  22. F Says:

    Neo:

    Another good article, for which I thank you again.

    I had to smile at this: I will add that if your brother-in-law, although a doctor, doesn’t know much about this particular area of medicine, than his opinion may not be particularly well-informed.”

    His opinion is VERY well informed. Just ask him how well informed it is.

  23. Matt_SE Says:

    Great nations aren’t murdered, they commit suicide. That maxim appears to extend down to the individual level.

  24. Ymar Sakar Says:

    The atheists and secular church of science said that these religious slippery slope arguments were fantasies.

    Death panels didn’t exist. Euthanasia was going to be voluntary and cost effective.

    Homo marriage was just about equal rights.

    Humans say a lot of things that end up as lies.

  25. Ymar Sakar Says:

    Matt_SE Says:
    August 5th, 2017 at 8:35 pm
    Great nations aren’t murdered, they commit suicide.

    Being sabotaged from another realm by Lucifer, isn’t suicide. It just looks like it.

  26. Ymar Sakar Says:

    Amis thought the same thing about their country and the Republicans. They thought they were committing suicide.

    In reality, the Demoncrats were the serial killers that manipulated the crime scene so that it looked like suicide.

    The death was by intent, and not by the intent of the victim.

  27. Ann Says:

    On a cheerier note: After a lifetime covering science, 98-year-old retires from ‘best job in the world’

    And get this: “Now that he’s finally retiring, Perlman doesn’t plan to slow down. He’s toying with the idea of writing a memoir on his life as a reporter.”

  28. John Guilfoyle Says:

    Thanks Neo…your wise sensitivity always shows.

    I’ve been bedside more times than I can count and seen life end too often to be immune to the seriousness and sadness of it.

    I never…ever advise folks to quit on life. We receive it as a gift & it will end according to the deciding of the One who is Giver of Life.

    I contend most of us get the “yips” when death advances against us…I suspect I might too, but the worth & value of the individual is diminished in no way by death’s advance or by any suffering that precedes it. And if this life is all you think you’ve got…let me assure you there’s more, and the offer of more is always open.

    And no…I’m not surprised by the slipping down that slope. It is inevitable.

  29. J.J. Says:

    People differ. I have a neighbor who is 90 years old. He had a stroke 15 years ago. He can barely walk and can’t hold his head up straight. He’s anything but depressed. He attends most neighborhood get-togethers and is always in a good mood. I marvel at his spirit. His wife is a long suffering caregiver with the patience of a saint. What spirit they both have.

    I enjoyed robust good health until 18 months ago. Since then two major surgeries and a slow climb back toward some semblance of health. There are days when my spirits lag. I know I’ll never be as well as I was 18 months ago and shouldn’t expect to be. But it depresses me. It’s then that I think of my neighbor and wonder why I’m not as indomitable as he.

    The very thought of another hospital stay fills me with dread. What keeps me going is my wife. I want to live to be with her to the end. We need each other. (Well, actually I need her more than she needs me.)

    Eighteen months ago I would not have understood people being depressed because they are old and in ill health. Today it is much easier to understand.

  30. Tim Turner Says:

    John Guilfoyle, in politics the inevitable is never inevitable unless you make it so, eh?

  31. John Guilfoyle Says:

    Hi Tim…I’ll respectively disagree.

    People longing to be God, and making decisions as if they were, is inevitable & given the opportunity to decide when someone else (or even ourselves) needs to die is too great a temptation for humans to resist.

    Please see again what the nice Dr said: “When assisted dying is becoming the more normal option at the end of life, there is a risk people will feel more inclined to ask for it…”

    It was inevitable that when the door opened giving folks the power to dictate the terms of living or dying more folks will act in God’s role. This isn’t just politics…it’s theology. 😉

  32. Tim Turner Says:

    My point being, that if you accept defeat, then it is inevitable.

  33. Somebody the Liberal Says:

    Did I get banned?

    Here’s the comment I just tried to post:

    Isn’t this a necessary consequence of preferencing personal freedom over government intrusion?

    I’m troubled by this but I don’t know that my feeling of being troubled should be the basis of public policy.

    Quite a few people here have made the argument that the key distinction between right and left is a preference for personal liberty vs state control. I think this is BS, of course, but taking it at face value: valuing personal liberty requires one to accept that people will make decisions you don’t like–sometimes to make objectively bad decisions–and believe that our collective freedom is more valuable than the cost of those bad decisions.

    so this is a pretty good case of choosing between principle (personal liberty) and an ick factor (helping the depressed kill themselves). But anyone preferencing the ick factor over principle has a much weaker argument against liberals who would also ask for state intervention against THEIR ick factors.

  34. OldTexan Says:

    Wow, there are some interesting comments above and the sharing of circumstances is great. Not all information is good for your commentors I have been reading for years and each person’s story is appreciated.

    As a go to church Methodist it is my feeling that our journey does not end here on this earth and that seems to make the end easier most of the time. Our family tends to live a long time and while I would not like to live as long as my dad, 93 years and be in such fragile health at the end bedridden and virtually blind he enjoyed being alive and his room in the nursing home was where the staff liked to hang our listening to him sign hymns, he sang in the choir most all of his life and he loved being gracious talking to people, even at the end.

    I have also worked with a cancer support group at my church, three times for me, and over the past two years we have lost three of men in our group and they were all nice guys who were smart fine gentlemen, active and on their feet getting out until a few weeks from the end. They kind of went out smiling and grateful for well lived lives so having said that, death and moving on sucks but it happens.

    As far as the end of things, my wife’s aunt out in Napa CA was in her 90’s when her health started failing over several months. At one point she collapsed in her retirement home and when she came to in the hospital she was mad as hell that she was not dead yet, all of her friends were gone and when they wanted to send her to rehab she told them they were nuts, she kind of turned her head to the wall and passed away in less than a month.

    Now that is the good side of moving on and I have seen some families where older relatives have a significant estate that will be divided up and the younger kids start acting like vultures. That is the situation that I see as scary because it would be real easy to decide that granny no longer has a good reason to live and even though she has been a crabby bitch all of her life it appears that she is unhappy now so let’s help her obtain some peace and let’s not bother asking her how she feels about it. In states where it is legal that worries me.

    I also know that white males when they reach a certain point of old age, infirmaty and don’t want to run up medical bills, are the largest group of gun suicides, mostly in the Western states. Would it be better for them to have medical help at the end? I don’t think so but some do. Having lost a young sister-in-law to suicide years ago I make a big distinction between healthy people with deep depression despair taking their lives when things as seen from the outside don’t seem nearly so bleak. Those suicides always leave a terrible scar in the family as they blame themselves for not doing enough and seeing the situation in time.

    I for one do not want to see any type of assisted demise beyond the palliative care we give loved ones as they reach the end of their journey. At my age, in my 70’s, being the oldest generation I go to a lot more funerals and hear of deaths of my friends way to often but that’s the way life works. Sorry for the rambling too much but you know, like the old folks used to say, “Your born, you pay taxes and you die.

  35. Tim Turner Says:

    Somebody the Liberal Says:

    I agree that the idea that the Right prefers more individual liberty is largely (though not entirely) mythical. Recognizing this is what drove me to officially separate from it. The Right is very poor on recognizing divergent social values, the left is atrocious at free economics. I would say that from my personal experience, there are more Republicans who accept gay marriage than there are Democrats who accept free markets. (I have yet to meet one, but there’s always hope?). But even the Republican party has a terrible record on free markets, and there are people who are not open to social freedom in the slightest. I had a wonderful dialog once with a gentleman who wanted to impose a theocracy (his word) in which he made it very clear that it was to be his Bible, and his interpretation of it, which would be forced upon his neighbors.

    You are very right:
    personal liberty requires one to accept that people will make decisions you don’t like

    There is another point here. I don’t have to assist people in killing themselves, I just don’t have the right to use force to prevent it.

  36. John Guilfoyle Says:

    Tim…I’ll accept it as inevitable that you’ll not understand what I’m saying…and it may be that I’m not being clear. So let’s leave it at that. Today’s a new day.

  37. Tim Turner Says:

    John Guilfoyle, I agree. We seem to be having very different conversations. No antagonism intended. Keep your spirits up, your hands clean, and soldier on.

  38. Peter Says:

    I have not read all the comments, so forgive me if I missed something.

    It seems we, or at least I, are (am) always hearing that those who live in Holland and the Scandinavian countries are some of the happiest people on the planet. So, why the rush toward assisted suicide? Does knowing that they never have to suffer in the end make them happier? What a twisted sense of happiness. It is all materialistic – a permissive drug culture, in some places open prostitution, the decline of traditional family, high taxes, lots of government services and support, more spiritualism, less religion. Seems to be a place where accepting a permanent state of delusion is now the national (is nationalism an acceptable term?) norm.

  39. Ymar Sakar Says:

    No large human organization prefers personal liberty over centralized dogma and Obedience.

    That is why human organizations always end up being corrupt, rigid, and inefficient as they grow in strength and size.

    Only individuals and small groups can ever love something like “individual freedom”. There no individuals in a large organization, except for the TOp hierarchy. Everybody else is merely a cog.

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Previously a lifelong Democrat, born in New York and living in New England, surrounded by liberals on all sides, I've found myself slowly but surely leaving the fold and becoming that dread thing: a neocon.
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