Dutch euthanasia figures present muddled picture

Michael Cook
BioEdge

Euthanasia in the Netherlands is nothing much to worry about, according to The Lancet. The latest survey shows that the overall levels of euthanasia and assisted suicide are about the same now as they were in 2002, when euthanasia was legalised. A small increase since 2005 is just due to the fact that more people are requesting euthanasia.

At least that was the spin in The Lancet’s press release. A closer examination of the article, “Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey“, shows that there are many things to worry about.

It is true that there is a “V” shaped curve in the number of cases of voluntary euthanasia. In 2001, before legalisation, about 2.6% of all deaths were due to voluntary euthanasia. In 2005, this dropped to 1.7%, and rose in 2010 back up to 2.8%.

But what accounts for the drop? It was not lack of interest. The proportion of patients requesting euthanasia rose from 4.8% of all patient deaths in 2005 to 6.7% in 2010. And doctors were also more willing to grant it. In 2005, 37% of these requests were granted and in 2010 45%.

The answer seems to be that doctors who ended the lives of their patients had switched from injecting barbiturates and muscle relaxants to “continuous deep sedation”. Although physicians were asked in the questionnaire (included as an appendix) whether this meant withdrawal of nutrition and hydration, it is not clear from the article whether it did. Presumably this continuous deep sedation means drugging the patient into unconsciousness, withdrawing food and water, and waiting for them to die.

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