To work, assisted dying needs clear limits

Early this year, different end of life options are being debated in the New Mexico Legislature, including assisted dying. I am myself a citizen of the first country that permitted assisted dying.

As a professor of ethics, I served on a committee overseeing the practice in the Netherlands for nine years.

Allowing aid in dying in the Netherlands dates back to 1985, when it was recommended that physician-assisted dying would no longer be punishable under a set of conditions, most importantly a well-informed patient request and the presence of unbearable suffering without prospect of improvement.

In 1994, physician-assisted dying was made legal in the form of a special clause in an existing law, followed by a separate law in 2001. Five regional committees (consisting of a lawyer, a physician and an ethicist) assess each case of physician-assisted dying and see whether it has fulfilled the criteria.

During my years on one of these committees (2005 to 2014), I personally reviewed 4,000 cases. Given the widespread support for physician-assisted dying in my country, I was convinced that legalization was the wisest, most respectful and most compassionate route.

However, it is not without concern that I have seen physician-assisted dying develop in the Netherlands.

In the first two decades, the numbers remained stable but, starting in 2007, the numbers headed up from 1,800 to more than 5,500 per year in 2015.

One in 25 deaths is now the result of physician-assisted dying.

From being a last resort, physician-assisted dying is on the road to becoming a preferred, if not the only, acceptable mode of dying in the case of cancer.

“Assisted dying” and “dying with dignity” have become virtual synonyms, with public opinion shifting toward considering it a patient’s right and a physician’s duty. Pressure on doctors can be intense.

Other developments include the formation of a network of traveling euthanizing doctors (the “End of Life Clinic”), providing physician-assisted dying to patients without a prior doctor-patient relationship.

From 29 cases in 2012, the clinic helped 365 people in 2015.

And whereas, in the pioneering years, virtually no patients with psychiatric illnesses or dementia were euthanized, we counted 160 such cases in 2015 alone.

The developments continue to unfold.

There is a strong public advocacy for legalizing child euthanasia. On Oct. 12, the Dutch Minister of Health announced state-organized physician-assisted dying for any elderly person who asks for it and who suffers from age, loneliness, meaninglessness or bereavement.

In the pioneering years in the Netherlands, terminal cancer was the most common reason for assisted dying. In hindsight, one of our biggest mistakes may have been that we did not include terminal illness as a condition. But even if we had done so, could we have contained the practice?

In the Netherlands, patient organizations have effectively campaigned for broader access to physician-assisted dying: Why only those with a terminal disease? Why only those with physical disease? Why only adults? Why only competent patients?

Indeed, why only those with a disease? To be honest, the cases that broke my heart the most during my time on the committee were people who were not even facing death: cases of sexual abuse, war traumas, a serious work-related setback with which a person is psychologically unable to cope.

In many markets, supply creates demand. My experience is that assisted dying is no exception.

Although I can very well sympathize with the suffering of so many, a physician-assisted dying law may have paradoxical effects.

Speaking for the Netherlands: In three decades, physician-assisted dying has not only relieved much suffering, but it has also changed our whole view on suffering, coping, aging and dying.

Other states may want to take that into account when they consider the options at the end of life.

Theo Boer is a professor of Ethics at the Universities of Kampen and Groningen, the Netherlands. He recently was visiting in Rio Rancho.

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