Netherlands: One-third of Doctors Willing to Euthanize Patients with Early Dementia

dementia, euthanasia, media coverage, media issues, Netherlands, Our News & Commentary Blog, reality check, research

Dutch media are framing the latest survey of medical professionals somewhat differently than I have in the headline here.  Radio Netherlands titles their story “Dutch doctors wary of euthanasia for dementia,” while DutchNews.nl features the title “Doctors reluctant to help patients with dementia die.”

Both news entitities take pains to minimize the percentage of doctors willing to euthanize patients in an early stage of dementia: Radio Netherlands refers to those willing as “Just 33 percent of Dutch doctors” while DutchNews.nl refers to “Only one third of Dutch doctors” (Emphasis added.)  They seem… what? Relieved? Reassured?

Or is it the rest of the world that they are trying to reassure?  That one-third is really a very small and insignificant percentage of doctors?

To me, the fact that one out of three doctors seems like an awful lot of doctors in the Netherlands are willing to go ahead and perform euthanasia on this (allegedly) new group of “eligibles” is kind of alarming, especially since the other two-thirds are just described as “wary” or “reluctant” – a far cry from “opposed.”

Question – do members of the Dutch media feel it’s their duty to help “spin” stories in certain ways that cast their country in a more positive light?

Here’s the info from the Radio Netherlands story:

Just 33 percent of Dutch doctors are willing to use euthanasia in cases of early dementia, a national survey conducted by three university hospitals shows.

The poll was carried out by the university hospitals of Utrecht, Groningen and Rotterdam, a television programme reported on Saturday.

People with dementia are only able to give their consent to euthanasia in the early stages of the disease. In the later stages, patients are too disoriented to make informed decisions.

The number of people with dementia who have resorted to euthanasia has risen from three in 2006 to 21 in 2010. The overall number of cases of euthanasia has also risen: in 2006 the body responsible for the judicial review of euthanasia cases was informed of 1,900 cases, compared with 2,700 in 2010.

I think it’s probably likely the number of these particular medical killings have been underreported, since it’s fairly new territory.  Look for the numbers to go up every year for this group of people.

The fact that a majority of physicians are uncomfortable with this practice won’t matter.  Back in 2009, I wrote about a discussion of Dutch euthanasia practices with physician Bert Keizer on a Radio Netherlands broadcast.

During that discussion, Dr. Keizer admitted to being very disturbed by the growing acceptance of legalizing the killing of disabled infants.  But, as also came out in the discussion, it didn’t matter what Dr. Keizer felt was unacceptable as long as there was another doctor willing to do it.

If anything, the situation is even worse when it comes to dementia in the Netherlands?  If your regular doctor refuses to consider complying with that kind of request, it won’t be hard to find someone from the one-third of physicians who are perfectly OK with it.

I’m waiting for the next press release from a “right to die” organization that says there’s no evidence of a “slippery slope” in the Netherlands.  I can hardly wait to see what sort of mangled reasoning supports that particular claim.  –Stephen Drake

Crippen’s Blog – “Making assisted suicide more accessible?”

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Crippen Cartoonist (aka Dave Lupton) is a brilliant cartoonist and a disability rights activist.  In my current mode of “catch-up,” I want to point people to his latest blog entry, which as usual, features cartoon, with click-able full text description. 

The latest entry is titled “Making assisted suicide more accessible?!”  Here are the first few paragraphs:

16 June 2011

A non-disabled friend of mine expressed suprise that not only was I unwilling to help him ensure that assisted suicide would be made fully accessible to disabled people, but that I was also very much against the idea of assisted suicide being made legal in the first place!

Recently retired from a life in the medical profession, John is now serving in a voluntary capacity on a panel set up to  address the issue of making assisted suicide legal. In his – in other areas commendable – awareness of disability equality he wanted to make sure that assisted suicide would be equally accessible to disabled people and he wondered if I would be able to help him think through some of the associated issues.

It became clear as I started to explain my position on this subject, that he hadn’t considered there would be people vehemently opposed to the whole concept of helping someone commit suicide. His rational medical mind had seen it purely as a way of helping people who were too ill to continue living, and who had made a decision when they’d been able to do so, to obtain assistance to end their life in a dignified and peaceful manner.

Anyone who’s a regular reader here or who has entered into this kind of situation can see where this is going.  Sometimes nothing constructive happens at all, sometimes you get through, or at least somewhat.

Read the rest of the blog entry – and the long comment thread – to see how it turned out.  –Stephen Drake

Two recent cases show what it takes to screw up a “mercy killing” defense

crime and punishment, homicide, Homicide / 'Mercy Killing', murder, Our News & Commentary Blog

As anyone who follows the news of old, ill, and disabled people who get killed by family members or “caregivers,” it’s all to clear that if the perpetrator claims the act was a “mercy killing,” it’s frequently a successful defense strategy.  The public tends to believe that the victim would have wanted to die, even if they didn’t leave any word behind to say that they wanted to be:

  • smothered with a pillow;
  • shot in the head;
  • given a medication overdose;

or any other highly effective means that family members and “caregivers” have used to kill family members/friends/clients who are old, ill or disabled.

On June 16th, two stories of killers whose “mercy killing” defenses failed came through my news feed.  They are instructive.  They give a pretty good idea as to just what it takes to nullify a “mercy killing” defense. 

The first comes from the Newcastle Herald in Australia:

A CARER who tried to murder his vulnerable and defenceless patient in the middle of the night was jailed for a maximum of eight years yesterday after the judge said it was “far removed from any idea of a mercy killing”.

Steven James McLaren, 55, will serve a non-parole period of five years after he told Newcastle District Court that he felt trapped and was “at the end of my tether” caring for Barry Harrison, 61, who suffered from motor neurone disease.

Mr Harrison had only some movement of his head and eyes with McLaren describing him as “more or less a quadriplegic”.

McLaren moved in to Mr Harrison’s Eleebana home in March 2010, Judge Berman said.

McLaren went into Mr Harrison’s bedroom about 2am on October 5, 2010, and adjusted Mr Harrison’s bed so Mr Harrison was lying horizontally, which would lead to him choking and dying.

McLaren, who previously pleaded guilty to attempted murder, said he expected Mr Harrison to die quickly and it would look like a natural death.

Instead, Mr Harrison woke, screamed for help and managed to survive for about six hours before a nurse found him on the floor.

The lesson here is, of course, you can’t claim that you acted out of mercy if your victim survives and accuses you of trying to murder him.

The second story comes from The Dispatch (Ocean City, MD).  The case involved a 58-year-old man accused of killing his 85-year-old mother:

SNOW HILL — After delivering a 30-minute dissertation on how much he cared for his late elderly mother and how much money he spent on that care, a Pennsylvania man last Friday was sentenced to 25 years in prison for repeatedly running her over on a rural road in northern Worcester County last August.

 More…

From the beginning, Steven Molin did not deny running over his mother as many as three times, but claimed the incident was an accident, caused in part by a faulty passenger side door on the 2008 Chevy work truck damaged in a different accident earlier in the day. However, a Worcester County Sheriff’s Office accident reconstructionist, after reviewing the physical evidence and interviewing Molin, determined the victim had been run over three times despite ample opportunity for the suspect to avoid hitting her after the first collision.

The takeaway here is that you’d better claim it was a “mercy killing” from the outset.  Claiming the death was an “accident” and changing over to the “mercy killing” defense doesn’t work – especially when a car is the murder weapon.

Of course, these cases are fairly unusual, most homicides defended as acts of mercy, the accused are careful to make sure the victim actually died (obviously, hence the use of “homicide” here).  Additionally, most perpetrators avoid using knives or blunt force, preferring guns, suffocation and medication overdoses.  Making a token attempt on one’s own life also helps with defense.

Sheesh.  No wonder so many people get away with murders of this type.  You have to be a special kind of stupid to screw it up as in the two cases linked above.  No less guilty or malicious than the “successful” killers, just a lot less intelligent.  –Stephen Drake 

American Medical News – “Kevorkian leaves mixed legacy” (NDY Quoted)

American Medical News, assisted suicide, bioethics, disabilities, Kevorkian, Our News & Commentary Blog, stephen drake, Timothy Quill

Since I was interviewed for this article in American Medical News, I was actively looking for its appearance online this morning.  The interview with the reporter lasted almost 45 minutes and covered a lot of ground, most of which didn’t get included in this relatively short article.  It is an attempt to explore the “legacy” that Kevorkian left us.

Below are come excerpts from the article Dr. Kevorkian leaves mixed legacy by Carolyne Krupa:

The death of pathologist Jack Kevorkian, MD, left many pondering the long-term influence of a highly controversial figure and what role he may have played in transforming the nation’s perception of dying.

Some think his aggressive push for physician-assisted suicide forced the medical profession to take a closer look at care of the terminally ill. But others say Dr. Kevorkian lacked a sense of proper medical ethics and that his actions were motivated more by a desire to advance his agenda than compassion for patients.

There were four “experts” interviewed – and I am one of the four.  The other were Michael Paletta, MD, “vice president of medical affairs for Hospice of Michigan and executive director of the hospice’s Maggie Allesee Center for Quality of Life;” Peg Sandeen, Executive Director of Death With Dignity National Center, one of the two largest assisted suicide advocacy organizations in the US; and Timothy E. Quill, MD, who is described as “a professor of medicine, psychiatry and medical humanities at the University of Rochester (N.Y.) School of Medicine and Dentistry” and also as someone who “supports physician-assisted death only as a last resort.” (more on this at the end of the blog entry)

Here’s the part from me, with some comments and clarification:

Dr. Kevorkian was particularly harmful to people with disabilities, said Stephen Drake, a research analyst with Not Dead Yet. The Rochester, N.Y.-based organization opposes legalized assisted suicide and was founded in 1996 in response to Dr. Kevorkian’s acquittal in the assisted suicides of two women with nonterminal conditions.

Dr. Kevorkian’s image has been sanitized by the media, which painted him largely as a hero to the suffering, Drake said. Many ignore that before he became famous, Dr. Kevorkian wrote extensively about his desire to allow human experimentation, he said.

Another concern is that Dr. Kevorkian and the media never looked at the social factors around the people whose suicides he assisted, Drake said. Other factors, such as marital or mobility problems, may have contributed to their desperation and helplessness, he added.

Ignoring those social factors demonstrates some of society’s prejudices to assume that simply having a disability would be cause enough to want to die, without looking more in-depth at the individual’s personal troubles, Drake said.

For the record – I never refer to Jack Kevorkian as “Dr.”

Readers of this blog will know that the comment about Kevorkian’s advocacy of human experimentation is incomplete.  His agenda was always to use “planned death” (execution, infanticide, assisted suicide, etc.) as an opportunity to keep someone alive and sedated for a few hours or days while experimenting on them, followed by organ harvesting.  His assisted suicide activities were part of that agenda.

Likewise, when “mobility” is mentioned as a social problem, I wasn’t talking about the impact of the mobility impairment itself, but the frustration, anger and despair that was a factor in at least one person who went to Kevorkian who waited endless months for a proper wheelchair – which finally arrived a few days after his death at Kevorkian’s hands.

Also, Kevorkian’s acquittal wasn’t the only catalyst for the formation of NDY.  There were also two court cases going to the Supreme Court arguing for a constitutional right to assisted suicide.  One of those cases was Vacco v. Quill – that’s the same “Quill” who is one of the “experts” interviewed for the article.

Quill’s limited indentification in terms of his relevance to the story is a problem in this article and how he is often identified in the press.  Quill doe not just “support” assisted suicide, he is a leading advocate of legalization and has been one since 1991. The summary of his efforts put toward legalization are summarized neatly on the Death With Dignity National Center website, where he is on the board of directors for both the organization and its Political Action Committee:

Quill has lectured widely and published numerous articles, including a 1991 New England Journal of Medicine article about “Diane,” a dying patient who requested assistance in dying. Quill is the author of four books, Physician Assisted Dying: The Case for Palliative Care and Patient Choice (Johns Hopkins University Press, co-edited with Margaret Battin), Caring for Patients at the End of Life: Facing an Uncertain Future Together (Oxford University Press), A Midwife Through the Dying Process, Stories of Healing and Hard Choices at the End of Life (Johns Hopkins University Press), and Death and Dignity: Making Choices and Taking Charge (W.W. Norton). He was the lead physician plaintiff in the New York State legal case challenging the law prohibiting physician aid in dying—Quill v. Vacco.

This also means that two out of the four sources used for this article are essentially both representatives of Death With Dignity National Center.  As I mentioned before, Quill is often described this way in assisted suicide articles and it is dishonest.  In an article about assisted suicide, someone who is a prominent political advocate of legalization should be identified that way.

If Tim Quill were really ethical, he would insist on being identified that way so that readers would be better able to evaluate his comments in relation to his position as a stakeholder in the debate.  –Stephen Drake

The American Muslim (publication) – “Euthanasia: a Modest Proposal” by Rev. Frank Julian Gelli

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It’s been a long couple of weeks.  The month started with the death of Jack Kevorkian and a nonstop barrage of eulogizing and mythologizing his life.  This week, we had the sorry spectacle of Terry Pratchett’s “infomercial” on assisted suicide featuring the spectacle of another rich disabled man drinking some poison and dying on camera.

It all gets old very fast.

I was on the lookout for something a little different.  I’m a little tired right now to thumb my own nose at the promoters of assisted suicide and euthanasia – and to have it come off convincingly.

So, instead, I found someone who is thumbing his nose at them and sharing his message with you.  It was just what I needed this Friday.

From The American Muslim, here are the first paragraphs to Euthanasia: a Modest Proposal by Rev. Frank Julian Gelli:

It is in the air. Eu and Thanatos. Two Greek words, meaning a ‘good death’.

Sir Terry Pratchett, science fiction novelist and Alzheimer sufferer, made a documentary about ‘assisted dying’. The aim: to make euthanasia legal in Britain. Sir Terry’s wife is not in favour, apparently, but he is. Golly! Verily, the Book of Proverbs is right, ‘a good wife is worth more than rubies’. I confess: If I had a wife, I would like her to be like Mrs Pratchett.

Euthanasia-talk is topical indeed. Elderly people in British care homes are victims of spending cuts. The quality of their care is deteriorating. Privatisation has resulted in falling standards. The financial crisis bites. State support is short. It can’t go on like this. And so on.

Good death fans of course swear up and down that it is voluntary euthanasia they are proposing. No one would be forced to top himself. Fair enough, conceptually. Still, when I was a parish priest I have dealt long enough in funerals and bereavements to be perhaps a wee bit sceptical of the happy concept. Where there is will, there is a way. Geddit?

That, however, you can argue, is carping. We must take the bull by the horns. Tackle the problem at the roots. Enough of pussyfooting. Time has time to be truly radical.

In 1729 the Irish writer Jonathan Swift published his pamphlet, A Modest Proposal for Preventing Children of Poor People in Ireland from being a Burden to the People or Parents…’etcetera. Simply put, Swift suggested that the large, excess child population of Ireland should be eaten. A one year old’s flesh was most delicious, nourishing and wholesome food, the great man averred.

It was a brilliant, stupendous idea. Because it bypassed the matter of the child’s voluntary submission to his lot. At the age of one, children are not capable of consent, so the matter of their agreeing to being eaten could not arise. It was ideal, moral, socially useful cannibalism.  Swift was a genius.

So am I. A genius-like priest.  Immodestly, I propose something similar. Let us eat the old folks. It not fair they should feel useless cast-offs. Their dignity demands they should have a use. As food. Let us eat them.

You can see where this is going, of course.  The good Rev. has done a nice job with this one, although I’d argue it would be a little stronger without the last paragraph.  But that’s a matter of taste more than anything.

If you’re in the mood to read something that treats Terry Pratchett and his fellow euthanasia enthusiasts with the appropriate amount of (dis)respect, please read the rest of Rev. Gelli’s essay here.

It was a great read for a Friday and getting in a better mood for the weekend.  –Stephen Drake