Dutch Euthanasia Case Highlights Europe’s Growing Culture of Death

NEWS ANALYSIS: Elderly dementia sufferer held down by relatives and killed by doctor. A criminal case is proceeding against the physician.

People take part in the March4Life (Marche pour la Vie, Mars voor het Leven) demonstration, on March 30, 2014, in Brussels. March4Life is a group of students and young professionals who want to promote respect for human life and is strongly opposed to abortion and euthanasia. The spread of legalized euthanasia is at its most acute in the Benelux countries (Belgium, Netherlands and Luxembourg).
People take part in the March4Life (Marche pour la Vie, Mars voor het Leven) demonstration, on March 30, 2014, in Brussels. March4Life is a group of students and young professionals who want to promote respect for human life and is strongly opposed to abortion and euthanasia. The spread of legalized euthanasia is at its most acute in the Benelux countries (Belgium, Netherlands and Luxembourg). (photo: Nicolas Maeterlinck/AFP/Getty Images)

The doctor asked the patient’s daughter and her son-in-law to help hold the woman down. It was then the 74-year-old, who suffered from severe dementia, began to struggle as the doctor proceeded to administer a lethal injection. Moments later, the woman was dead.

This is not the plot of a horror movie. Instead, these are the basic facts of what is alleged to have happened in a Dutch care home in 2016, facts which now form part of the criminal case being brought against the doctor who performed the euthanasia. The case is also gaining world attention as a potential indicator of how euthanasia laws might fare in other countries.  


Life on the Cheap

In a Dutch court, prosecutors now say that the doctor did not obtain the full consent of the unnamed woman. They point to the fact that the elderly patient fought for her life as the lethal injection was administered — proof in itself, prosecutors argue, that she could not have given consent, or given it with the knowledge and understanding required for her consent to be meaningful.

The woman killed had been diagnosed with Alzheimer’s disease in 2012. Before being admitted to the care home where she died, she signed a statement saying that she wished to be euthanized. There was a coda to her statement, however, which said that she “wanted to be able to decide [when to die] while still in my senses and when I think the time is right.”

The law case is due to conclude in the coming weeks, but, surprisingly, given the facts, even if the unnamed, now retired, female doctor is convicted of any offense, state prosecutors are not asking that a custodial sentence be imposed on her. A spokeswoman for the Dutch prosecution service, Sanna van der Harg, said, “We do not doubt the doctor’s honest intentions.” She added, “A crucial question in this case is how long a doctor should continue consulting a patient with dementia, if the patient at an earlier stage already requested euthanasia.” Nevertheless, Van der Harg admitted that in the current case “a more intensive discussion” should have taken place before ending the patient’s life.

The reason for the Dutch state’s reluctance to press a prison sentence for the doctor and its seeming ambivalence about bringing to court other such cases comes amid current widespread political and social acceptance of euthanasia in the Netherlands. The dead woman’s family, indeed, continues to approve the actions of the doctor who killed their elderly relative.


Dutch Law

The Netherlands was the first country to legalize euthanasia, doing so in 2002 (the state of Oregon in the United States legalized it in 1997). The following year, there were 1,626 officially reported instances of euthanasia in the country. For 2017 the number of reported cases had increased to 6,585.

The case mentioned above is the first involving euthanasia to come before a Dutch court. Dr. Gordon Macdonald, CEO of the British-based Care Not Killing, told the Register that what is at stake here is not the country’s acceptance of euthanasia: “It has been made clear that the prosecution is being brought not in the interests of justice, but rather to secure clarity on process. With regulators and euthanasia campaigners closely intermingled, this case shines a spotlight on the weakness of safeguards and review procedures, as well as, frighteningly, on the whole culture around attitudes to end-of-life care in the Netherlands.”

Andreas Thonhauser is spokesman for Alliance Defending Freedom International (ADFI), a Christian legal advocacy organization that protects fundamental human freedoms and promotes the inherent dignity of all people. In an interview with the Register, Thonhauser  views the current case before the Dutch courts as symptomatic of a deeper malaise within Dutch society, one particularly reflected in its view of vulnerable patients. “The case in the Netherlands exposes the threat that legalizing euthanasia poses to individuals and the society as a whole,” he said. “Instead of simply taking care of the most vulnerable, medical staff are facing a lot of pressure to take controversial decisions regarding the lives of elderly.” He added, “Once a country allows euthanasia, as in the Netherlands, there is no logical stopping point.”

The spread of legalized euthanasia is at its most acute in the Benelux countries (Belgium, Netherlands and Luxembourg). Doctors in Belgium have also ended up appearing before their country’s courts accused of illegal killing, despite the fact that, like the Netherlands, Belgium has notoriously lax euthanasia laws.


Death in Belgium

The most prominent Belgian euthanasia case is that of the killing of Godelieve De Troyer. That case has now gone to the European Court of Human Rights (ECHR). In 2012 Tom Mortier learned that his mother, Godelieve, had been euthanized the previous day. The explanation given for this was that she was suffering “untreatable depression.” Euthanasia has been legal in Belgium, as in the Netherlands, since 2002, with the law specifying that those asking to end their lives must be in a “medically futile condition of constant and unbearable physical or mental suffering that cannot be alleviated, resulting from a serious and incurable disorder caused by illness or accident.”

At the ECHR, Mortier has filed an application against Belgium and is being supported by ADF International. According to ADFI spokesman Thonhauser, Tom Mortier’s mother was physically healthy and her psychiatrist was of the opinion that she did not satisfy the requirements for the Belgian euthanasia law. Disturbingly, Thonhauser pointed out that “the doctor who administered a lethal injection to Mortier’s mother without informing her family has been one of the most outspoken proponents of euthanasia.” For Thonhauser, this death is representative of “the slippery slope in Belgium, and in this case, we see the tragic consequences.”

Thonhauser said the mounting evidence in the most recent Belgian government report on euthanasia reveals that approximately six people per day are killed via state-sanctioned euthanasia but, he said, he’s worried that “this may yet be the tip of the iceberg.”

“The figures expose the truth that, once these laws are passed, the impact of euthanasia cannot be controlled,” added Thonhauser.


U.S. and U.K.

In light of what is happening on the Continent, Care Not Killing’s Macdonald observed, “The track record of those European countries which have legalized either assisted suicide or euthanasia should serve as a warning to legislators, concerning both the growth in uptake, the expansion of the law and the changes in how illness and disability are perceived in society.”

But he remains hopeful that when legislators both in the U.K. and U.S. are “presented with the full facts and the dangers posed to vulnerable people and those with disabilities by legalizing assisted suicide or euthanasia, most countries in Europe will continue to outlaw them.”

However, he added that vigilance is needed to ensure that this remains the case both in the United Kingdom and elsewhere, given the strong push currently to legalize assisted suicide and/or euthanasia in some U.S. states, in the U.K., in Australia and New Zealand. To ensure that euthanasia does not become more widespread globally, he highlighted, “It is important that the arguments against such a change in the law are being presented to legislators in an effective way.’”

In the U.K. euthanasia and assisted suicide remain illegal. However, there have been recent attempts at Westminster to legalize assisted suicide in certain circumstances. The last such attempt was rejected by Parliament in 2015. Reflecting upon the case before the Dutch courts, U.K. member of parliament Fiona Bruce told the Register: “This tragic [Dutch] case highlights exactly why it is so important for U.K. parliamentarians to stand firm by their clear decision of 2015 not to change our law to introduce assisted dying.”

Such sentiments were echoed by Baroness Finlay of LLandaff, who, speaking to the Register, said, “In those jurisdictions where doctors have been licensed to supply or inject lethal drugs to patients, there have been relentless year-on-year increases in death rates. In the Netherlands one death in every 22 is now from euthanasia, and the boundaries of Holland’s Termination of Life on Request and Assisted Suicide law are being constantly expanded to encompass new groups of people, such as the mentally ill.”


Life in Britain

Finlay said that recent British attempts to change the law were “vaguely worded statements that cannot be verified, and they are not subject to independent audit. They are incapable of protecting vulnerable seriously ill people or of detecting coercion.” As a result, she says British parliamentarians have “seen through them and consistently rejected such ‘assisted dying’ bills.”  

Part of the reason for the U.K.’s continued rejection, MacDonald maintains, is that the U.K.’s palliative-care provision and innovation are seen as world leading. He added, “It is likely that a majority of MPs will continue to oppose the legalization of assisted suicide. However, there remains a vociferous minority of MPs who are relentless in pushing for a change in the law.”

In a parliamentary debate earlier this year, he said, secured at short notice by assisted-suicide enthusiasts, “A number of MPs continued to make clear that the threat to vulnerable people and to the practice of medicine was too grave, with mooted criteria [for assisted suicide] arbitrary and open to expansion, and proposed safeguards insufficient to protect those in greatest need of care and support.” It remains crucial, therefore, he emphasized, “that sympathy for ‘hard cases’ is tempered by engagement with the evidence on how these measures work in reality.”


Register correspondent K.V. Turley writes from London