Statement from Care Not Killing on Euthanasia

The Care Not Killing Alliance has warned Parliament, the public and the media not to be misled by a report published on Thursday that it says downplays the risk to vulnerable people posed by the legalisation of euthanasia. The warning comes amidst fears that fresh attempts will shortly be made to legalise the practice in Britain, most likely beginning with Scotland, which is seen as a soft target by pro-euthanasia advocates.

Dr Peter Saunders, Campaign Director of Care Not Killing, warned:

People should be aware that the prominence being given to this new review is part of a deliberate campaign to soften up the British public for the legalisation of euthanasia. In the Netherlands healthcare is covered by insurance, but in the UK most people rely on the State. In a cash-strapped NHS, where hospitals are being closed and elder abuse is on the rise, there is growing prejudice against the chronically ill and disabled who are seen as disproportionate consumers of limited resources. Legalising euthanasia would place vulnerable lives at risk. And the Dutch statistics, when properly examined, actually raise great cause for concern.

We should not be placing before health providers in Britain the temptation to consider euthanasia as a therapeutic option to be used in the patients' "best interests". Once euthanasia is established as a legal "therapy", it will be made the subject of cost/benefit assessment by health managers and economists. And in a cost conscious health service £5 for a lethal injection will be a tempting therapeutic option to £500 per week for effective palliative care.

Care Not Killing has always argued that legalising euthanasia would place pressure, whether real or imagined, on vulnerable people - the lonely, elderly, sick, disabled or depressed - to request early death. These people often already feel themselves to be a financial or emotional burden on relatives, carers or society and this is why they need strong legal protection. The "right" to die, can so easily become a coercive offer, a duty to die. The law should not be changed just because a small number of insistent people wish to have their lives ended by doctors. It would result in a much larger number of vulnerable people being placed at risk.

This fear was borne out by opinion polls published at the time of the defeat of Lord Joffe's Assisted Dying Bill in May 2006, which showed that 65 percent of people agreed that if the law changed "vulnerable people could feel under pressure to opt for suicide", 75% of people agreed that "people with treatable illness such as depression might opt prematurely for suicide", 73% said that a change in the law would "make it more difficult to detect rogue doctors such as Dr Harold Shipman" and 82% said that if Dutch laws were adopted here they would be concerned that people would be killed without an explicit request.

The pro-euthanasia lobby, by contrast, has attempted to reassure people that legalising euthanasia would not increase pressure on vulnerable people and has therefore campaigned to give prominence to the latest article purporting to demonstrate this, published in the Journal of Medical Ethics today (Thursday 27 September 2007).

About every five years, statistics on Dutch euthanasia are released. The figures for 2005, published in May this year and highlighted today, show that the number of euthanasia cases in the Netherlands fell from 3,500 in 2001 to 2,325 in 2005. The drop, from 2.6% to 1.7% for euthanasia cases as a percentage of all deaths, may appear reassuring on the surface and this is indeed how it is being spun.

However, these figures, which were set out in a detailed report in the New England Journal of Medicine by a group of Dutch doctors, including some of the country's leading advocates of euthanasia, on deeper scrutiny reveal a very different picture. They show that a small decrease in voluntary euthanasia has been more than offset by a hefty increase in what is called "terminal sedation". Patients are given drugs which sedate them "continuously and deeply" until death, in 8.2% of all deaths! To put it more starkly, voluntary euthanasia (1.7%), non-voluntary euthanasia (0.4%) and terminal sedation accompanied by withdrawal of nutrition and hydration, now account for nearly one in ten Dutch deaths. Even if we were to disregard the increasing use of "terminal sedation" by Dutch doctors the argument that legalising euthanasia in the Netherlands has not led to an increase in people having their lives ended without giving consent is deeply flawed for the very simple reason that euthanasia has been legally sanctioned in the Netherlands for over 20 years.

In 1984 the Dutch Medical Association (KNMG) ruled that performing euthanasia was ethically permissible provided certain criteria were met and the Ministry of Justice confirmed in 1985 that physicians who performed euthanasia using the KNMG's criteria and reported it to the coroner would not be prosecuted. In other words the legalisation of VAE and PAS occurred in 1984 not 2002, and notably before any of the official surveys were carried out.

Furthermore, the courts have interpreted the law extremely liberally underlined by the paucity of convictions of doctors for non-voluntary euthanasia (which has never been legalised) and the leniency of sentences imposed on doctors found guilty of breaking the law.

It is therefore quite disingenuous to argue that the official surveys have revealed no significant increase in non-voluntary euthanasia as a result of legalisation. The law, indeed the whole legal climate, had changed seven years before the first official survey was published in 1991. As early as 1990 over 1,000 Dutch citizens per year were having their lives ended by doctors without their consent. Non-voluntary euthanasia was rampant in 1990 and is equally rampant now. Dutch doctors who practise euthanasia are not on the slippery slope. From the very beginning, they have been at the bottom. These concerns were further heightened in 2005 when Dutch doctors instituted the Groningen protocol, enabling the killing of severely disabled children.

Britain should not be going down the Dutch road. Instead, we need the excellent palliative care already available in this country to be made much more widely accessible. There are no full time palliative care posts in the Netherlands at all. This, together with the fact that patients with the worst symptoms are most likely to request euthanasia, makes a strong case for making good palliative care more widely accessible. Requests for euthanasia are extremely rare when the needs of dying patients are properly met.