Euthanasia

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A new book of anti-VAD polemical anecdotes, published by Springer

The other day a TV commercial from more than 30 years ago popped into my head. It was a humorous slice-of-life scene in which a teenage son gobbles down a breakfast bowl of Sultana Bran cereal. He complains that his health-kick girlfriend had made him eat vegetarian the night before. His family eye each other with mirth as he eats.

The punch line? “Don’t mention it’s healthy and they’ll eat it by the boxful.”

sultana_bran_ad_1990.jpg The Kellogg's Sultana Bran TV commercial from 1990.

Despite having worked in advertising research for years, I’m sure I hadn’t thought of this ad for at least a couple of decades. So what brought this vignette suddenly to mind?

It was the release of a new book by academic publisher, Springer: Devos, T, (Ed.) 2021, Euthanasia: Searching for the Full Story - Experiences and Insights of Belgian Doctors and Nurses, Springer, Leuven.

How terrific to have a new academic tome on the Belgian voluntary assisted dying (VAD) experience, I thought, as I downloaded the eBook version.

But then…

Imagine my surprise and disappointment then, to discover this is no scholarly tome with ethics-committee-approved study methodologies, carefully cited and transparent sources whose authenticity and veracity could be checked by anyone with a smidgin of scholarly acumen.

No, the kindest description I can give this blancmange of offenses is… a series of “essays” all singing from the same hymn sheet. More on that shortly.

The book launches into — let’s not beat about the bush — bullshit from the get go. In the Foreword, Jacques Ricot invokes the Hippocratic Oath as a still-relevant “religious standard”. Oh dear. You mean that oath that prohibits surgery, prevents women from entering the profession, and swears allegiance to ancient Greek gods?

He then goes on to describe VAD as a “desperate act of two people [the doctor and patient] trapped by helplessness.” He invokes cracks opening up in sea walls and waves that can only widen them. There’s your horizontal oceanic equivalent of the inevitable “slippery slope”.

Helpfully, he forewarns that all the authors in the book “do not believe that euthanasia can be a medical or a caring act.” OK, so not a range of views, then.

He also refers to the authors as “resistance fighters”, giving a heads-up that these writers feel they’re losing the battle.

And yet more

Then, anti-VAD campaigner Margaret Somerville repeats her rubbish claims that legalised VAD leads to suicide contagion. I’ve repeatedly taken Somerville to task over her serial misinformation, as well as noting the latest evidence from Switzerland which VAD opponents never mention… for a reason.

Somerville repeats yet again her refrain that “the case against [versus for] euthanasia is much more difficult to promote … because it is more complex”. No, it isn’t. It’s just that the majority now no longer take conservative religious doctrine as … shall we say, “gospel”. That’s especially true when her strongest ambit is to appeal to “a human way of knowing” (without mentioning her hobby horse, “moral intuition”, by name), and expressly noting that the stories that follow are not based on the usual scientific standards of evidence.

And there you have it. A series of “essays” by persons ideologically opposed to VAD, adorned with numerous uncheckable anecdotes and tawdry claims, appeals to slippery slopes, misrepresentation of data such as the non-voluntary euthanasia rate in Belgium, “intuitive” claims that the bereaved suffer as badly from lawful VAD as do families of those who have suicided violently and alone (despite multiple peer-reviewed studies showing VAD bereaved cope well). The list goes on.

Who are these people?

This of course begs the question: who are these people putting themselves forward as experts in VAD? Remember, these are people claiming expertise in a subject they’ve never participated in, and swear they never will. No doubt they are indeed experts in their own individual disciplines. But not in VAD.

It’s like asking (only) a bunch of hardened atheists to write an authoritative book on Christian spirituality.

Well, many of the names are already well-known in VAD (and especially anti-VAD) circles. Others took a bit of research to track down. Much of the work for the following backgrounders was accomplished by my friend the talented Chrys Stevenson. We compared notes.

The point of the research was not to attempt an inappropriate ad hominem attack. Without attempting to bore, I’ve already given a host of reasons as to why the quality of the essays in this book are very low. No, the point is to find common influences and agendas as to why that might be.

So lean in, dear reader, here we go. And to aid comprehension, may I suggest that you watch for the words in bold?

The editor — Timothy Devos

Timothy Devos is a Professor of Medicine (haematology) at Catholic University Leuven. He is a past president of the Medicine and Dignity of Man Association, an apostolate of the Catholic Regnum Christi movement, which believes that “the positions adopted by the Catholic Church in matters of bioethics are good, prudent”.

Foreword 1 — Jacques Ricot

Jacques Ricot is an Associate Researcher at Nantes University in France. In a 2003 paper he argues that secular philosophy needs to draw on the religious understanding of forgiveness. In 2014 he attended a conference on “dying with dignity” at the Catholic Notre Dame, Paris, articulating views harmonious with Catholic doctrine. In 2018, the European Federation of Catholic Doctors Associations and the Catholic Centre of French Doctors thanked him for valuable contributions to their thinking about human medicine.

Foreword 2 — Margaret Somerville

Professor of Bioethics at the (Catholic) University of Notre Dame Australia. (This is curious given that her CV mentions no earned tertiary qualification in either ethics or philosophy.) Somerville is a loyal Catholic who has for years been given pre-eminent position regarding Catholic bioethics above even the church itself at the L.J. Goody Bioethics Centre, as I’ve pointed out before.

The L.J. Goody Bioethics Centre is run by the Catholic Archdiocese of Perth. The Catholic Archbishops of Perth and Sydney are the ultimate controllers of the University of Notre Dame Australia.

Foreword 2 — Wesley Ely

Dr Wesley Ely is a Professor of Medicine at Vanderbilt University Medical Centre in Nashville, Tennessee. He is President of the Nashville Guild of the Catholic Medical Association. He has given numerous addresses from a Catholic perspective on topics such as “Preaching the gospel through service”, “Five principles of service in living the gospel”, “Deepening our prayer life”, “Viaticum: lessons learned from dying patients seeking our Lord”, “Top 10 tips at the heart of Christian discernment” and “A treatise on the true devotion to the blessed virgin by a lay doctor”.

Contributor — Eric Vermeer

Mr Vermeer is a nurse educator and the ordained Deacon of the Catholic diocese of Namur. His adopted son is also a Catholic priest. He is a past President of the European Institute of Bioethics, a group that claims to be independent and not of a religious nature, yet “attentive to religious traditions”. It lobbies for positions that are consistent with Vatican doctrine, such as against abortion and VAD. Quite a number of the Institute’s committees are known religious people, including some from the Catholic University of Leuven.

Mr Vermeer has recorded an anti-VAD video for ADF International, which runs the Arete Academy, a centre for religious academics based on “excellence and moral value”… at least according to their interpretation of the Bible.

Contributor — Catherine Dopchie

Dr Catherine Dopchie is an oncologist at the Centre Hospital of Wallonia. She told the Society for Religious Information Italy, published by the Catholic Press Agency, that “death is the enemy of mankind”, that “we have been created for life”, that “those who have met God in their lives, know that death is not the winner”, and that “every man is precious to God and that the entire life is sacred”.

Dr Dopchie has also recorded an anti-VAD video making unsubstantiated claims, for ADF International.

Contributor — Willem Lemmens

Having earned his doctorate at the Catholic University of Leuven, Professor Willem Lemmens is now Chair of the Department of Philosophy at the University of Antwerp. In 2018, Professor Lemmens argued against VAD at the (Catholic) Anscombe Bioethics Centre in the UK, and spoke with Catholic newspaper Crux, to spread the misinformation that Belgium’s law was originally only for terminal illness (it never was), and to complain that (Catholic) Belgian Brothers of Charity were now allowing VAD to occur in their healthcare facilities.

He also sits on the General Council of the University Centre Saint-Ignatius Antwerp, which was established by a Jesuit (Catholic) order, and whose purpose is to continue to promote Jesuit Christian ideology.

Contributor — An Haekens

Dr An Haekens was educated at the Catholic University Leuven. She is a psychiatrist and medical director at the (Catholic) Alexian Care Group in Tienen, Belgium. It was established by the (Catholic) Belgian Brothers of Charity and states that “we start from our own Christian identity” and “we want to keep alive and implement the spirituality of the Alexians”.

Dr Haekens writes periodically for Belgian Catholic magazine Tertio, including stating that she would never participate in VAD. In 2021 she was interviewed by Belgian Catholic radio station Radio Maria, having been awarded the annual prize for spiritual care by the Professional Association of Care Pastors, the association for Catholic chaplains.

She is married to Dr Didier Pollefeyt, Catholic Professor of Theology and Religious Studies at the Catholic University of Leuven. He is also an Honorary Professor at the Australian Catholic University.

Contributor — Rivka Karplus

Dr Rivka Karplus is a family physician and an internal medicine and infections specialist, based in Israel. In 2018 he attended a colloquium at the College des Bernardins in Paris — a Catholic theological and biblical studies centre — as a representative of the Jerusalem Kehilla, a congregation of Hebrew-speaking Catholics. He is warmly cited in a 2016 anti-VAD publication by the Catholic Caritas in Veritate Foundation, which attempts to provide representatives at the UN and other international organisations with Catholic, Christian “expertise and strategic thinking”.

Contributor — Marie Frings

Dr Marie Frings is a Brussells-based GP specialising in palliative care. She writes for Catholic group Consecrated Lives which promotes increasing evangelical commitments. In such an article in 2007, she cites the Catholic Congregation for the Doctrine of the Faith as an authority on end-of-life decisions, and notes that sometimes she felt uncomfortable that patients would have their arms tied to be force-fed against their wishes so they lived indefinitely. She firmed her views that tube feeding was not mandatory when it is an extraordinary measure, with the help of several Catholic theologians and the pro-life committee of the episcopal conference of American (Catholic) Bishops.

She argued “respecting the conscience of others” in this regard, yet expressly rejects such conscience when it comes to choosing a peaceful, hastened death by VAD.

Contributor — Benoit Beuselinck

Dr Benoit Beuselinck graduated from the Catholic University of Leuven in Belgium, and has for years worked in the university’s hospitals. In 2017 he spoke at an anti-VAD conference at the Catholic Anscombe Bioethics Centre in the UK.

In an article in the Catholic magazine Logia, he claims that “proper palliative care makes assisted dying unnecessary”, even though it is well-established that this isn’t true.

He alleges in the Catholic Herald that Belgian nurses and social workers are quitting their jobs because palliative care units are being turned into “houses of euthanasia”, and that doctors in palliative care units “have to euthanise patients”. He also claims that some patients are afraid to go to hospital in case they are either coerced into euthanasia or are deliberately killed without their consent. This is a perversion of the original Netherlands accusation by the Vatican, which itself was entirely false.

Dr Beuselinck has also made an anti-VAD video for ADF International, making unsubstantiated claims that “doctors hide behind their patients’ wishes”, “supply creates demand”, “the doctor has his back to the wall”, “we want euthanasia for everyone”, “doctors who prefer not to do it are not respected”. He cherry-picks Belgian non-voluntary euthanasia data to wrongly make the case that their VAD law has caused (or at least worsened) that practice; the opposite of the truth. He says that euthanasia is an act against nature, opens the floodgates, that we no longer favour the love we show in taking care of someone, and that the depressed may now think “if the doctor can kill, then what is my life worth?”

Contributor — Julie Blanchard

Dr Julie Blanchard is a French-trained GP who specialises in palliative care. She works at the Catholic University of Leuven’s second hospital, in Namur, and never participates in VAD. Contrary to Dr Beuselinck’s claims that palliative care workers opposed to VAD are disrespected and forced to participate, Dr Blanchard reports that other doctors respect her opposition, and that VAD teams take care to ensure those who are against VAD are not present at the time of a lethal injection.

It's astonishing how inconsistencies like this — those opposing VAD are respected but are not respected — reduce the book’s coherence.

Contributor — François Trufin

François Trufin is an emergency nurse at St Nikolaus Hospital in Eupen, Belgium. The hospital was founded and continues to be sponsored by the Catholic church, “continuing [the] obligation of the founders” for a “Christian worldview”.

Religious petticoats and the Catholic Communicator’s Guild

So there you have it: the Catholic connections of the people involved in the production of this risible nonsense, which brims with innuendo, arguments and misinformation consistent with those of the Catholic church and other Catholic apologists.

I’ve written before how Catholic Archbishop Anthony Fisher has expressly argued for organising a line-up of sympathetic (i.e. Catholic) doctors, lawyers and others to put such information about, and yet, how they hide their religious petticoats while doing so. I’ve further exposed a network of Catholics who promote the church’s line on VAD — a network I call the Catholic Communicator’s Guild.

This book furnishes an international example of the same principle: a group of Catholics promoting entrenched church lines on VAD, but hiding their religious petticoats all the while.

You may wonder how many times the word “Catholic” appears in said book. The answer is: exactly zero. And mentions of “religion” and “faith” appear as abstract and conceptual argument, e.g. if a person of faith…

Not the first time it’s been published

But a further issue arises in respect of this book: it’s not the first time it’s been published. It was published two years ago by Mols Editions (Wavre) under the title Euthanasia: Behind the Scenes — Reflections and Experiences of Caregivers. Tellingly, it was published in French and mentions the French parliament grappling with VAD law reform. (The current French VAD Bill, which appears to be supported by a majority of MPs, has been filibustered with well over 2,000 (two thousand) amendments submitted by just five MPs.)

Unlike the original which you have to buy, this Springer version is “Open Access”, meaning you can download the book from the publisher for free. So is this further edition vanity publishing?

The reason I ask is that Springer Publishing is owned by Springer Nature. That’s a company whose purpose is to make money for its owners via academic publishing. So publications have to be paid for either by sales, or by authors. Since there are no sales, the authors (or someone on their behalf) will have had to pay for the book.

According to their fee schedule, Springer charge US$15k (around AUD$20k) plus taxes for publishing a tome of this nature.

So: who paid for the book?

Conclusion

Far from a carefully researched collection of studies into VAD practice in Belgium, this polemical book relies heavily on the “moral intuitions” of innuendo, unverified anecdote and misinformation. It’s consistent with the propaganda put about by the Catholic church, yet not once throughout the entire book does anyone mention their deep Catholic connections. Indeed, you could be forgiven for thinking they’d taken some care to cover their religious petticoats.

A serious compendium of proper, scholarly studies of VAD practice, good and bad, is always welcome. This book is not it.

In my view, the tome does no favours for Springer, which has a solid reputation for academic and scholarly publication.

And, back to that 1990 TV commercial for boxes of breakfast cereal. It had popped into my head as an analogue: “Don’t mention it’s religious and they’ll publish it by the book-full.”


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A forensic analysis exposes Theo Boer's smoke and mirrors on 'suicide contagion'

In my most recent article in the Journal of Assisted Dying, I forensically analyse Dutch ethicist Professor Theo Boer’s 2017 paper purporting to find suicide contagion from assisted dying in the Netherlands. It doesn’t go well for Professor Boer, to put it mildly. You can find the full article here.

I also find an astonishing coincidence that occurred in 2014, the year Boer went feral against the Dutch euthanasia law.

Multiple fatal flaws

In the ‘analysis’ outlined in his article, Boer commits a number of fatal scientific no-noes, including failing to analyse the variable he actually surmised might cause suicide contagion, cherry-picking data that supported his conclusion while ignoring or offhandedly dismissing data at odds with his conclusion, and wrongly forming a causative conclusion from a simple correlation while failing to control for any confounding variables of which there are many.

A litany of scientific offences

In addition to the fatal flaws, Boer’s article contains numerous other scientific and academic offences. My forensic analysis concludes:

“In summary, Boer’s article contains a litany of scientific and scholarly failures. Its speculations are ill-informed, poorly-assembled, incoherent in places and mostly uncited, the data cherry-picked and invalidly interpreted, and the laissez faire methodology incapable of validly supporting its conclusion.
 

Boer conjures up mere smoke and mirrors to argue suicide contagion from VAD in the Netherlands. The article should be retracted.”

The article also reflects badly on the journal that published this smoke and mirrors: the Journal of Ethics in Mental Health. Neither peer review nor editorial effort identified or attempted to correct any of the nonsense in the article.

What was he thinking?

Professor Boer is an expert in Reformist Protestant theology. As a religious ethicist, it’s astonishing that he considered himself suited to conducting and publishing a ‘causative’ scientific study.

In his article, Boer proposed VAD as the only factor to contribute to changes in the Netherlands’ general suicide rate (and dismissed the Belgian data which contradicted his theory).

In reality, numerous risk and protective factors affect the suicide rate, and in the Netherlands as I’ve established using their official government data, just one factor — unemployment — explains 80% of the variance in the Dutch suicide rate since 1960. Boer casually dismisses this without providing the faintest fume of an empirical analysis himself.

Boer’s article did little but amply demonstrate his underlying anchoring and confirmation bias on the subject, his unfamiliarity with the complexity of suicide, and ignorance of proper scientific principles.

For good measure, he casually threw in a comment about “suicide contagion” or copycat suicides, without understanding that in suicide, copying is the method of causing death. But by definition, general suiciders don’t follow the provisions of the euthanasia Act.

His endeavour made as little sense as me writing a conclusive article about Reformist Protestant theology, about which I know very little.

A copycat analysis?

Coincidentally, the structure of the storyline, the litany of scientific offences committed, and the conclusions reached in Boer’s article were surprisingly similar to those in an ‘analysis’ of Oregon’s suicide rate in another paper by Jones and Paton. Like Boer, Jones and Paton start out by surmising that assisted dying ought to lower the general suicide rate, and conclude the opposite.

Boer approvingly cites the Jones and Paton article, even though a forensic analysis found no fewer than ten major scientific flaws in it and provided multiple sources of empirical evidence at odds with the article’s conclusions.

But Boer manages to cock even the citation up, referring to the article’s authors as Holmes and Paton.

Will the real Theo Boer please stand up?

Boer notes that he’s always been a euthanasia sceptic. Nevertheless, as a Reformist Protestant, he had long accepted assisted dying in “emergency” situations, of which intolerable and otherwise unrelievable suffering is a ‘qualifying’ criterion, and which is the substance of the Dutch euthanasia law (it’s regarded in legal circles as a law of “necessity”). He also opined that the Dutch model was a decent one that other jurisdictions could emulate.

Boer served as the ethicist member of one of the five Dutch euthanasia review commissions, examining every case reported to it between 2005 and 2014.

In 2014 he publicly quit his post on the review committee, slamming the Dutch assisted dying system. He’s been badmouthing it to anyone who will listen, since.

In preparation for this analysis, I asked Boer if his vocal opposition to the Dutch assisted dying model was now based on an in-principle opposition to assisted dying, or only in regard to more recent practice under the Dutch euthanasia Act. Despite a couple of iterations, I didn’t get a specific answer.

The law hasn’t changed

Here’s the point. While Boer repeatedly opines that things changed radically in the Netherlands around 2007, the country’s euthanasia Act hasn’t changed since it was passed in 2001 (and came into effect in 2002). Not. One. Word.

In addition, the Dutch Supreme Court determined in 1994 that individuals with mental (in the absence of concomitant physical) illness could qualify under the then regulatory euthanasia framework, and it was found that cases occurred every year.

And the 2001 Act formalised in statute the regulatory framework that had existed since at least 1984, when the Dutch medical association first published guidelines for euthanasia.

Thus, the Act reflects very long-standing practice, and it hasn’t changed since it was enacted, in contrast to Boer’s claim that things have radically changed.

Flimsy and incoherent ‘ethics’ part 1

This brings us to the first fatal incoherence of Boer’s “ethics”: that he now opposes the law because people with psychiatric illness and other conditions are, in slightly increasing numbers, availing themselves of the euthanasia law. It is these cases against which Boer rails, despite having previously said the Dutch model is a good example for the world, and having actively participated in the system.

Boer’s flip flop is to argue that a law that permits assisted dying under a range of medical conditions (and has done so for decades) is a good law, provided some of those who might qualify (like psychiatric cases) never use it.

Try and explain the ethics behind that position.

Flimsy and incoherent ‘ethics’ part 2

The second fatal incoherence of Boer’s ‘ethics’ is his repeated complaint that until around 2007, the numbers of euthanasia cases was “somewhat steady”, but increased after that. Never mind that the majority of the increase was still in relation to terminal cancer: Boer simply railed at the increased numbers as a major problem.

But, try and explain using ethical principles, why it is appropriate for 2,000 people a year to avail themselves of the euthanasia law, but inappropriate for 4,000 (who all qualify)?

Indeed, the Dutch euthanasia Act makes no mention of numbers: there is no legislated limit on the count of people who might choose to use the law. Rather, it is based on due care criteria, outlining the circumstances of who may qualify, and the process by which they may.

The legislature’s intent remains unchanged and is still being adhered to, though more people, the majority of whom have terminal cancer, are using the law.

It’s astonishing that a Professor of Ethics fails to reflect on the fatal incoherence of his own ‘ethical’ arguments.

What happened?

Boer, who had supported and promoted the Dutch euthanasia model suddenly and incoherently changed his position to vocally opposed in 2014. What happened?

One factor might shed some light. In 2014, Boer was appointed to the endowed professorship of Lindeboom Chair in Ethics in Healthcare at Kampen Theological University.

While Kampen Theological University is a Dutch Reformist Protestant institution and therefore may support assisted dying in “emergency” cases, the Lindeboom Institute, which endows Boer’s eponymous professorship, is less understanding.

The Lindeboom Institute was co-founded by several orthodox Christian institutions and cooperates with the Netherlands Evangelical University which studies science from an creationist Biblical perspective.

The Institute demands “biblically sound medical ethics” along with “Christian norms and values”. You’d be left wondering what that actually means, until you find on its website that the Board’s role is “the protection of people at all stages of life”.

In addition, participating organisations that fund the Lindeboom endowment, like the Dutch Patients Association, Pro Life Health Insurance and the Foundation for Christian Philosophy, are strongly opposed to assisted dying in any form.

It turns out that the authors of that other ‘analysis’ that commits numerous similar scientific offences which generate smoke and mirrors, Jones and Paton, are devout conservative Catholics.

Gosh. What a coincidence.


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Netherlands 'suicide contagion' from assisted dying: Theo Boer's smoke and mirrors


Author(s)

Neil Francis

Journal

Journal of Assisted Dying, vol. 4, no. 1, pp. 1–11.

Abstract

Background: Concerns had been raised about the scientific quality of a 2017 article by ethicist Theo Boer in which he theorised that lawful voluntary assisted dying (VAD) would potentially ‘dampen’ suicide rates, but drew the opposite conclusion: the suggestion that VAD cases have caused higher suicide rates.
Methods: A structured, forensic examination of the article was conducted.
Results: Numerous serious shortcomings were found, including (a) profound unfamiliarity with the complexity of suicide; (b) lack of a clear and specific pre-hoc methodology; (c) numerous unsupported speculations; (d) cherry-picked data and casual dismissal of data at odds with the conclusion; (e) a simple correlation interpreted as causation while failing to control for any confounding factors; (f) incoherent, contradictory and misleading statements; and (g) multiple editorial errors.
Conclusions: Boer’s article is poorly conceived and carelessly assembled, revealing unfamiliarity with both the subject matter and with scientific principles. The conclusions drawn are not supported by the article’s methodology or data. The article offers mere smoke and mirrors to conclude that VAD may increase suicide rates, at odds with wider evidence.

Article keywords

voluntary assisted dying, euthanasia, suicide contagion, Werther effect, Netherlands, methodology

Full PDF

Download the full PDF: Download the full article (5.4Mb)

Citation

Francis, N 2019, 'Netherlands "suicide contagion" from assisted dying: Theo Boer's smoke and mirrors', Journal of Assisted Dying, vol. 4, no. 1, pp. 1-11.

Download the citation in RIS format: RIS.gif


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DyingForChoice has translated the entire 2016-2017 report into English

Belgium's Federal Commission of Control and Evaluation of Euthanasia this week published its full 2016–2017 biennial report. The report is published only in French and Dutch, which places English-speaking jurisdictions at something of a disadvantage.

DyingForChoice has translated the entire report, as well as a copy of the Belgian Euthanasia Act (2002) as it currently stands with amenedments, so that English-speaking audiences can read and understand it.

A summary of key points, the full report in English, and a full copy of the Euthanasia Act, can be found in this Fact File.


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DyingForChoice has translated the Belgian 2016-2017 report into English

The Belgian Federal Commission of Control and Evaluation of Euthanasia has released its full 2016–2017 report. Its reports are published only in Belgium's two national langauges: French and Dutch. So that English-speaking countries can read the report in full, DyingForChoice.com has translated the entire 70 page report into English.

Major takeouts of the 2016–2017 report include:

  • There is ample evidence that doctors take diligent care by often consulting more widely than the Act requires.
  • Assisted dying by advance directive remains very uncommon (1.3% of 2016/17 cases): almost all cases are by current request.
  • There has been a significant increase in the ‘poly-morbidities’ category, in part because of a change in the classification system, but also because more folks fall into this category as the population ages.
  • Cancer is still the major reason that patients choose assisted dying (64% in 2016/17), though its proportion of contributing illnesses is falling.
  • The number of assisted dying cases in relation to psychiatric illness went down, not up, compared to previous years.
  • Since changing the law in 2014 to permit assisted dying choice for minors, there have been just three cases: two in 2016 and one in 2017, all of severe and intractable illness. Extensive consultation occurred in each of the three cases, including assessment of decision-making capacity by at least one specialist child psychiatrist or psychologist.
  • The typical age profile of euthanasia cases has in recent years increased a decile, as the population ages. Our own analysis of Belgian official death stats (not the Commission’s) shows that the elderly are not an ‘at risk’ group: the age distribution profile of assisted deaths is still younger on average than total deaths.
  • The Commission notes that cancer diagnoses are increasing, so the counts of assisted deaths are expected to continue to rise in coming years.
  • The Commission discusses several cases that required extended review, but no cases were referred to the public prosecutor in 2016/17.

 

The full (unofficial) English report can be downloaded here: PDF 1.4Mb.

A full (unofficial) English translation of the current version of the Belgium Euthanasia Act can be downloaded here: PDF 0.3Mb.

The authoritative original versions of the Belgian 2016-2017 report can be accessed in French and Dutch.

 

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Update: Margaret Somerville is now Professor of Ethics at the Catholic University of Notre Dame Australia.

In the previous video a claim by Catholic Professor of Ethics Margaret Somerville was rebutted: that the Dutch and Belgians seek health care in Germany because they fear being killed by their own doctors and without being asked. In this video, she furthers her bizarre claim by referring to Dutch and Belgian non-voluntary euthanasia rates as 'proof' of her border-crossing healthcare thesis.

However, her cherry-picked statistic establishes nothing, whereas her claim is contradicted by robust research, which I discuss in this video.

It's unclear why Professor Somerville seems to be unaware of or ignores readily-available yet contradictory evidence of central importance to her claim.

This 'non-voluntary slippery slope' claim is another one that's popular amongst campaigners against assisted dying.

 

Transcript

Neil Francis: In the last video, we established as false, Professor Margaret Somerville’s absurd claim of the Dutch going to Germany for health care because they feared being killed by their doctors. But she goes on.

Margaret Somerville: In actual fact they’ve got good reason to fear that, uh, there’s a minimum of, a minimum of 500 cases a year, of doctors who administer euthanasia to people in the Netherlands, where it’s legal, and the patient does not know they’re being given euthanasia, and has not consented to it. Some reports put the figure as high as 2000 cases a year.

Neil Francis: And she makes a similar case for Belgium. So let’s look at the empirical evidence.

Neil Francis: What she’s referring to is non-voluntary euthanasia, or NVE. It occurs in every jurisdiction around the world. A study published in 2003 found these rates. You’ll notice that Italy had the lowest and Belgium the highest NVE rates. And at the time of this study, which countries had legalised assisted dying?

Neil Francis: Switzerland had since 1942, and the Netherlands since 1982. But none of the others had. So the Swiss and Dutch NVE rates, with assisted dying laws, were lower than Denmark’s, without one. And the higher Belgian rate wasn’t caused by an assisted dying law, because none existed at the time.

Neil Francis: But did the Belgian and Dutch NVE rates go up when each country legalised assisted dying by statute in 2002? Here’s what happened in Belgium: the rate didn’t go up — it went down, and the drop is highly statistically significant.

Neil Francis: And in the time since Professor Somerville made her misleading claim, it’s remained lower.

Neil Francis: And here’s what happened in the Netherlands. This rate before the Act is around 1,000 cases a year, and this one after the Act is around 500, the rate that Professor Somerville refers to in her claim as “the minimum”. What she failed to mention is that since statutory legalisation of assisted dying, the Dutch NVE rate dropped, not risen, and to a similar level as the UK, the world’s gold standard for palliative care, and which has never had an assisted dying law.

Neil Francis: And since Professor Somerville made her misleading claim, it’s dropped even further.

Neil Francis: If Professor believes that she has verifiable empirical evidence to back up her claims, let her produce it for examination. Until then, her non-voluntary euthanasia “slippery slope ”is nothing more than fear-mongering innuendo.

Visit the YouTube page.

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Update: Margaret Somerville is now Professor of Ethics at the Catholic University of Notre Dame Australia.

Catholic Professor of Ethics Margaret Somerville claimed in a University address that elderly Dutch people are fearful of being euthanased in nursing homes and hospitals and instead travel to Germany for health care.

She provided no sources or evidence for her claim.

Dr Els Borst, the Minister resonsible for the Netherlands' euthanasia law, reveals these claims about 'fear of being killed' in nursing homes as 'absolute lies.' Dutch Senator Heleen Dupuis confirms that it is untrue.

The claim is popular amongst opponents of assisted dying law reform. It raises questions about how a Professor of Ethics came to state is as authoriative fact.

Transcript

Neil Francis: Former Dutch Minister for Health, Dr Els Borst, shared an experience her Government had with the Vatican about assisted dying

Els Borst: Their journal, the Osservatore Romano, was writing, was publishing articles saying that in the Netherlands, people who went to a nursing home or an old people's home, didn't dare to do that any more because they were so afraid they would be killed by their doctor after a week or so.

Els Borst: And we were so angry about this, absolute lies, that we went together, to the Vatican, and we told them that if they didn't stop that sort of lies in their journal, that we would stop diplomatic relations with Vatican City.

Els Borst: We had an ambassador there, and my colleague the Minister for Foreign Affairs said, "I'll withdraw that ambassador and he'll never return."

Else Borst: And then it stopped.

Neil Francis: Well perhaps the Vatican did, but here's Catholic Professor of Ethics, Margaret Somerville.

Margaret Somerville: Old Dutch citizens are seeking admission to nursing homes and hospitals in Germany, which has a strict prohibition against euthanasia because of its Nazi past, and they're too frightened to go into nursing homes or hospitals in the Netherlands.

Neil Francis: I asked Dutch Senator, Professor Heleen Dupuis, about the claim.

Heleen Dupuis: OK, stupid. It is simply not true.

Neil Francis: It's time to stop spreading such fearmongering scuttlebutt.

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Update: Margaret Somerville is now Professor of Ethics at the Catholic University of Notre Dame Australia.

Catholic Professor of Ethics Margaret Somerville claimed in a University address that the Minister who brought in the Netherlands' euthanasia Act (that's Dr Els Borst), said that doing so had been "a serious mistake."

In an offence against scholalry standards, Prof. Somerville did not check her facts with the primary source before making the claim. I know, because I did. I interviewed Dr Borst in Utrecht: Prof. Somerville had not contacted Dr Borst, and Dr Borst stated clearly and without hestitation that she still thought it a good law.

Prof. Somerville instead chose to repeat scuttlebut circulating amongst assisted dying law reform opponents.

Transcript

Neil Francis: Before her death, I visited Dr Els Borst in Utrecht, to seek her current views about the Netherlands' euthanasia Act, which she introduced into the Dutch parliament, and which had been in effect for many years.

Voice of Neil Francis (interview): What are your feellings about the law?

Els Borst: I'm still very happy with it. I think we did the right thing there, also in the way we formulated it.

Neil Francis: But despite the clarity of Dr Borst's continued support for the law, Professor Somerville claimed the opposite in an address at the University of Tasmania.

Margaret Somerville: The Minister who was responsible for shepherding through the legislation that legalised euthanasia in the Netherlands admitted publicly that doing so had been a serious mistake."

Neil Francis: Oh dear. I showed Dr Borst the video of Professor Somerville's claim, and here's her response.

Els Borst: I know that story. I'd like to meet this Margaret S... what's her name?

Vice of Neil Francis: Margaret Somerville

Els Borst: ... well maybe she wouldn't listen anyway.

Neil Francis: The public have a right to ask why Professor Somerville chose to spread scuttlebut, instead of checking her sources in a proper, scholarly fashion.

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Assisted dying rates in Dutch-speaking cultures (orange bars) are much higher than elsewhere.

In this whitepaper, Benelux (Belgium, Netherlands and Luxembourg) primary empirical data on assisted dying is analysed — including with new and advanced approaches — to provide fresh insights into contemporary practices. Investigation reveals that the assisted dying rate in Dutch-speaking cultures appears to be uniquely higher than in other cultures irrespective of the permissiveness of the legislative framework, yet is still practiced conservatively.

Download a full copy of the Whitepaper here: PDF (648Kb).

Summary

This new compilation and unique analysis of primary research data from statutory authorities and the peer-reviewed literature provides fresh insights into assisted dying practice in Benelux, including:

  1. Rates of assisted dying in the Netherlands and Belgium have followed an expected sigmoid curve, now beginning to level out.
  2. Several factors have contributed to the higher increase in the Netherlands rate, including recovery from a suppression of cases immediately following statutory reform, a rise in cancer diagnoses, and an increase in granting of assisted dying through new visiting teams launched in 2012.
  3. Both Netherlands and Belgium doctors demonstrate caution if not conservatism when assessing assisted dying requests.
  4. Despite most assisted dying occurring in cases of cancer, fewer than one in ten cancer deaths in the Netherlands and one in twenty in Belgium is an assisted death.
  5. Other conditions such as degenerative neurological, pulmonary and circulatory illnesses each account for a very small proportion of the increase in cases since legalisation in Benelux.
  6. The assisted dying rate in dementia and other mental illness is very low despite controversy around—and a tiny rise in granting of—such cases.
  7. The hypothesis that females or the elderly would be ‘vulnerable’ to assisted dying law is contradicted by the data.
  8. The rate of non-voluntary euthanasia has decreased significantly in both the Netherlands and Belgium since assisted dying was permitted by statute.
  9. Assisted dying rates in Dutch-speaking cultures are significantly higher than in non-Dutch cultures, seemingly unrelated to the permissiveness of the jurisdiction’s legal framework.

 

beneluxratessmall.gif
Benelux country reported assisted dying rates (as a percentage of all deaths)
as at 2014. The three countries have similar assisted dying laws.
 

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The AMA fails to represent the breadth of physicians perspectives around assisted dying.

This informative Go Gentle Australia video explains why the Australian Medical Association is out of touch with the wider Australian doctor community. Around a third of Australian doctors are members of the AMA.

The AMA currently holds a position of hostility towards assisted dying law reform, as it did against abortion before that was formally legalised. The doctors in this video explain how the AMA does not represent their views on assisted dying in restricted circumstances.

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