Thursday, March 1, 2012

Brave New World?

Bob recently came across the 2010 Annual Report of the Netherlands’ five Regional Euthanasia Review Committees. The Report states that “notifications” increased 19% in 2010 – from 2,626 to 3,136. A “notification” is an official notice from a physician to one of the Dutch Regional Euthanasia Committees that the physician has terminated a life - a human life - by request of the patient. It is important to understand that the reviews conducted by the Euthanasia Committees do not take place prior to the death of the patient, but afterward.

This Report is relevant to the debate that is growing in the United States over end-of-life care, and I recommend reading the whole article.

End-of-life care can be very expensive and, by definition, does not save lives. Discussion of such care quickly brings up many difficult ethical and financial issues. For example, “dying with dignity”. For example, a very large share of Medicare expenses are incurred caring for people in their last 6 months of life. For example, Medicare does not cover non-medical expenses for people who can no longer perform basic activities of daily living, which places a large and growing social burden on families, plus a large and growing financial burden on Medicaid. There is debate whether care that is “futile” should be delivered anyway – or withheld. If you read the Euthanasia Report, reflect that such issues frame one of the most critical medical, social, ethical, and financial problems America faces – in our lifetimes, and for generations to come.

The Dutch are attempting to face these issues explicitly. Whether or not you agree with the Dutch approach to end-of-life care, I recommend you be aware what the Dutch are doing, and why.

What are my own opinions?

I don’t yet know enough about it, but several things about the Dutch approach seem positive. First, their euthanasia law does not grant government the power to terminate any life. The decisions are reserved to the patient, the patient’s family, and the patient’s physicians. Also, instead of a priori review the law sets out uniform criteria that physicians must follow, requires a review process to evaluate compliance, and then publishes the review findings for all cases.

(I think it’s unsettling that the Dutch government has not adequately staffed the Euthanasia Committees, so that their findings are not being published. Of the more than 3,000 notifications received in 2010, apparently the only findings actually published are the 15 or so included in the 2010 Report. While unfunded government programs are nothing new, this one is unsettling. The Euthanasia Committees “greatly regret” this - see Page 3 - expressing no regret at the sharply rising numbers of self-requested terminations.)


Alexander Solzhenitsyn wrote about a regime that not so many years ago, officially found political opponents "mentally ill" as a convenient excuse to imprison them.

I don't mean to compare the Netherlands with the USSR. I only mean to pose a few questions - - because laws can be changed:

Is the next step for the world’s progressive states to embrace the morality of killing those judged to be in sufficiently poor physical health? And if so, by what criteria will "sufficiently poor" be judged? (e.g., before they run up our taxes or spend our inheritances?) Criteria decided by whom? (Bureaucrats or physicians?) Should physicians be willing partners in this type of activity? Is the Hippocratic Oath now fully euthanised?

I also worry that once a nation has stepped onto the path of euthanasia - as the Netherlands did several years ago with newborns - it is flirting with moral free-fall and no one should be surprised how that may evolve.

O Brave New World that hath such people in’t.

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