In response to the excellent article on what we can learn from the expanding practice of euthanasia in the Netherlands (Death on demand: Has euthanasia gone too far?, 18 January), we would like to add our assessment of the effects of assisted dying legislation on vulnerable patient groups. As experts in the fields of intellectual disability and palliative care, coming from both the Netherlands and the UK, we reviewed 16 case reports (published online by the Dutch Euthanasia Review Committee) of people with intellectual disabilities or autism spectrum disorders who have requested, and received, euthanasia.
Their “unbearable suffering” (a legal requirement) was regularly described not in terms of acquired somatic or psychiatric illness but in terms of the normal characteristics and variations of their lifelong condition or disability. This included people’s inability to adapt to new situations, maintaining social contacts or having meaningful relationships; a lack of effective coping strategies; and treatment refusal due to an inability to consider feasible alternatives to euthanasia.
Loneliness, feeling isolated and being unable to participate in society were all seen as valid causes of unbearable suffering. Euthanasia was agreed for these patients, because their physicians deemed them to be suffering unbearably “without prospect of improvement” (another legal requirement).
Euthanasia has become normalised in the Netherlands. Growing numbers of people are asking to die. But who can really assess that someone’s suffering is so bad that it is better to be dead than alive? And what are the “prospects of improvement” in a society where disabled people face stark inequalities in health and social care?
Read more at The Guardian…