Daniel Callahan (co-founder and President Emeritus of The Hastings Center): ‘The advocates for physician-assisted suicide make use of a favourite method from the spin-tool box, that of obfuscation, defined in dictionaries as an effort to render something unclear, evasive, or confusing.’ (Callahan, 2008) Robert Twycross (Reader, Oxford University): ‘[The pro lobby’s] attempt to ‘prettify’ the language of death by not using terms such as assisted suicide, euthanasia, and killing…’ (Twycross, 1990) Wesley J.Smith (journalist and author of Forced Exit): ‘According to Compassion & Choices, when a terminally ill patient swallows an intentionally prescribed lethal overdose of barbiturates, it isn’t really suicide. Because the word ‘suicide’ has negative connotations, and C&C wants people to feel positive about some self-killings.’ (Smith, 2013) During the last 30 years, euthanasia and/or physician-assisted suicide (PAS) have been legalized in a number of countries.
End of Life Clinic In 2012, the Dutch Association for Voluntary Euthanasia (NVVE) founded the End-of-Life Clinic or Levenseindekliniek (see Levenseindekliniek).
The Dutch have reported their practices each 5 years since 1990 (Table 1) (van der Maas et al, 1991; van der Maas et al, 1996; Onwuteaka-Philipsen et al, 2003; van der Heide et al, 2007; Onwuteaka-Philipsen et al, 2012b; van der Heide et al, 2017).
They are an approximation, given the limitations of the published data, but they suggest of the order of 450,000 people may have been involved in the Dutch experiment.
Henk ten Have (Professor of Medical Ethics at the University Medical Centre of Njmegen) and Jos Welie (Professor of Health Policy and Ethics, Creighton University, Omaha): ‘The important lesson to be learned from the Dutch experiment is the virtual impossibility of regulating the practice of euthanasia and PAS through public debate, laws and policies.’ (Ten Have and Welie, 2005) Neil M Gorsuch (Associate Justice of the Supreme Court of the United States and author of The Future of Assisted Suicide): Does a regime dependent on self-reporting by physicians who have no interest in recording any case falling outside the guidelines adequately protect against lives taken erroneously, mistakenly, or as a result of abuse or coercion? (Gorsuch, 2006) The ‘slippery slope’ is the gradual extension of assisted suicide to widening groups of patients after it is legally permitted for patients designated as terminally ill (Hendin et al, 1997a).
Withholding or withdrawing therapy may be entirely clinically appropriate, the possibility of life-shortening being acknowledged, but not intended.
In contrast, withholding or withdrawing therapy performed with the intention of hastening death or ending life, is no different to euthanasia—these are deaths caused by the active intervention of the physician.
The figures are also available from The Royal Dutch Medical Association (KNMG) website (see KNMG).
Reports for 20 are available (see Regional Euthanasia Review Committees. The figures in Table 2 are calculated from the Dutch data.
In Holland and Belgium, euthanasia is defined as being at the patient’s request, so cases of ‘ending of life without the patient’s explicit request’ have to be counted separately.
It is ethically and morally no different to euthanasia.