The ‘Groningen protocol’ for euthanasia of disabled babies in the Netherlands

In an interview this morning on BBC Five Live (at 0705) on the Paul Lamb case (listen here) I was asked by the presenter Nicky Campbell about evidence for a slippery slope following the legalisation of euthanasia in other jurisdictions.

In my answer I mentioned the steady escalation in numbers of cases in Belgium and the Netherlands (see hereand here) and said that one third of nurses had carried out euthanasia illegally in Belgium and that one third of cases in some parts of Belgium had been involuntary although the law did not allow this.

I also mentioned the ‘Groningen Protocol’under which disabled babies had been given lethal injections in the Netherlands.

Campbell appeared not to know about this and asked me on air to email him information about it to which I agreed. Another BBC journalist phoned me after the interview to check my sources.

I sent her a link to the original paper on the ‘Groningen Protocol’ from the New England Medical Journal in 2005.

The full reference is ‘Verhagen E, Sauer P. "The Groningen Protocol—Euthenasia in Severely Ill Newborns." New England Journal of Medicine 2005; 352(10):959-62’

It says that ‘Twenty-two cases of euthanasia in newborns have been reported to district attorneys' offices in the Netherlands during the past seven years’ but also highlights underreporting:

‘Given that the national survey indicated that such procedures are performed in 15 to 20 newborns per year, the fact that an average of three cases were reported annually suggests that most cases are simply not being reported.’

The 22 babies killed all had spina bifida and/or hydrocephalus – conditions which many disabled people live with in Britain today (Here is another report on the protocol from CBHD citing the 22 documented cases).

Under the ‘Groningen Protocol’ the termination of a child's life (under age 12)is acceptable if four requirements were properly fulfilled:

1. The presence of hopeless and unbearable suffering
2. The consent of the parents to termination of life
3. Medical consultation having taken place
4. Careful execution of the termination

A more recent report suggests there has been a reduction in cases of direct newborn euthanasia in the Netherlands since 2005 because of 1. More efficient prenatal detection and late abortion 2. More use of ‘terminal sedation’ not recorded officially as euthanasia 3. Continued underreporting

Other issues I mentioned to the BBC in my email included:

1. Almost half of Belgium’s euthanasia nurses have admitted to killing without consent, despite the fact that involuntary euthanasia is illegal in Belgium and that nurses are not allowed to perform even voluntary euthanasia. 

2.  In Belgium, nearly half of all cases of euthanasia are not reported to the Federal Control and Evaluation Committee. Legal requirements were more frequently not met in unreported cases than in reported cases and a written request for euthanasia was absent in 88%.

3. A recent study found that in the Flemish part of Belgium, 66 of 208 cases of ‘euthanasia’ (32%) occurred in the absence of request or consent.

4. According to a recent report Belgium is now the ‘world leader’ in organ removal after euthanasia with at least nine cases since 2005 but suggestions are that there would have been many more had more euthanasia patients had transplantable organs.

5. The stunning 5,000% increase in Belgian euthanasia cases in eleven years since legalisation.

6. Summary of recent developments in Netherlands documenting a 15-20% increase in euthanasia cases per year since 2006 (gives good overview of overall situation).

7. The latest Lancet paper on the subject giving 12.3% as the figure for terminal sedation deaths in the Netherlands and summarising other past papers in NEJM/Lancet

I gather that Nicky Campbell has since agreed on twitter with my opponent in the interview (Andrew Copson of the British Humanist Association) that I was ‘a past master in extreme and irrelevant claims’ (I'd be interested to hear his evidence for that btw) but at least he will be able to verify the truth of my claims about euthanasia in Belgium and the Netherlands from the links given above.

For ten year report on Euthanasia in Belgium see here.

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Warning sounded to UK as Oregon assisted suicide deaths hit record high

Lord Falconer has just announced that he is about to introduce a new bill into the House of Lords to legalise assisted suicide along the lines of the Oregon model – assisted suicide for mentally competent adults who have less than six months to live.

Members of the House of Lords should note that statistics released just last month (full report here) show that the number of assisted suicide prescriptions and deaths in Oregon, once again, increased in 2012 and has now reached an all-time high.

Falconer’s bill, however, only requires a twelve month life expectancy and so is thereby even more liberal than Oregon’s.

There were 59 assisted suicide deaths in Oregon in 2009, 65 in 2010, 71 in 2011 and 77 in 2012; a 30% increase overall in just four years.

The number of prescriptions for assisted suicide was 95 in 2009, 97 in 2010, 114 in 2011 and 115 in 2012; 115 in 2012; a 21% increase since 2009.

Overall assisted suicides have gone from 16 in 1998 to 77 in 2012, an overall increase of 381% (see chart above).

This pattern of incremental extension is similar to that seen in the Netherlands and Switzerland, other countries that have changed the law.

A major factor fuelling this increase is suicide contagion - the so-called Werther effect. This is particularly dangerous when assisted suicides are backed by celebrities as they are here and given high media profile as they are frequently by the BBC.

The Oregon numbers may not seem large but we need to remember that Oregon has a very small population relative to the UK and that they may well be an underestimate as they are based on physicians' self-reporting.

But for argument's sake let's simply take them at face value. How would they then translate to Britain?

Back in 2006, and based on Oregon’s total of 38 assisted suicide deaths in 2005, the House of Lords calculated that with an Oregon-type law we would have about 650 cases of assisted suicide a year in Britain.

But as the numbers in Oregon have since doubled to 77 the UK equivalent would now be 1,300. With Falconer’s more liberal interpretation of what constitutes ‘terminally ill’ the numbers here would be expected to be higher still.

Currently assisted suicide is illegal here and we see only 15-20 Britons going to Dignitas in Switzerland to die each year.

We should learn from the Oregon experience and be resisting these moves.

Any change in the law to allow assisted suicide (a form of euthanasia) would inevitably place pressure on vulnerable people to end their lives so as not to be a burden on others and these pressures would be particularly acutely felt at a time of economic recession when many families are struggling to make ends meet and health budgets are being slashed.

And once legalised there will inevitably be incremental extension as we have seen in Oregon, Switzerland and the Netherlands. Legalisation leads to normalisation.

Currently only two US states, Oregon and Washington, have legalised assisted suicide, each on the basis of a referendum.

By contrast whenever a bill has been brought before a US state parliament it has been defeated. This has happened over 120 times in the last 20 years.

Thirty-four states prohibit assisted suicide outright. Massachusetts and six other states have banned it through legal precedent.

It is often argued by the pro-euthanasia lobby that opposition to the legalisation of assisted suicide is largely faith-based. But this is not true.

In Massachusetts, a left leaning Democrat state which rejected assisted suicide in a referendum last year, the opposition of doctors and disabled people has been very significant indeed.

This is because one of the most powerful arguments against it is public safety – any change in the law will put pressure on vulnerable people to end their lives and no law can be adequately safeguarded against abuse.

I have previously blogged about the shroud of secrecy which surrounds assisted suicide practice in Oregon, the worrying trends in neighbouring Washington state, which enacted a similar law more recently and the way the Oregon law steers people toward suicide.

Also deeply concerning are reports of depressed patients being killed without being treated, doctor shopping, deaths taking place without witnesses present (raising questions about elder abuse) and the fact that 44 of the 77 who died last year (57%) said that they were concerned about being a burden on family, friends and caregivers.

The lessons are clear. Let’s not go there.

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Warning to UK - Oregon Health Plan steers patients towards suicide

Members of the pro-euthanasia movement frequently point to the US state of Oregon, which legalised assisted suicide in 1997, as a model which Britain should follow.

Lord Falconer and Margo Macdonald MSP are two British politicians who have frequently sung the praises of Oregon which allows assisted suicide for mentally competent adults with less than six months to live (although Falconer’s and Macdonald’s recently proposed bills to be debated in the New Year are much more lax on their definition of ‘terminally ill’).

I have previously blogged about the huge increase in assisted suicide cases in Oregon since legalisation (see graph), the shroud of secrecy which surrounds assisted suicide practice there and the worrying trends in neighbouring Washington state which enacted a similar law more recently.

I was therefore interested to see on Margaret Dore’s ‘Choice is an Illusion’ site recently evidence of how the Oregon Health Plan is steering patients to suicide. Dore is an attorney in Washington.

Last Friday, the Canadian Department of Justice filed evidence in Leblanc v. Canada, including the affidavit of Oregon doctor Ken Stevens. Therein, Dr Stevens talks about his patient, Jeanette Hall. He also describes how with legal assisted suicide, the Oregon Health Plan steers patients to suicide.

The Oregon Health Plan is a government health plan administered by the State of Oregon.

If assisted suicide were to be legalised in Britain, a similar pattern could well ensue. If so, the taxpayer will pay for a patient to die, but not to live.

In a recent poll by Communicate Research 60% of Tory MPs said they believed that legalising assisted suicide in the current economic climate would increase the risk that vulnerable people might opt for suicide so as not to be a financial burden upon loved ones.

78% agreed that if doctors are allowed to prescribe lethal drugs to patients on request, vulnerable people could feel under pressure to opt for suicide.

The full text of Dr Stevens affidavit is here. It concludes as follows:

AFFIDAVIT OF KENNETH R. STEVENS, JR., MD

1. I am a doctor in Oregon USA where physician-assisted suicide is legal. I am also a Professor Emeritus and a former Chair of the Department of Radiation Oncology, Oregon Health & Science University, Portland, Oregon. I have treated thousands of patients with cancer.

2. In Oregon, our assisted suicide law applies to patients predicted to have less than six months to live. I write to clarify for the court that this does not necessarily mean that patients are dying.

3. In 2000, I had a cancer patient named Jeanette Hall. Another doctor had given her a terminal diagnosis of six months to a year to live, which was based on her not being treated for cancer. I understand that he had referred her to me.

4. At our first meeting, Jeanette told me plainly that she did not want to be treated and that was going to "do" our law,i.e., kill herself with a lethal dose of barbiturates. It was very much a settled decision.

5. I, personally, did not and do not believe in assisted suicide. I also believed that her cancer was treatable and that her prospects were good. She was not, however, interested in treatment. She had made up her mind, but she continued to see me.

6. On the third or fourth visit, I asked her about her family and learned that she had a son. I asked her how he would feel if she went through with her plan. Shortly after that, she agreed to be treated and she is still alive today. Indeed, she is thrilled to be alive. It's been twelve years.

7. For Jeanette, the mere presence of legal assisted suicide had steered her to suicide.

8. Today, for patients under the Oregon Health Plan (Medicaid), there is also a financial incentive to commit suicide: The Plan covers the cost. The Plan's "Statements of Intent for the April 1, 2012 Prioritized List of Health Services," states: "It is the intent of the [Oregon Health Services] Commission that services under ORS 127.800-127.897 (Oregon Death with Dignity Act) be covered for those that wish to avail themselves to those services."

9. Under the Oregon Health Plan, there is also a financial incentive towards suicide because the Plan will not necessarily pay for a patient's treatment. For example, patients with cancer are denied treatment if they have a "less than 24 months median survival with treatment" and fit other criteria. This is the Plan's "Guideline Note 12."

10. The term, "less than 24 months median survival with treatment,"means that statistically half the patients receiving treatment will live less than 24 months (two years) and the other half will live longer than two years.

11. Some of the patients living longer than two years will likely live far longer than two years, as much as five, ten or twenty years depending on the type of cancer. This is because there are always some people who beat the odds.

12. All such persons who fit within "Guideline Note 12" will nonetheless be denied treatment. Their suicides under Oregon's assisted suicide act will be covered.

13. I also write to clarify a difference between physician-assisted suicide and end-of-life palliative care in which dying patients receive medication for the intended purpose of relieving pain, which may incidentally hasten death. This is the principle of double effect. This is not physician-assisted suicide in which death is intended for patients who may or may not be dying anytime soon.

14. The Oregon Health Plan is a government health plan administered by the State of Oregon. If assisted suicide is legalized in Canada, your government health plan could follow a similar pattern. If so, the plan will pay for a patient to die, but not to live.

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Assisted suicide deaths increase by 40% in one year in Washington State

The number of Washington state residents who died of physician-assisted suicide rose to 70 in 2011, up from 51 in 2010 and 36 in 2009, when the state’s Death With Dignity Act took effect.

The Washington State Dept. of Health reported in May that 103 patients requested and received lethal doses of medications from 80 different physicians in 2011.

In addition to the 70 who died after ingesting lethal drugs, 19 died of natural causes. An additional five died, but it is unclear whether they took the drugs. No reports were received for the remaining nine patients, indicating that they were still alive at year’s end.

The vast majority of the terminally ill patients who received life-ending drugs feared loss of autonomy, dignity and ability to participate in activities that make life enjoyable.

More than 90% were white, and 75% had at least some college education. Nearly 80% of the patients had cancer, said the report.

Seventy-one patients in neighbouring Oregon died of physician-assisted suicide in 2011. Since 1998, when Oregon’s first-of-its-kind law took effect, 753 patients in Oregon and Washington have died with physicians’ aid.

Just last month I highlighted the huge increase in deaths from assisted suicide in Oregon and Switzerland of 450% and 700% respectively over ten years as further evidence of the incremental extension that inevitably follows any change in the law. Washington is now showing the same pattern with almost a 100% increase in two years.

Assisted suicide thankfully remains illegal in Britain and we see only a small trickle of 15-20 Britons per year going to the Dignitas facility in Zurich to end their lives.

But with an Oregon- type law we would see 1,200 deaths annually.

It is no wonder that over 100 attempts to legalise assisted suicide in other US states have failed over the last 15 years and that Oregon and Washington remain the only states to have legalised the practice on the basis of a referendum.

Earlier this month Georgia became the latest US state to ban it.

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Huge increase in assisted suicide cases in Oregon and Switzerland sounds strong warning to Britain

There has been a massive increase in cases of assisted suicide in both Oregon and Switzerland over recent years according to the latest figures.

The Oregon ‘Death with Dignity Act’ allows terminally-ill Oregonians ‘to end their lives through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose’.

It also requires the Oregon Health Authority to collect information about the patients and physicians who participate in the Act, and publish an annual statistical report.

The latest figures show that cases of assisted suicide have gone from 16 in 1998 to 71 in 2011, an increase of 450% (see chart).

The US state of Oregon legalised assisted suicide in 1997 following a referendum. Thus far over 100 attempts to get other US state parliaments to change their laws have failed and only the state of Washington has followed suit, again on the basis of a referendum.

Switzerland has seen a 700% increase in assisted suicides over the same period. Swiss authorities have recorded a steady rise of assisted suicides in recent years, from 43 in 1998 to 297 in 2009. Earlier figures are not available, even though assisted suicide has been legal in Switzerland since 1942.

These figures include only Swiss nationals and not the growing number of people from abroad who are making use of facilities like Dignitas.

The experience of both countries demonstrates that when assisted suicide is legalised there will inevitably be incremental extension.

A major factor fuelling this increase is suicide contagion - the so-called Werther effect. This is particularly dangerous when assisted suicides are backed by celebrities as they are here and given high media profile as they are frequently by the BBC.

The Oregon and Swiss numbers may not seem large to some but we need to remember that Oregon and Switzerland have small populations relative to the UK.

Back in 2006 the House of Lords calculated that with an Oregon-type law we would have about 650 cases of assisted suicide a year in Britain. But given the increase of numbers in Oregon the UK equivalent would now be well over 1,000. Currently assisted suicide is illegal here and we see only 15-20 Britons going to Dignitas in Switzerland to die each year.

However, later this year we will see renewed attempts to change the law in this country.

Margo Macdonald is planning to present a bill based on the Oregon model to the Scottish Parliament and the pressure group Dignity in Dying (formerly the Voluntary Euthanasia) is planning a mass lobby of the Westminster Parliament on 4 July in support of a new bill they plan to introduce by means of their parliamentary wing, the All Party Group on ‘Choice at the End of Life’.

We should learn from the Oregon and Swiss experience and be resisting these moves.

Any change in the law to allow assisted suicide (a form of euthanasia) would inevitably place pressure on vulnerable people to end their lives so as not to be a burden on others and these pressures would be particularly acutely felt at a time of economic recession when many families are struggling to make ends meet and health budgets are being slashed.

And once legalised there will inevitably be incremental extension as we have seen in Oregon and Switzerland. Legalisation leads to normalisation.

Let’s not go there.

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Shroud of Secrecy surrounds Assisted Suicide in Oregon

I was doing an interview on BBC Radio Wales this am on the Ottaway debate when a spokesman for Dignity in Dying (formerly the Voluntary Euthanasia Society) was again singing the praises of the law allowing assisted suicide in the US state of Oregon. The ‘Death with Dignity Act’ was passed there in 1997.

Back in 2006 the House of Lords calculated that with an Oregon-type law we would have about 650 cases of assisted suicide a year in Britain, whereas as currently we see only 15-20 going to Dignitas in Switzerland to die currently. But given the increase of numbers in Oregon the UK equivalent would now be well over 1,000.

Life Site News has just published a piece by Jonathan Imbody, which draws attention to the recent critique of the Public Health Department of the Oregon Health Authority’s report for physician-assisted suicides for the 2011 year by the Physicians for Compassionate Care Education.

They note the following:

•There were more prescriptions and deaths than in any previous year; the number of prescriptions written for lethal doses of barbiturates increased from 97 in 2010 to 114 in 2011, and the reported deaths from assisted suicide increased from 65 to 71. This is indicative of an increase in hopelessness and despair among a vulnerable population with serious illness.

•62 doctors wrote 114 prescriptions, with some writing up to 14 prescriptions each. Some doctors knew the patient for only one week before writing the prescriptions. It is known that some doctors are prominent prescribers of lethal barbiturates for assisted suicide.

•As has occurred in prior years, not all who attempt to take the drugs will die. Two patients ingested the medication but failed to die. Each regained consciousness and died more than a day later, 30 hours and 38 hours respectively, of their underlying illness; they were not considered to have died from the ingested drugs. These are not easy drugs to take, they are bitter and foul-tasting, and vomiting does occur despite anti-emetics.

•As in previous years, there was virtually no formal evaluation for underlying depression, anxiety or other serious mental health issue. Only one of the 71 patients was referred for psychiatric evaluation. OHSU researchers in 2008 reported that 25% of patients requesting assisted suicide were considered to be depressed.

•As in previous years, pain has not been a major concern; only one third of patients had inadequate pain control or concern about it. The most commonly expressed concerns of those dying from physician-assisted suicide were unchanged from previous reports: less able to engage in activities making life enjoyable, losing autonomy, and loss of dignity.

•In only six cases was the prescribing physician present at the time of ingestion, in 3 other cases another provider was present. Thus, very little is known or reported regarding events at the time of ingestion of the medications. For 62 patients there was either no provider present or the information regarding presence of a provider was unknown. Physicians appear to be disengaged with patients at the end.

•In essence then, complications were unknown for 59 patients, and any information regarding minutes between ingestion and unconsciousness and death was unknown for 63 patients.

•The shroud of secrecy surrounding assisted suicide is heavier than ever. With each passing year, Oregonians know less and less about what is really happening with assisted suicides in the state.

Ironic then that DID and Margo Macdonald MSP continue to pursue a law change based on the Oregon model.

Let’s learn from Oregon and not go in that direction.

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