As the New Zealand euthanasia referendum approaches, voters could be helped by looking at the experience in other countries before making up their minds on this complex topic. At the end of July, Czechia became the latest country to reject the legalisation of euthanasia following similar rejections in Portugal and Finland. The opposition to the bill was largely based on concerns about the impact on the elderly and vulnerable. The final nail in the coffin was the Ministry of Social Affairs’ assessment that the bill did not contain enough safeguards against human error or violations of the law.
Wherever euthanasia is proposed, its advocates normally try to alleviate concerns by explaining that the system would be carefully controlled and tightly monitored — after all, we are talking about the deliberate ending of someone’s life. In evaluating what they say, we do not have to rely on speculation. Instead, we can look to the way these so-called “safeguards” function in countries that have already legalised these practices.
I represent Tom Mortier, a Belgian university lecturer in his landmark case at the European Court of Human Rights. In 2012, his physically healthy 64-year-old mother was euthanised for what the doctor called ‘incurable depression’. After more than six years of research, and close analysis of responses provided by the Belgium government, it is clear that the reality falls a long way short of the promises made when the Belgian legislation was passed in 2002.
- Myth: Euthanasia is possible only where there is suffering that cannot be alleviated
This was the standard built into the Belgian euthanasia law, but its interpretation has been watered down to the point that it provides no protection. In the case of Tom’s mother, doctors knew that she was struggling with depression, in part because of distance from her family. And yet when she refused to reach out to them, they quickly concluded her suffering was incurable. By this logic, almost anything could be considered incurable.
- Myth: Euthanasia must be approved by two independent doctors
One of the supposed safeguards is that a doctor’s decision must be confirmed by one, or in some cases two other doctors. And yet in the case of Tom’s mother, the doctors involved were members of the same pro-euthanasia organisation. Hardly an “independent” verification, but it was considered acceptable by the Belgian authorities. Moreover, in the weeks before her euthanasia, Tom’s mother made a 2,500 EUR payment to this organisation, which presents yet another possible conflict.
- Myth: The paperwork must be completed in a timely way
According to the Belgian law, the official euthanasia form must be filed with the government within four working days. In the case of Tom’s mother, the government admits it was received at least two months late. And yet, when the Commission reviewed this form, it found no cause for concern.
- Myth: Cases must be reviewed by an independent euthanasia review commission
Not only did the Belgian Commission fail to see the obvious issues with the form in this case, it has reviewed over 12,000 cases and only referred one for investigation to the prosecutor. That statistic is less surprising in light of the fact that the Commission has been co-chaired since its creation by a leading euthanasia activist, who happens to be the doctor who euthanised Tom’s mother.
- Myth: There is a robust system for dealing with conflicts of interest within the euthanasia commission
Given the Commission is packed with doctors who advocate for and practice euthanasia, you might imagine it has a robust system for dealing with potential conflicts of interest. Instead, the Belgian government has told the European Court of Human Rights that its procedure simply requires a doctor to sit silently in the room while the rest of the Commission discusses whether or not their case should be referred for criminal investigation. It is hard to imagine a more useless system of oversight.
- Myth: The system is open to external scrutiny
To maintain public confidence, it is important that the decisions of the Commission be subject to scrutiny. In the case of Tom’s mother, the Commission — led by the doctor who carried out the euthanasia — simply refused to release the form to her next of kin. When Tom filed a complaint, the prosecutor initially “misplaced” it. After locating it, he took the next three years investigating it to then conclude with a single-sentence letter stating there was insufficient evidence to proceed. And yet we now know that even a quick glance at the euthanasia form should have raised cause for significant concern.
- Myth: The patient must have made a settled and voluntary decision
Tom’s mother was suffering from a diagnosed psychiatric condition at the point at which her life was ended by lethal injection. To satisfy this apparent requirement, the doctor simply scribbled on the form that she had been “asking for it for years.” And yet this doctor had only met her months earlier; he specialises in cancer, not psychiatry; and appears only to have been approached because of his unquestioning approach to euthanasia.
To those who would say, “this is just one case.” It is. But that is one life, one mother, and one grandmother too many. She leaves behind children and grandchildren who are still — years on — dealing with the fallout. And the issues identified in this case go much deeper. Who knows how many other tragedies have been nodded through by this defective system? Moreover, once these laws are passed, there is no logical stopping point. Their advocates push for more and more. That has happened in Belgium — where child euthanasia was legalised in 2012 — and in the Netherlands — which is debating making euthanasia available for elderly people who are “tired of life”, after already expanding the law to include those suffering with dementia.
As we grapple with the implications of euthanasia and assisted suicide, we owe it to ourselves, and to the sick and the vulnerable, to weigh up not just the “best case scenario” that some paint, but to wrestle with the dark reality that is revealed when we really pull back the curtain on these practices. The sad conclusion is that these so-called “safeguards” are much more window dressing than providing any real protection. And the reality is that these laws are more likely to harm than to help the vulnerable.