Journal of Medical Ethics article: Scottish Support for assisted suicide is weakening.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Scottish Parliament

An article by David Albert Jones was published in the Journal of Medical Ethics on April 15, 2024 explaining that support for assisted suicide in Scotland is weakening.

On 27 March 2024, Liam McArthur introduced his Assisted Dying for Terminally Ill Adults (Scotland) Bill. He said that he was “absolutely convinced” that the legislation would be passed as “there is growing public support for the policy”. Similarly, when the Bill was proposed in 2022 it was argued that public opinion “seems to be shifting in favour of a law change.” Again, a recent article in defence of the Bill appealed to the “increasing and now overwhelming” support in Scotland for a change in the law. This was based on “several polls” cited in the Policy Memorandum that accompanied the Bill.

The Memorandum cites four polls giving 87% (March 2019), 72% (June 2021), 77% (July 2023) and 71% (December 2023) support for “assisted dying”. In addition, a more recent poll (March 2024) of 4,132 adults in Scotland showed 78% in favour.

It is noteworthy that the three polls commissioned by Dignity in Dying Scotland (March 2019, July 2023 and March 2024), generated the highest figures for support. This is in part because the questions referred to terminal illness and included other reassurances. They also asked if people “strongly support[ed]” assisted dying or only “somewhat” or “tend[ed] to” support. Asking in this way ensures that people who are ambivalent but tend to be in favour on balance or in principle are included as supporters.

Jones explains that strong support for assisted suicide is declining:

These polls thus measured how many “strongly support[ed]” legalising assisted dying. This was 55% in 2019, 45% in 2023, and 40% in 2024. It is evident that the level of strong support has declined and that a majority of Scots are no longer strongly in favour, but are ambivalent to some degree or are opposed.

Jones explains that the public is confused by the meaning of the term - assisted dying:

To measure change in support over time, it is important to use the same question and to conduct multiple repeated polling. YouGov provides a bimonthly “tracker” (August 2019 to April 2024) for the questions: “Do you think the law should or should not be changed to allow someone to assist in the suicide of someone suffering from a terminal illness?” and “Do you think the law should or should not be changed to allow someone to assist in the suicide of someone suffering from a painful, incurable but NOT terminal illness?”

Support in Scotland in April 2024, as measured by these questions, was 71% and 41% respectively. This is lower than the polls quoted above in part because of the reference to “assisted suicide” rather than “assisted dying”. There is evidence that many people are confused about what is included in “assisted dying”. A survey conducted in 2021 found that most people thought that this meant either “giving people who are dying the right to stop life-prolonging treatment” (42%) or “providing hospice-type care to people who are dying” (10%).

In any case, the usefulness of the tracker lies less in the snapshot of support and more in capturing change over time. These trackers, each repeated 31 times over five years, clearly show that support for assisted suicide in Scotland has declined measurably.

Support for assisted suicide is less than 50% when it applies to people who are not terminally ill and yet Scotland's euthanasia bill permits people who are not terminally ill to be killed by euthanasia. Jones explains:

The second tracker also shows that support is well under 50% if assisted suicide would be provided to people who are not terminally ill. It might seem that the Assisted Dying for Terminally Ill Adults (Scotland) Bill is indeed restricted to people who are terminally ill. However, unlike similar legislation in the United States, New Zealand or Australia, the Scottish Bill defines “terminal illness” with no reference to a person being close to death. The term is used to cover anyone with an advanced progressive condition that would be expected to shorten life if not treated. This would include conditions such as type 1 diabetes. It is unclear if this is what the public understands by the term “terminal illness”.

Jones ends his article by stating that support for assisted suicide is not overwhelming and it is not growing:

Public support for legalisation of assisted suicide in Scotland is thus neither “overwhelming” nor “growing”. Less than half strongly support a change in the law. Less than half want their MP to vote to change in the law. Less than half support assisted suicide for non-terminal conditions (as the proposed Bill seems to include). Few if any regard assisted dying / assisted suicide as being among the most important issues facing Scotland and all indications are that Scottish support for its legalisation has declined markedly in recent years.

MSPs should assess for themselves the merits and/or dangers of the proposed Bill without fearing that they will be out of step with public opinion. Indeed, if they feel ambivalent or hesitant on this issue then they are probably reflecting the views of most people in Scotland.

Scotland's deceptive euthanasia bill redefines terminal illness to include people with disabilities (Link).

Québec quadriplegic man "chooses" euthanasia after suffering horrific negligent care.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Normand Meunier

Rachel Watts reported for CBC News on April 12, 2024 that a quadriplegic man, Normand Meunier (66) "choose" to die by (MAiD) after developing a severe bedsore at a hospital in Saint-Jérôme, Québec. Meunier experienced a tragic spinal chord injury in 2022.

Sylvie Brosseau told CBC news that:

Before being admitted to an intensive care bed for his third respiratory virus in three months this winter, Meunier was stuck on a stretcher in the emergency room for four days.

His partner, Sylvie Brosseau, says without having access to a special mattress, Meunier developed a major pressure sore on his buttocks that eventually worsened to the point where bone and muscle were exposed and visible — making his recovery and prognosis bleak.

"Ninety-five hours on a stretcher, unacceptable," Brosseau told Radio-Canada in an interview.

"Every time we go to the hospital, it's my duty to tell them that Normand is quadriplegic and needs an alternating pressure mattress … I don't understand how this can happen, because a mattress is the most basic thing."

Meunier's death by euthanasia is one of many stories of people who "choose" to die after receiving negligent medical care.

Jean-Pierre Beauchemin, a retired geriatrician and professor at Université Laval's faculty of medicine tod CBC news:

"When you're lying down, always in the same position, there's hyper-pressure between the bone and the skin,"

"A pressure sore can open in less than 24 hours, and then take a very long time to close."

The buttocks, heels, elbows and knees are particularly vulnerable.

A rotation schedule every two hours is generally necessary for a person confined to bed, according to a Quebec Health Ministry reference sheet.

Steven Laperrière, the director general of the Regroupement des activistes pour l'inclusion au Québec (RAPLIQ), which supports people with disabilities told CBC news:

"That whole story is a crying shame,"

"It's really a case of disbelief … What are we doing in order to help disabled persons or sick people to live in dignity prior to dying in dignity?"

He says the health-care institution was "negligent to say the least" and that getting a proper mattress is not like "trying to get a space shuttle into orbit."

"It's pretty basic … Nobody will convince me that within a few hours the proper mattress could not have been found," said Laperrière.

"To me, that's totally a lack of professionalism," said Laperrière, who says Meunier "would probably still be alive today" if staff had "been really professional about it."

Trudo Lemmens

Trudo Lemmens, The Scholl Chair in Health Law and Policy at the University of Toronto said that this case is "an illustration of problems in our health-care system." Lemmens told CBC news:

"Then the system responds by saying: 'well, you have access to medical assistance and dying,'"

"Medical assistance in dying is more easily available and on a more regular basis than some of the most basic care."

He says he is increasingly hearing stories of people who are struggling in the system and turn to MAID.

"It's deeply troubling,"

Watts reported that along with Brosseau, Moelle épinière et motricité Québec (MÉMO-Qc), an advocacy group for people with disabilities, is now demanding the Quebec government launch an independent inquest into Meunier's death. They believe the health authority's internal investigation is insufficient.

The disability group is seeking a meeting with Christian Dubé, Quebec's health minister, concerning the circumstances and lack of care that people with disabilities are experiencing in Québec.

By the way, euthanasia is all about "choice", "freedom" and "autonomy."

President of Belgium's largest health insurance fund promotes euthanasia as an answer to healthcare funding.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Luc Van Gorp

The Belga News Agency reported on April 8, 2024 that Luc Van Gorp, the President of Belgiums largest health insurance fund, Christian Mutualities (CM) is suggesting that Belgium cannot fund its healthcare needs and requires more deaths by euthanasia.

Van Gorp commented on the increasing financial pressure related to Belgium's aging population and healthcare funding.  He stated:

"No matter how much you end up investing, it will still not be enough"

A Times of London article reported that Van Gorp's response is to promote euthanasia for those who are "tired of living":

Belgium’s euthanasia laws should cover elderly people who are “tired of life” or who feel they are a burden on the public purse, a health insurance chief has urged. Luc Van Gorp, 57, the president of the CM health fund, a Christian mutual insurance provider, said that the number of Belgians over 80 would double to 1.2 million by 2050.

“Many elderly people are tired of life. Why would you necessarily want to prolong such a life? Those people don’t want that themselves, and when it comes to budgets: it only costs the government money,” he told the Nieuwsblad newspaper. “We must remove the stigma.”Essentially Van Gorp is advocating for euthanasia for those who "tired of living." 

The Belga News reported:

That is why he is advocating "a radically different approach". He said we should not be asking "how long can I live", but "how long can I live a quality life" and advocates a gentler form of euthanasia for people who feel their lives are complete. Suicide, says Van Gorp, is too negative a term. "I would rather call it giving back life."

Be careful for what you wish for. Belgium may need to undergo health care reform but Belgium's euthanasia is arguably the most permissive killing law in the world.

Van Gorp may think his ideology is "progressive" but in reality it is related to the eugenic ideology that created the German T-4 euthanasia program that killed approximately 300,000 people during the Second World War based on a concept that they were "useless eaters."

Canada is also experiencing financial pressure in funding healthcare. But the concept that someone who is elderly should "choose" do die isn't actually about a "choice" but about an obligation to get out of the way and die. History is eerily beginning to repeat itself.

Young people need suicide prevention not promotion.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Mary Fahey

Mary Fahey has written a powerful op-ed that was published in the Manchester Union Leader on April 10, 2024 in response to New Hampshire assisted suicide legalization bill HB 1283.

Fahey opposes assisted suicide based on her personal experience. She writes:

At 23 years old, I have more chronic, incurable, and life-altering diseases than I can count on one hand. I am also a survivor of a suicide attempt and have dealt with strong suicidal ideation as I’ve faced daily suffering and the loss of my health as I knew it. While I have gotten the help I need to learn to live happily with my near constant illness, it has been one of the hardest tasks of my life, a task further burdened by the countless doctors I saw who knew little to nothing of my conditions or how to treat them.

Fahey states that she has found happiness, in her struggles from her friends and family in her life. Fahey continues:

This legislation fails to reinforce the value of New Hampshire citizens. Rather, assisted suicide, by its nature, creates a cruel scale of value on human lives, deeming some more worthy than others simply based on their circumstances. With assisted suicide, we are no longer stating that we should protect all lives from suicide, instead, we are saying that some lives should be exempt from that protection, that some lives are simply not worth living.

Fahey, who has survived a suicide attempt continues:

As a society, we work diligently to prevent suicide in healthy individuals, because of the knowledge that their lives have inherent and immeasurable value, and we know their death would be a tragedy. Is it our place to remove that value and promote suicide simply because someone is challenged by suffering? Doing so has devastating and far-reaching consequences, especially for New Hampshire’s young people, for whom suicide rates are already on the rise.

The supporters of this bill assert that medical aid in dying (MAID) is not actually suicide, because those who utilize it do not wish to die, and those who end their lives by suicide do wish to die, and therefore it puts no one at risk. I find this claim incredibly false. When I attempted suicide, I did not wish to die, rather, I desperately wished to live. I simply saw no alternative to the mental and physical suffering I was experiencing.

Fahey has also lost several friends to suicide. She writes:

Recently, I lost a childhood friend to suicide. He was young, with a young family. Another young woman I know of took her life last month; her obituary reads “she made a heart-breaking decision in an effort to pursue peace.” Passing HB 1283 will clearly send the message to vulnerable young people that intentionally and unnaturally ending one’s life in the face of suffering is a legitimate solution to their pain.

Fahey lives with suffering but normalizing suicide and death are not the answer. Fahey writes:

One of the greatest burdens in my personal health journey has not been the illness itself, but reconciling the unavoidable pain, discomfort, and fear with the goodness of life. I believe many young people in a similar position would say the same. I still struggle to accept this, but while I can hardly remember a day without bodily suffering, I also cannot remember a day where I have not been able to find great meaning and joy.

When the proponents of this bill state that it is not only permissible, but dignified, to take one’s life when confronting great adversity, it undermines the efforts of all of those, like myself, who have fought so hard to live in the face of grave, and often silent, suffering. It puts countless New Hampshire young people at risk by normalizing suicide as an acceptable solution to their burdens.

Fahey ends her article by urging people to contact their state Senator to oppose assisted suicide.

Contrary to the message of this bill, our suffering doesn’t define us. Our lives, however difficult, however limited, are worth living and celebrating. The Granite State needs to protect lives, not legislate ways to end them. I urge those who value every life to reach out to their state senator and ask them to vote against HB 1283.

People with disabilities need help to live not to die (Link).

Punk poet, John Cooper Clarke totally opposes assisted suicide.

The writer of "Bed Blocker Blues" opposes assisted suicide.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

In a recent interview with Judith Woods that was published in the Telegraph, former punk poet and writer of the Bed Blocker Blues, John Cooper Clarke, stated that he is totally opposed to assisted dying. Woods reports:

“I’m totally against assisted dying,” he says. “I’m sure people have the most heartbreaking tales to tell but extreme cases make for bad legislation. The whole issue is literally a matter of life and death and in Europe where it’s legal, we’re already seeing a mission creep where people are ending their lives for things like incurable depression. Just because someone is feeling a bit hopeless that’s no reason to kill them or help them to kill themselves and to make it worse, it’s dressed up in the language of human rights, as if there were some kind of liberation to it. I just don’t see how helping people die improves life as we know it.”

Clarke (75) is currently on tour promoting his latest volume of poetry.

Clarke lived a punk lifestyle and is "enjoying a 21st century Renaissance nobody saw coming." Woods reported:

Cooper Clarke now describes the post-punk era, when he descended into drug addiction, as his wilderness years. In his well-written and hugely well-received 2020 autobiography I Wanna Be Yours he describes his early years in fabulous detail but rather brushes over the 1980s. “Those were dark times,” he says simply. “Why would I want to dwell on them?

For the euthanasia lobby folk who think Clarke opposes assisted dying because he never experienced death, Clarke also commented on a friend who recently died of brain cancer.

Clarke is responding to this life and death issue from a straight forward human perspective.

Irish Psychiatrist issues warning as physically healthy Dutch and Canadian autistic women are approved for death by euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

As Ireland debates legalizing euthanasia, a leading psychiatrist issued a warning that the recent case of a physically healthy 28-year-old autistic woman in the Netherlands, and a healthy 27-year-old autistic woman in Canada who have been approved for euthanasia could also become a reality in Ireland if euthanasia is legalized.

Maria Maynes was published by RIPT on April 9, 2024 concerning the debate to legalize euthanasia in Ireland. Maynes interviewed Consultant psychiatrist, Professor Patricia Casey, a specialist in Adult Psychiatry. Maynes reportes:

recent cases unfolding worldwide involving physically healthy young people should provide evidence to Irish lawmakers that “the slippery slope exists,” as she expressed particular concern about those with autism choosing assisted suicide or euthanasia.

Last month, this publication also reported on the Canadian case of an unnamed 27-year-old woman, who was also autistic, and had chosen to die by physician assisted suicide. While the father of the unnamed woman tried to intervene through court action, arguing that she did not have the ability to consent to the death under Canada’s MAiD programme, his intervention was unsuccessful.

There have also been cases in Belgium, where Asperger’s (now subsumed under the autistic spectrum) is among the most common conditions for which Belgians seek euthanasia on mental health grounds, alongside personality disorders and depression.

Maynes quoted Casey as stating:

“There is a danger that when young, autistic people see a problem that they will look for what they see is a simple solution, or a trendy solution,” she said.

Casey also stated:

“I was struck by the photograph of 28-year-old Zoraya ter Beek in the Netherlands, who was pictured surreally embraced in the arms of her boyfriend while announcing that she was due to die on May 28th. This photograph conceals the turmoil and nihilism behind her decision and may well be used in the future to promote assisted dying as a calming answer to one’s problems.”

Professor Casey compares the issue to the romanticizing of suicide that was successfully countered by national campaigns. Professor Casey fears that the same type of romanticizing of death by euthanasia will also occur.

Professor Anne Doherty examined the issue of suicide rates in jurisdictions that have legalized euthanasia and assisted suicide. Professor Casey referred to her research and stated:

“Prof Doherty found that the rate of non-assisted suicide increased after assisted suicide was legalised, and I fear we will see exactly the same pattern. I also think it is very nihilistic to say to people, ‘There is no help. Why don’t you go for assisted suicide?’ I mean, it is such a dark thing to say to anybody. I think it should be absolutely taboo, but instead of that, it is now becoming glamorised.”

Professor also commented on the "bracket creep" in countries that have legalized euthanasia and stated:

“This is what has happened in a range of countries. The Netherlands, for instance, didn’t start with euthanasia for young people with mental illness. It legislated initially for those with terminal illness. Similarly in Canada and in Belgium. Now all of those countries are allowing assisted suicide for young people, or for people with mental illness – or a combination of both.”

As for the concern that people with Autism are more susceptible to requesting euthanasia, Casey stated:

“One of the reasons a young person with autism may be more susceptible is due to the fact that a lot of those with autism have unusual interests and hobbies. For example, some would have an interest in the afterlife, or the occult, or similar. We also know that some individuals who are on the autistic spectrum have very fixed beliefs about things, and so can be quite suggestible.”

“Once something has been suggested, the person can fixate on that. I think the interest in unusual things, something we often see in those with ASD, and some of the things that are outside the norm, along with their tendency to fixate on things, would make that person particularly vulnerable. For instance, people with rigid thinking, such as many of those with ASD, find it difficult to consider alternative solutions to problems. And this may render them more than willing to choose this particular pathway to death.”

Professor Casey also commented on the Social Contagion that is likely to happen with euthanasia:

“There will be a social contagion aspect, because as we know, teenagers and young adults are always online now. One person engaging in, or planning, an assisted suicide, will be in touch with others in their group and that contagion effect is very toxic.”

“We must not forget that suicide clusters existed in the recent past, because of social contagion. And it is difficult to escape that prospect in relation to assisted suicide, also.”

Ireland is currently debating the legalization of euthanasia. A recent parliamentary report was released which advocated that euthanasia be legalized for a person diagnosed with a disease, illness or medical condition that is both incurable and irreversible; advanced, progressive, and will likely cause death within six months (or within 12 months in the case of someone with a neuro-degenerative disease, illness or condition; and suffering in a manner that the person “cannot be relieved in a manner that the person finds tolerable.”

The Irish report obviously decided to push for the legalization of euthanasia in a fairly wide open manner.

For further reading, Gordon Friesen, the President of the Euthanasia Prevention Coalition issued a warning to Ireland in his article: If euthanasia is legalized as a cure for suffering, then suffering people will be "cured" with euthanasia!

Great news: Judge prevents euthanasia death of Calgary Autistic woman.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

I have great news.

Justice Anne Kirker, on April 8, 2024; issued a stay of the injunction pending a determination of an appeal in the case of the 27-year-old autistic Calgary woman whose father has been trying to prevent her death by euthanasia (MAiD).

In other words, the woman will not be allowed to be killed by euthanasia until after the Court of Appeal makes a decision in this case. The trial is tentatively set for October 2024.

This case concerns a 27-year-old autistic woman who lives with her family and has been approved for death by MAiD (euthanasia) but whose father claims that, based on the law, she does not qualify to be killed by euthanasia.

This case concerns me greatly since I have an autistic son.

CBC News reported on March 12, 2024 on the Calgary court case concerning a father who petitioned the court to prevent the euthanasia death of his 27-year-old autistic daughter, who lives at home. The father stated that his daughter did not have a medical condition that qualifies under the law and yet the daughter had already been approved for death by lethal poison.

CBC News reporter, Meghan Grant reported on March 25, 2024 that Justice Feasby ruled that the 27-year-old daughter can die by euthanasia despite her father's concerns. Justice Feasby withdrew the temporary injunction that prevented the woman from dying by euthanasia but maintained a 30 day stay of the injunction, which gave the father time to appeal the decision.

Justice Feasby ordered an assessment of the role of Alberta Health Services with relation to the approval of euthanasia for the daughter.

On April 2, 2024, Kevin Martin reported for the Calgary Herald that the father of the 27-year-old autistic woman appealed the decision to the Alberta Court of Appeal.

On April 8, Justice Anne Kirker ordered a stay on the injunction to prevent the death of the 27-year-old autistic woman until after the appeal is heard. The date of the appeal is not known but will likely be heard in October.

The Euthanasia Prevention Coalition will seek to intervene in the Appeal.

When the right to die becomes a duty to die.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition.

Euthanasia and assisted suicide are currently being debated in England, Scotland, Ireland, Jersey and the Isle of Man. Each jurisdiction is debating a different proposal.

Sonia Sodha

Sonia Sodha wrote an excellent opinion column that was published in the Guardian on April 7, 2024. Sodha wonder who will step in to save the most at risk? and she states: Proponents of legalising assisted dying are right to stop and think of the possible unintended consequences. Sodha explains:

It’s rare to get a politician who openly admits they are torn on an issue, but in recent days there have been two striking examples. First, Wes Streeting, Labour’s shadow health secretary, admitted that though he voted to legalise assisted dying a few years ago, he feels conflicted. Then Nicola Sturgeon, former Scottish first minister, wrote a piece saying that, with new Scottish legislation on the table, the reservations she expected to subside are becoming stronger.

Sodha also supported euthanasia but has now changed her position. Sodha explains:

A decade ago, I would have supported assisted dying out of a respect for personal autonomy and a desire to alleviate suffering. Today, I understand these objectives are not standalone but need to be weighed against the impact on those for whom an abstract liberal notion like autonomy is highly simplistic, and the state-sanctioned wrongful deaths that seem to me impossible to avoid.

Sodha further explains why she now opposes euthanasia:

The first prompt for my reappraisal has been my evolving understanding of the complexity of relationships. We are not all autonomous islands floating in a sea of humanity; we are highly influenced by each other and by cultural norms. Writing about domestic abuse has opened my eyes to the extent that coercively controlling relationships drive people to do things because others want them to. Of course there will be women who get a terminal diagnosis, whose partners have been emotionally abusive to them for years – telling them their life isn’t worth living – who will come under intolerable pressure to opt for assisted dying. How can we ignore that around a third of female suicides are thought to be related to intimate partner abuse? Or that some men who violently kill their sick wives rely on defences such as “mercy killing” and “suicide pacts”, sometimes very effectively? Even the fact that men are much more likely than women to leave their partners after a terminal diagnosis feels salient to understanding the gendered implications.

Sodha explains how the risk of coercion is a wider issue:

The risk of coercion goes beyond intimate partners in a society riven with ageism and anti-disability prejudice; what happened to older people in care homes during Covid is just one example. More than a fifth of people over 65 have experienced physical, emotional, financial or sexual abuse. There are relatives who will find ways – perhaps quite subtly, even unintentionally – of hinting to people with a terminal diagnosis who need round-the-clock care that they should opt for assisted dying. How would that make you feel? Almost half of people who chose assisted death in Oregon in 2022 cited concern about being a burden.

Then there is the internal pressure that arises from some feeling that they ought to do it to save relatives difficulty and financial consequences: where the right to die becomes the duty to die. That message will be reinforced at a societal level; Times columnist Matthew Parris recently argued in a widely condemned column that assisted dying could help address the cost of an ageing population; that there are those willing to be honest about this should give serious pause for thought. Moreover, palliative care doctors talk about how the wish to die is not stable, and often abates in terminally ill patients in the wake of an initial diagnosis, and can be affected by depression, which is hard to diagnose.

Sodha then refers to the International evidence with legalised euthanasia.

The most cited example is Canada, where a limited form of medical assistance in dying (MAiD) was legalised in 2016 for people with “grievous and irremediable medical conditions” with assurances about its narrow scope. Today, that definition has been interpreted to include a person with severe sensitivities to chemicals unable to access appropriate housing from the state, and there have been reports of officials promoting assisted dying to people with disabilities applying for government assistance and medical professionals trying to coerce people into it. A parliamentary committee has recommended MAiD should be extended to some sick children and it is set to be expanded to people with chronic mental illness. In the Netherlands, euthanasia is an option for people who are autistic and lonely and is about to be extended to children of all ages. In Oregon, where the law has remained more stable, terminal conditions today include arthritis and anorexia.

Sodha comments on the House of Lords debate that assured people that safeguards can be maintained. Sodha writes:

Medical professionals are not trained in or necessarily any good at detecting coercive control; judges will have limited evidence to make their own call. In the family courts, judges can fail to detect coercive control even when confronted with detailed evidence about intra-familial relationships. Narcissistic abusers can be highly adept at fooling professionals. What level of outside influence is considered too much, how is it measured, and how sure must a judge be, given life and death is at stake, surely rendering the balance of probability evidentiary threshold usually applied in the family courts inappropriate?

Sadha criticized the House of Lords debate by writing:

In the House of Lords debate, there was a marked failure to engage with these detailed concerns. Some claimed there is no evidence of problems abroad, as if coercively influenced wrongful deaths would magically reveal themselves after the fact. One only need look at the fight to reveal the true number of hidden homicides of women by their abusers to understand the naivety in that and, in somewhere like Oregon, the system is simply not set up to catch wrongful deaths. With brutal utilitarian honesty, former supreme court president Lord Neuberger acknowledged there would be abuses, but argued the benefits for those acting autonomously would outweigh them.

Sodha concludes by challenging politicians to examine the complexity of the issue. She writes:

We live in a social media-driven world characterised by excessive moral certainty, in which powerful individual stories that invoke strong emotions can dominate the discourse to the detriment of the voiceless. There is a real risk that a law gets passed without any of these devastating concerns being addressed. Assisted dying is not a right-left issue, but it garners more support from MPs on the left, including Keir Starmer, and a Labour government might feel under pressure to introduce big reforms that don’t cost money given its self-imposed fiscal constraints. That is why voices like Streeting’s and Sturgeon’s are so important; we desperately need politicians willing to acknowledge that assisted dying is one of the most complex and fraught ethical questions they will ever be asked to confront.

More articles on this topic:

• Warning to Ireland. If euthanasia is legalized as a cure for suffering, then suffering people will be "cured" by euthanasia! (Link). 
• Autistic healthy 28-year-old Dutch woman scheduled to die by euthanasia (Link). 
• Netherlands 2023 euthanasia report. A 23% increase in euthanasia for psychological suffering (Link).

Belgian 2023 euthanasia report. Euthanasia for psychiatric reasons almost doubled.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition.

When jurisdictions release their euthanasia data I publish an article updating the data from the previous year. This year I missed the February 27 release of the 2023 Belgian euthanasia data. 

The 2023 basic data indicates that the number of euthanasia deaths increased by 15.4% to 3,423 deaths and there were 48 euthanasia deaths for psychiatric conditions up from 26 in 2022.

Thankfully the Australian Care Alliance published an article on the Belgian euthanasia experience which includes the 2023 data. Here is their report.

Euthanasia became legal in Belgium on 3 September 2002.

Increase in numbers

In Belgium deaths by legal euthanasia increased more than fourteenfold (1456%) from 235 in 2003 – the first full year of legalisation – to 3,423 in 2023. From 2020 to 2021 alone the increase was 10.4%, with further increases of 9.85% from 2021 to 2022 and 15.4% from 2022 to 2023.

Officially reported euthanasia now accounts for one in 33 (3.03%) of all deaths in Belgium in 2023.

Organ donation

There was a total of 64 cases of organ donation with euthanasia in Belgium between 2005 and 2021.

One case involved a 52 year old woman with a mental disorder manifested with the symptom of auto-mutilation – cutting to cause self-harm. Her consent to euthanasia and organ donation was accepted despite this particular mental illness.

Polypathology

In 2023 there were 793 cases (23.2% of all cases) of euthanasia for polypathology, that is two or more conditions none of which in itself is sufficient ground for euthanasia.

Death not expected in the foreseeable future

In 2023 there were 713 cases (20.8%) of euthanasia where the person was not expected to die in the foreseeable future. Euthanasia where death was not expected increased by 38.9% from 2022 to 2023 while euthanasia where death was expected only increased by 10.47% over the same period.

This included 372 (10.9% of all cases) for polypathology; 35 for cognitive disorders; 48 for psychiatric disorders (double the number for 2022); and a range of physical non-terminal conditions, including arthritis (18), eye disorders (8), chromosomal and congenital abnormalities (3) and injuries from external causes (9).
No physical suffering

In 2023, 56 (1.9%) cases involved no physical suffering at all. This includes, for example, some cancer patients “whose physical suffering is alleviated by painkillers” but who “may suffer psychologically from the loss of dignity or a loss of autonomy.”

Five children

Five children have so far been killed under the Belgian law. Three children were killed by euthanasia in 2016/2017. These were a 17-year-old child who was suffering from muscular dystrophy; a nine year old child, who had a brain tumour, and an 11 year old child, who was suffering from cystic fibrosis.

Luc Proot a member of the Belgium’s Federal Euthanasia Evaluation and Control Commission, commented to Charles Lane of the Washington Post that he “saw mental and physical suffering so overwhelming that I thought we did a good thing”. As Lane points out he is referring to the Committee approving the cases after the fact based on reports from the doctors who carried out the killing. It is curious that Proot refers to “mental and physical suffering” when the Belgian law specifically refers only to “unbearable physical suffering” in relation to children in contrast to a reference to “unbearable physical or psychological suffering” for adults. This comment raises a doubt in relation to each of these three cases of child euthanasia as to whether there was “unbearable physical suffering” that could not be alleviated.

Good palliative care can relieve the various forms of physical suffering associated with end-stage brain tumours.

Life expectancy for people with cystic fibrosis (CF) is increasing significantly in response to developments in treatment regimes. In the United States the median predicted age of survival for people with CF has now increased to 47 years. It is by no means clear that the 11 year old child euthanased in Belgium in 2016 or 2017 was facing imminent death. He or she may have had years to live. Depression is also a particular issue with CF. The “mental suffering” mentioned by Luc Proot may have been relieved through appropriate treatment.

The 17 year old child had Duchenne muscular dystrophy (DMD). “Until relatively recently, boys with DMD usually did not survive much beyond their teen years. Thanks to advances in cardiac and respiratory care, life expectancy is increasing and many young adults with DMD attend college, have careers, get married and have children. Survival into the early 30s is becoming more common, and there are cases of men living into their 40s and 50s.” On the available information it is not clear whether in this case the child was both imminently dying and experiencing unbearable physical suffering that could not be alleviated.

A fourth child was killed by euthanasia in 2019; and a fifth child was killed in 2023.
Euthanasia to complete failed suicide attempts

Between 2014 and 2017 two patients who were in an irreversible coma after a suicide attempt were euthanased based on an advance directive 5 months and 35 months respectively before the suicide attempt.

Euthanasia for psychiatric conditions and dementia

In 2023 there were 41 cases of euthanasia for cognitive disorders (including Alzheimer’s and other dementias) as well as 48 cases of euthanasia for psychiatric conditions.

In 2022 there were 42 cases of euthanasia for cognitive disorders (including Alzheimer’s and other dementias) as well as 26 cases of euthanasia for psychiatric conditions.

Between 2018 and 2021, there were 97 cases of euthanasia for cognitive disorders (including Alzheimer’s and other dementias) as well as 102 cases of euthanasia for psychiatric conditions and including depression/bipolar disorder (36), personality disorders (35), anxiety/stress disorders (10), schizophrenia (10), autism (6), and anorexia (2).

Extraordinarily, one person was euthanased in 2018 for “Commonly occurring behavioral and emotional disturbances during childhood and adolescence (such as attachment disorder)” and one person in 2020 for “Mental and behavioral disorders related to the use of psychoactive substances”.

The Commission reports that:

In young patients, the unbearable and persistent nature of the suffering was frequently associated with experiences from the past. In this regard, it was a question of sexual abuse, neglect as a child, rejection by parents, self-destructive behavior and suicide attempts. In addition, failed suicide attempts have made those affected aware that there is also another, more dignified way to end their life.

Euthanasia by advanced directive

19 people were killed by euthanasia in 2023 while unable to give consent, pursuant to an advanced directive. 

A case of euthanasia without request

One case reported in 2016/2017 concerned an interruptive act of life without request from the patient.

In this complex case where the patient had not made an explicit request, some members of the Commission felt that the law on euthanasia had been violated and that the file should be sent to the public prosecutor. Indeed, demand is one of the essential legal conditions. However, other members considered that a referral to the prosecution was not appropriate. The two-thirds majority, legally required for referral to the King's Attorney (see Article 8 of the law) was not reached (9 for referral to the King's public prosecutor, 7 against).

This high threshold of two-thirds majority of the Commission for referral to the public prosecutor helps explain why only one case has ever been referred (in 2015). 

Euthanasia tourism

The place of residence is only required to be reported in the first part of a euthanasia report filed by the doctor performing euthanasia. This part only gets open when questions arise. However, in 2020 and 2021 doctors did refer in the second part of the report to people who were foreigners who came to Belgium to seek euthanasia. There were 79 such cases reported in this way (up from 45 reported in 2016 and 2017) but there may be many more. Of the 79 reported cases “More than half of the deaths were expected in the near future” meaning several were cases where death was not expected in the short term.

There were 110 cases of euthanasia tourism in 2023. Of these 44 (40%) were cases where death was not expected in the foreseeable future.

Conclusion

The 22-year experiment with euthanasia in Belgium is fatally flawed. It has resulted in the abandonment of the disabled, the mentally ill, the suicidal and the victims of child abuse to hopelessness and State sanctioned death by lethal injection. 

Warning to Ireland: If euthanasia is legalized as a cure for suffering, then suffering people will be "cured" with euthanasia!

By Gordon Friesen
President, Euthanasia Prevention Coalition

Gordon Friesen

Through the years Alex Schadenberg has written many articles (and hosted many others) on the subject of euthanasia in the British cultural diaspora that are published on the EPC blog. By that term, I mean, above all, those countries such as Canada, Australia, and New Zealand whose populations are (or at least recently were) of majority British stock. Most lately Alex has written pieces on the Channel Islands, Scotland, and the UK itself.

Unfortunately this very significant cultural and political group appears to have fully embraced the notion of euthanasia. And because all of its members have a largely common social structure, they appear to be on track to do so in one particular fashion, for which Canada most unhappily provides us with the template.

One final example, Ireland, is found at the heart of British history, being itself one of the "British Isles", but having resolutely rejected British Imperialism all the way back to William the Conqueror! In recent memory, the Irish have literally fought their way out of the Empire, slammed the door on the Commonwealth.

Unfortunately, however, that independent streak is not reflected in their evolving policy on euthanasia.

Over the last half year, the Irish Houses of Parliament (The Oireachtas), have studied euthanasia in a Joint Committee on Assisted Dying. Readers of this blog will be familiar with the names Leonie Herx, Trudo Lemmens, and Heidi Janz, all of whom spoke before the Committee (October 17, 2023: Assisted dying in Canada), and also Mark Komrad (October 3, 2023: Assisted dying in the United States). I personally submitted a pamphlet-length criticism of euthanasia but sadly, these efforts have proved fruitless, as we may plainly see in the recently released Final Report of that body (March 2024).

Conclusions of the Irish Joint Committee on Assisted Dying

In all probability the Irish will soon authorize euthanasia for people "diagnosed with a disease, illness or medical condition... causing suffering to the person that cannot be relieved in a manner that the person finds tolerable".

There are, of course, other requirements, such as an expected death within six months (or 12 for certain conditions); of full mental capacity (including at the time of euthanasia); and of major age. However, as experience has clearly demonstrated in Canada, there can be no logical basis for confidence in any such secondary requirements:

From the moment that we first admit the principle of euthanasia, practised as a cure for suffering, ALL classes of suffering individuals can (and eventually will) gain access to euthanasia through the vehicle of fairness-based judicial litigation and legislative extensions to eliminate discrimination. It might take a year or a few years. But given the assumptions of our commonly shared British sense of Justice, that outcome is reasonably inevitable.

Public responsibility for medical care

Another common assumption throughout the British diaspora is that medical care is a collective responsibility. As a medical treatment, then, euthanasia will be available, as in Canada, throughout the entire medical industry. It will not be a simple liberty. It will be a claimable right (entitlement). And this status is made clear by the fact that (despite individual conscience protection) objecting physicians will be required to make referrals to "participating health care professionals" (and/or) "a national oversight body" to get the job done).

Similarly, again (because medical homicide is to be an entitled medical treatment), there is no doubt that we are talking about true euthanasia and not assisted suicide, since: 

"any potential legislation for assisted dying should provide a means of access to treatment for individuals who require assistance during the administration."

As I have noted in previous articles, it is these two elements (true medical euthanasia employed as a "cure" or "treatment" for suffering) and euthanasia provided as a publicly guaranteed entitlement (rather than a simple liberty), which explain the amazing ten times greater frequency which separates Canada from Oregon-style assisted suicide regimes. And it is therefore the Canadian group to which Ireland will apparently belong.

I must in fairness mention a number of well-intentioned safeguards and social justice measures included by the Irish legislators in their recommendations. These include: ratification of the "Optional Protocol to the United Nations Convention on the Rights of Persons with Disabilities" (UNCRPD); extensive capacity testing; measures to avoid coercion (without, however, recognizing the inevitably coercive effect of the entire projected regime); strict oversight; clinical separation of Palliative Care from assisted death; administrative separation of Palliative Care budgets; increased support of Palliative Care; information and counselling on alternatives to euthanasia, etc., etc....

However, pious assertions regarding care of the "least fortunate" and the "most vulnerable" can do little to change actual budgetary realities. And procedural safeguards (like the three member physician committees) tend to disappear like mist on a summer morning. Or to use a time-honoured Irish colloquialism: They are not worth a Tinker's damn!

Our Irish friends should, therefore, have no illusions: 

If euthanasia is legalized as a cure for suffering, then suffering people will be "cured" with euthanasia!

Indeed, "euthanasia" itself is but a misleading euphemism. The correct term is "medical homicide". And the plainest description is thus:

Suffering people will be killed.

Despite justified criticism, those of us who trace our roots to the British tradition may be rightfully proud of many positive political and social principles diffused around the globe.

Unfortunately, medical euthanasia is not one of them.

Gordon Friesen, April 7, 2024

Autistic 28-year-old Dutch woman scheduled to die by euthanasia

Alex Schadenberg
Executive Director

Euthanasia Prevention Coalition

Rupa Subramanya reported for the Free Press on April 1 that Zoraya ter Beek, an Autistic Dutch woman (28) who has depression, is scheduled to die by euthanasia in early May. Subramanya reports:

Ter Beek, who lives in a little Dutch town near the German border, once had ambitions to become a psychiatrist, but she was never able to muster the will to finish school or start a career. She said she was hobbled by her depression and autism and borderline personality disorder. Now she was tired of living—despite, she said, being in love with her boyfriend, a 40-year-old IT programmer, and living in a nice house with their two cats.

She recalled her psychiatrist telling her that they had tried everything, that “there’s nothing more we can do for you. It’s never gonna get any better.”

At that point, she said, she decided to die. “I was always very clear that if it doesn’t get better, I can’t do this anymore.”

Subramanya outlines one of the weaknesses with the Dutch euthanasia law by stating:

When she’s dead, a euthanasia review committee will evaluate her death to ensure the doctor adhered to “due care criteria,” and the Dutch government will (almost certainly) declare that the life of Zoraya ter Beek was lawfully ended.

Notice how the euthanasia review committee will examine her death after she has died, not before she has died. Subramanya reports ter Beek as stating:

“I’m a little afraid of dying, because it’s the ultimate unknown,” she said. “We don’t really know what’s next—or is there nothing? That’s the scary part.”

The story of Zoraya ter Beek has some similarities to the story of the 27-year-old autistic Calgary woman who was approved for euthanasia but whose father is attempting to prevent the death through the courts (Link).

Subramanya then states:

Typically, when we think of people who are considering assisted suicide, we think of people facing terminal illness. But this new group is suffering from other syndromes—depression or anxiety exacerbated, they say, by economic uncertainty, the climate, social media, and a seemingly limitless array of fears and disappointments.

Professor Theo Boer was a member of the Netherlands Euthanasia Review Committee for 10 years. Subramanya interviewed Boer and writes:

“I entered the review committee in 2005, and I was there until 2014,” Boer told me. “In those years, I saw the Dutch euthanasia practice evolve from death being a last resort to death being a default option.” He ultimately resigned.

Boer had in mind people like Zoraya ter Beek—who, critics argue, have been tacitly encouraged to kill themselves by laws that destigmatize suicide, a social media culture that glamorizes it, and radical right-to-die activists who insist we should be free to kill ourselves whenever our lives are “complete.”

Subramanya concludes:

They have fallen victim, in critics’ eyes, to a kind of suicide contagion.

Statistics suggest these critics have a point.

In 2001, the Netherlands became the first country in the world to make euthanasia legal. Since then, the number of people who increasingly choose to die is startling.

Netherlands 2023 euthanasia reports a 20% increase in euthanasia for mental illness.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The 2023 Netherlands euthanasia report, that was recently released, indicates that the number of euthanasia deaths increased and the number of euthanasia deaths based on mental illness increased by 20%.

The Netherlands Times reported that there were 9,068 reported euthanasia deaths in 2023 which was up from 8,720 in 2022. There was also a 20% increase in euthanasia for psychological reasons in 2023 with 138 reported deaths.

The Netherlands Times refers to reported euthanasia deaths because studies indicate that approximately 20% of the euthanasia deaths are not reported.

Link to my article on the 2022 Netherlands euthanasia report (Link).

50% of the euthanasia deaths for psychological reasons are carried out by the Euthanasia Expertise Center (EE) euthanasia clinic. The (EE) received were more requests for euthanasia for psychological reasons from young people and approved more deaths for this age group. The Netherlands Times reported:

EE saw a significant increase in requests last year from young people with psychiatric issues. The center received 322 requests from people aged 18 to 30, which is over 50 percent more than last year. The RTE numbers showed that 40 requests for assisted suicide were granted to people 30 years old or younger.

The NL Times stated that euthanasia for psychological reasons accounted for 1.5% of all euthanasia deaths in the Netherlands in 2023.

Father of 27-year-old autistic woman appeals court ruling in euthanasia decision.

Alex Schadenberg
Executive Director Euthanasia Prevention Coalition

The father of a 27-year-old autistic woman who has been approved for euthanasia, has appealed the decision.

Meghan Grant reported for CBC News on March 25, 2024 that a Calgary judge ruled that a 27-year-old Calgary Autistic woman can go ahead with a MAID death despite her father's concerns. There is a publication ban on the names of the participants. The judge did order a 30 day stay to give the father an opportunity to appeal the decision.

This case is very close to me since I have an autistic son.

Grant reported that:

The daughter had been approved for euthanasia by one doctor and turned down by another doctor. The father took issue with the role of the Alberta Health Service in finding the second doctor to approve the death. Grant reports:

Her father took issue with the third doctor who signed off on M.V.'s MAID approval "because he was not independent or objective."

At the March 11 hearing, Sarah Miller, counsel for the father, called the situation "a novel issue for Alberta" because the province operates a system where there is no appeal process and no means of reviewing a person's MAID approval.

Justice Feasby did order an assessment of the Alberta Health Service's role. Grant reports:

While Feasby found the "court cannot review a MAID applicant's decision-making or the clinical judgment of the doctors and nurse practitioners," he did rule the actions of the MAID navigator — a person who works for AHS and helps co-ordinate a patient's eligibility assessment — can be examined.

Feasby ruled the courts can review whether the AHS MAID navigator followed its own policy.

"There can be no doubt that it is a serious issue," wrote Feasby. "The AHS MAID policy is part of the legal framework governing medical assistance in dying and, as such, is a matter of life and death."

Nonetheless, Feasby only granted a 30 day continuance of the injunction based on a possible appeal, he did not extend the injunction until the role of the Alberta Health Service is examined.

On April 2, 2024, Kevin Martin reported for the Calgary Herald that the father of the 27-year-old Autistic woman appealed the decision to the Alberta Court of Appeal. Martin reported:

The judicial ruling that lifted an injunction blocking the assisted suicide of a Calgary woman has been appealed by her father.

Lawyers Sarah Miller and Emily Amirkhari filed two separate notices in the Alberta Court of Appeal on Tuesday appealing rulings by Justice Colin Feasby of applications made by their client, who can only be identified by the initials W.V.

Justice Feasby ruled on March 25 2024 that the temporary injunction preventing M.V. (daughter) from dying by euthanasia was to be lifted. The lawyers for W.V. (father) filed two appeals. The first appeal is based on an alleged error in law by Justice Feasby based on the unwillingness of the daughter to answer questions in court. The second appeal is asking the Alberta Court of Appeal to maintain the temporary injunction while the court proceedings take place.

Martin reported:

The father wants to know how his daughter, who has autism and attention deficit hyperactivity disorder (ADHD), qualifies for the life-ending procedure, which has been approved by two doctors.

Among the errors the lawyers say Feasby made in his ruling was finding the father does not have a private interest to seek a judicial review.

“The pain of losing a child, even an adult child, is not something that any parent should experience,” Feasby said in his written decision.

“(The parents) have devoted their lives to raising M.V. from birth and have continued to support her since she has come of age.

“They will understandably be devastated by her death,” he said.

Canada's euthanasia law was not designed to protect vulnerable people. The law is designed to protect the doctors who are willing to kill. 

The Euthanasia Prevention Coalition will seek to intervene in the appeal.