Thursday 28 April 2016

Has Euthanasia brought dignity to the sick in Holland? Not at all

This is a full transcript, in the original English, of my recent interview with Esme Wiegman about euthanasia in Holland. The news report, in Portuguese, can be read here.

Esta é uma transcrição completa, no inglês original, da minha recente entrevista com Esme Wiegman sobre a eutanásia na Holanda. A reportagem pode ser lida aqui.

What exactly is the Dutch Patient’s Association, and what is your position?
We are a Christian pro-life organization with 58 thousand members. We focus on medical-ethical issues but we are also an organization which gives free help to people who need care in their home situations.

I was a member of the Dutch Parliament for five and a half years and spokeswoman for medical and ethical issues.

Could you explain to us exactly what the law in the Netherlands is concerning Euthanasia?
What the law actually says is also not clear for many people in the Netherlands. Euthanasia is actually still forbidden, but for doctors there are criteria to follow which can exclude them from punishment in cases of euthanasia. That is what the law says, but lots of people in the Netherlands and in all of Europe think that people in the Netherlands have a right to Euthanasia, but that is not what the law actually says.

In practice, however, is that what happens? Or is it as if euthanasia has been fully legalised?
In practice people think they have the right to euthanasia and when they ask for it doctors have to explain to them exactly what the law says. One of the criteria is about unbearable suffering. But what is unbearable suffering? When the law began in 2002, everybody was thinking that pain was the most important reason for euthanasia, patients with terminal illnesses or suffering from cancer. But nowadays loss of dignity is also a reason many people ask for euthanasia. 

Sometimes doctors say that this is also a form of unbearable suffering, and that they will give euthanasia, and last Monday we saw a case on Dutch television about people who were suffering from dementia and who asked for euthanasia, or, rather, the family asked for euthanasia and it was given. 

So there are cases in Holland where people are being euthanized at the request of the family and not their own request?
Well, they say it was her own request from some years ago, written, but is it really clear that a request from years ago is still valid now? We don't know. But some doctor says that he knows the patient and we can euthanize her.

The Portuguese manifesto for legalizing Euthanasia defines Euthanasia as “the reply to an informed, conscious and repeated request to hasten or abbreviate the death of patients in great pain and with no hope for a cure”. In your experience, does this fit the practice of Euthanasia in the Netherlands, Belgium and Switzerland, the only European countries where the practice is legal?
No, I am afraid it is not. 

Because the criteria in our law are very wide. Exactly how wide they are was visible on television last Monday. What exactly is unbearable suffering? It was better when our law spoke only about terminally ill patients, that was clear, but the criteria now is very open and very wide. 

Defenders of Euthanasia often speak of a right to death with dignity. Has the legalization of Euthanasia brought more dignity to patients in Holland?
Not at all. 

I am also in favour of dying with dignity, but by that I mean good palliative care. So the word dignity is very misleading in a debate. The right of dying with dignity says something about the standard of good care and good palliative care, but not about a right to euthanasia.

Proponents of Euthanasia insist that it should be a last resort for the desperate and always speak only of voluntary euthanasia. Yet in the countries where it is legal we see repeated calls to expand the law and make it available for psychiatric patients, children and even for people who are not even sick but just “tired of living”…Is it realistic to speak of euthanasia only in these terms?
No I don't. Because what exactly is voluntary?

Patients are always patients with a context? What is their complete situation? Not only of their personal health but also family, the places where they live, it is more complex than only being your own voluntary will.

The context of patients is very important.

There are also stories of elderly people moving to Germany, where Euthanasia is illegal, out of fear of being euthanized against their will. Are these credible?
I am not familiar with them, but I don't think they are realistic. I am worried about our laws, but I am not worried about situations where people are forced to having euthanasia. 

But I am worried about what all this tells us about our opinion of elderly people. Because elderly people can suffer in life because of loss of family and because they feel life has become meaningless. I think that is a problem in the Netherlands, but our answer should not be euthanasia, but thinking how to treat those people, what can we give them that might make their life still meaningful?

Is there also a danger that people will ask for euthanasia not because they want to die, but because they don't want to be a burden to their families?
I think that is a very realistic scenario, and people may not use these words, but I think it is realistic. Elderly people might think they do not want to be a burden, but they also think of loss of dignity and significance. That is a problem. They don't want to be a burden but they also do not want to get help because they equate this with a loss of dignity. 

Is euthanasia still a difficult topic in Holland? Or is everybody fine with it?
I think last Monday what we saw on television made lots of people angry. Some said we shouldn't show euthanasia on television, but others said that the answer for this woman suffering from dementia...

It is not only pro-life Christians who are against euthanasia and are speaking out now, but also people who work in healthcare and are asking if this is what we need in our society. So yes, there are critics, but a majority in the country say that the law is ok, and also that if people want euthanasia, who are they to say no?

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