Euthanasia and physician-assisted suicide are becoming legalized – and normalized – in more and more jurisdictions around the world. While originally intended to allow a swift and painless death for patients with terminal illnesses, they're increasingly being used to end the lives of people who are perfectly healthy. What's the difference between these two practices? In euthanasia the doctor takes the lead; in physician-assisted suicide, as the term suggests, the doctor stands by and helps out. Euthanasia, in turn, can be broken down into categories. It can be voluntary or involuntary, passive (withholding treatment) or active (for example, administering a lethal drug). In practice, it's not always easy to draw lines between one of these things and another, and legal definitions vary from one nation to another.
When I wrote about this topic for Front Page in 2014, active euthanasia was allowed in three countries in the world: Belgium, the Netherlands, and Luxembourg. Now, it's also permitted in Colombia and Canada, with India allowing passive euthanasia. In several other nations and U.S. jurisdictions – namely Switzerland, Germany, South Korea, Japan, Washington state, Oregon, Colorado, Hawaii, Vermont, Montana, California, and the District of Columbia – euthanasia is illegal but physician-assisted suicide is permitted. It should also be pointed out that in many countries with socialized health-care systems, while technically forbidding euthanasia or assisted suicide, have what may fairly be described as death panels, which effectively condemn patients to death by denying them life-saving treatments in cases when the cost to the government is deemed to be too steep in comparison to the benefits accorded to the patient.
There's more. The Netherlands and Belgium don't just allow euthanasia for adults. In those countries, terminally ill persons as young as twelve years old may also choose to be put to death. Then there are the cases of people who aren't physically unwell but are nonetheless considered expendable. In both the Netherlands and Belgium, people whose only illness is psychological are allowed to check out with the help of a doctor. In an article published in March, Cassy Fiano-Chesser wrote about a 29-year-old Dutchwoman named Aurelia Brouwers, who “suffered from anxiety, eating disorders, depression, psychosis, and a history of self-harm.” Brouwers asked to be put to death, and her doctors complied.
There's no excuse whatsoever for this. It's extremely common for people with serious psychiatric issues to either try to off themselves or to ask to be taken out. Responsible doctors don't help them cross the bar; they try to help them get better. But that's apparently an old-fashioned view in the Netherlands, where abetting the self-slaughter of the mentally unstable is a growth industry: in 2012, there were 12 assisted suicides of mentally ill persons; in 2014, 43; in 2016, 64; in 2017, 83. In addition, 169 people in the Netherlands were euthanized last year on the grounds that they were afflicted with dementia, even though most of them were in the early stages of memory loss. In the Netherlands, Fiano-Chesser notes, “people have been euthanized for being autistic, suicidal victims of sexual abuse, or addicts. Other victims have suffered delusions or heard voices.”
Fiano-Chesser quoted a Dutch doctor who had supported the ratification of his country's assisted-suicide law but who changed his mind pronto after seeing how broadly and casually it was implemented. “Supply has created demand,” he warned. “We’re getting used to euthanasia, that is exactly what should not happen. We’re no longer speaking about the exceptional situations that the law was created for, but a gradual process towards organised death.” In response to these gruesome developments in the Netherlands (and in Belgium as well), the American Psychiatric Association has condemned the physician-assisted suicide of mentally ill individuals, with Dr. Mark Komrad, a member of that organization's ethics committee, telling Fiano-Chesser that in every country that allows physician-assisted suicide, the same kind of chilling mission creep has been observed: laws originally intended solely to permit doctors to dispatch the terminally ill have eventually been invoked to justify the snuffing out of people who are in tip-top physical shape, especially psychiatric patients.
It is, indeed, a slippery slope. In January of last year, Fiano-Chesser reported on the case of a 74-year-old Dutch woman with dementia who had supposedly stated at some earlier date that she wanted to undergo assisted suicide when “the time is right” – although she had apparently never signed any document to that effect, or at least not a document that clearly spelled out the conditions under which she would allow herself to be extinguished. Eventually her dementia progressed to the point at which a physician at her nursing home decided that it was time for her to cash in her chips. Her family agreed, even though the woman herself had of late “repeatedly said that she didn't want to die.”
The physician instructed a female colleague to finish the patient off, but the patient herself proved uncooperative, struggling so much when the lady doctor tried to administer the lethal injection that the latter had to ask the patient's family “to hold her down” while she stuck the needle in. An official panel later pronounced that the killer (sorry, the doctor) had acted “in good faith,” but – and here's the one bright spot in this entire litany of horror stories – a regional review committee has now said that she acted unethically and has sent her case on to yet another board. (This, by the way, is how cases of medical abuse or negligence are handled in many countries with socialized medicine: the law doesn't provide you with the option of suing for malpractice, so your fate is in the hands of boards, panels, and committees made up of the defendant's colleagues, who, in a small country, are very likely to consist of his or her friends, ex-professors, or former students.)
In my 2014 article, I pondered the kind of mentality that embraces euthanasia not merely as a dreaded last resort in the grimmest of terminal cases but as an instant solution to a wide range of human ills. “What we are dealing with here,” I wrote,
is people who are certain that they are noble and good. They believe in the cycle of life. They believe in quality of life. They just don't happen to believe in the individual life. In fact, they view the individual life as getting in the way of things they value more....They regard people who focus on the individual life as childlike sentimentalists who don't grasp that every individual life is only part of a larger design, a “bigger picture,” and should be extinguished the moment it becomes burdensome or inconvenient.
These people, I was quick to add, would likely deny that they're indifferent to the individual life. They'd say that they just believe that an individual life loses its value when that individual's health or living conditions or other circumstances deviate too far from perfection. What is frightening, of course, is that the degree of deviation that they're willing to permit is steadily shriveling, and the list of afflictions that they consider severe enough to warrant death is growing longer by the year.