National Affairs Rory Leishman

National Affairs Rory Leishman

Less than a year after the Supreme Court of Canada unanimously legalized euthanasia for mentally competent patients in the 2015 Carter ruling, Liberals and New Democrats on the Special Joint Committee of Parliament on Physician-Assisted Dying unanimously recommended that the law on euthanasia should extend to mentally incompetent patients as well.

Everyone who supports this so-called progressive reform, should contemplate the shocking case of a 74-year old dementia patient in the Netherlands who was euthanized in a nursing home over her strenuous objections.

On July 24, the Regional Health-Care Disciplinary Board for The Hague observed in its ruling on this incident that the victim (identified only as “the patient”) was a former kindergarten teacher, who had been diagnosed with Alzheimer’s four years before her death in April, 2016.

Prior to becoming mentally incompetent, the patient had signed a medical directive stating: “I certainly do not want to be placed in an institution for demented elderly people.” Having recalled how her demented mother had languished for 12 years in a nursing home, the patient wrote: “I know what I’m talking about. I certainly do not want to experience this. It has seriously traumatized me and has saddened the whole family.”

Scarcely a year later, the patient was so mentally incompetent that her aged husband could no longer care for her at home. As a result, she ended up in a nursing home against her wishes. There, as anticipated, she was often profoundly unhappy. Sometimes, she slapped, kicked and bit members of the staff in a blind rage. According to her gerontologist. “Only when her family was with her did the patient find life acceptable.”

The Dutch Termination of Life on Request and Assisted Suicide (Review Procedures) Act allows a physician to euthanize a patient in accordance with certain specified criteria. Among these, the physician must be satisfied (a) that the patient has made a “voluntary and well-considered” request for euthanasia and (b) that the patient is “suffering unbearably with no prospect of improvement.”

The Act also stipulates that a physician can euthanize a mentally incompetent patient if the patient had made a voluntary and well-considered request for euthanasia in an advance directive signed before becoming mentally incapacitated. However, the lawwarns: “The due care criteria (set out for mentally competent patients) apply mutatis mutandis,” (that is, the necessary changes having been made).

Within a few weeks after the patient entered the nursing home, both her gerontologist and a consulting psychiatrist concluded that she was suffering unbearably and met all the other legal requirements for euthanasia. At the urging of the patient’s husband and with the concurrence of her daughter, the gerontologist then set a date for putting the patient to death.

At the appointed hour, the gerontologist and members of the patient’s immediate family — her husband, daughter, the daughter’s husband and the patient’s sister — gathered in the patient’s room, where they all reportedly enjoyed a last cup of coffee together. To avoid any unpleasant reactions from the now often bewildered, unpredictable and sometimes violent patient, the gerontologist surreptitiously laced her coffee with a powerful soporific.

Soon, the patient fell asleep; the gerontologist began to infuse a lethal dose of thiopental into her arm; and then, suddenly, the procedure went horribly wrong: The patient awakened, stared aghast at the infusion line, struggled to sit up and attempted to wrench the line out of her arm.

Naturally, the gerontologist and family members were shocked. But they soon regained their composure and resolved to carry on with the euthanasia regardless of the patient’s objections. While members of the family firmly held the patient down, the doctor methodically proceeded to kill her.

In due course, the disciplinary board summoned the gerontologist to explain why she had ignored the patient’s objections during the euthanasia procedure. In response, the gerontologist testified that she had felt the patient was so demented that she could no longer understand her own best interests. In summarizing the evidence, the disciplinary board observed: “Even if the patient at this moment had said, ‘I do not want to die,’ the gerontologist would have carried on with the euthanasia.”

In its ruling, the disciplinary board firmly rejected such cavalier disregard for the wishes of a demented patient. “Demented patients also still retain the right to refuse euthanasia,” the board said. In a precedent-setting clarification of the law, the board made plain that even if a mentally incompetent patient had signed a clear and unambiguous advance directive requesting euthanasia, a physician must not euthanize the patient if the “behaviors/expressions” of the patient immediately before or after the procedure is underway “are not in line with this declaration of intent.”

By this standard, the gerontologist was clearly in the wrong. As the board pointed out: “On the day of the euthanasia, the patient did not in any way express a death wish. To the contrary, she even made plans that day to go out that same evening for a meal with her family.” Yet without notifying the patient, the gerontologist surreptitiously gave her a soporific and continued to euthanize her over her strong verbal and physical objections.

On this basis, the board concluded that the gerontologist had clearly violated the due care criteria of the Termination of Life on Request and Assisted Suicide Act. In consequence, the board could have cancelled the gerontologist’s licence to practise medicine, but decided, instead, merely to issue her a formal reprimand on the ground that she had acted in good faith to serve the best interests of her patient.

This is the first rebuke the board has ever issued to a physician for violating the Dutch euthanasia law since the law’s inception in 2002.

Currently, the gerontologist is appealing the ruling and the Dutch Justice Ministry is weighing the propriety of laying criminal charges against her.

Meanwhile, public disclosure of the killing of the helpless, severely demented, 74-year-old former kindergarten teacher has caused quite a sensation in the Netherlands. More than 450 Dutch physicians have signed a protest petition stating: “Will we give a lethal injection to a patient with advanced dementia on the basis of an advance directive? No we will not do that.  Our moral disgust at ending the life of a defenseless patient is too great.”

Among the physicians who initiated this petition was Bodewijn Chabot, a leading geriatric psychiatrist. In 1992, 10 years before euthanasia and assisted-suicide were legalized in the Netherlands, he assisted in the suicide of a physically healthy and mentally competent, 50-year-old Dutch woman who was profoundly depressed over the death of her two sons. He was duly prosecuted and convicted, but the court imposed no punishment on the ground that Chabot had been motivated by sincere compassion for his patient.

Chabot has now changed his mind (somewhat) on euthanasia.

Having recounted how he had assisted in the suicide in 1992, Chabot avowed, in a newspaper article, “With the knowledge I now have, I would not do it again.” He also affirmed that he would never euthanize any other of his patients, including those who are suffering from severe dementia.

However, Chabot went on to write that he would also tell the patient that if you want to die, you should kill yourself and I will tell you how to do it safely and effectively without any medical assistance.

That is appalling! How can a brilliant physician like Chabot not grasp that aiding and abetting in a suicide with advice is hardly less evil that handing over a lethal potion or a loaded gun to a suicidal patient?

Could dementia patients end up getting euthanized in Canada? Most definitely — especially if the Liberals and New Democrats on the Parliamentary Committee on Physician-Assisted Dying get their way. In the committee’s report, these self-styled compassionate and progressive politicians unanimously recommended that Parliament include a provision in the law on medical assistance in dying to allow for the use of legally binding, advance requests for euthanasia at “any time after one is diagnosed with a condition that is reasonably likely to cause loss of competence.”

If such a law were in effect, any Canadian dementia patient who signed an advanced request for medical assistance in dying could also be legally killed in a nursing home despite his or her strenuous objections.

That Parliament has yet to amend the law to permit euthanasia for mentally incompetent patients is hardly reassuring. After all, it was not Parliament, but the Supreme Court of Canada that initiated legalized “physician-assisted death for a competent adult person who clearly consents to the termination of life.” Soon, this same Court could also arbitrarily extend these limits to cover physician-assisted death for mentally incompetent patients as well.

Let us face it: We, Canadians, are no longer a free and self-governing people. In one generation, we have sunk to the lowly status of feckless vassals who let the Supreme Court of Canada usurp legislative authority over even the most vital questions of life and death.