An expert witness for the Quebec National Assembly’s Special Commission on the Issue of Dying with Dignity testified on Feb. 17 that legalizing euthanasia and assisted suicide will lead to widespread abuse and the killing of the vulnerable.

Dr. François Primeau, a professor of psychiatry at Laval University and Chief of Geranto-Psychiatry at the Hôtel-Dieu de Lévis Hospital, used the Netherlands as an example of the impossibility of posing restrictions on the practice. “In the face of the experience of the Netherlands, believing that restrictions will contain these abuses is at best naïve, and at worst is magical thinking,” he said.

In 2009 in the Netherlands, there were 2,636 deaths by euthanasia, a 45 per cent increase in deaths from 2003. Primeau observed, “they don’t count in this total the 550 cases of euthanasia without consent, nor the 400 cases of assisted suicide, nor the 20 per cent of euthanasia cases that were not reported, nor the infants that died.” In fact, the professor and psychiastrist noted, “euthanasia has been performed on minors younger than 12 years old, on depressed patients, on handicapped newborns and on patients suffering from mental illness.” Primeau believes that patients want euthanasia because they feel depressed or demoralized, which can be treated without recourse to lethal means.

The contravention of euthanasia restrictions in the Netherlands noted by Primeau are accompanied by even more startling statistics. Dr. John Keown found that in 1990, 52 per cent of intentional doctor-assisted deaths were not explicitly requested by the patient. A 1997 study in the British Medical Journal wrote about 222 deaths reported by 89 doctors in 1995; of these, 97 were due to an end-of-life decision. Out of the 67 most recent cases, 51 patients were under 65 years old, only two patients “explicitly asked to die”, and there was “some communication” in 23 cases. The Remmelink report, a Dutch euthanasia survey, found there are more than 1,000 unwilling euthanasia victims each year. Herbert Hendin, a researcher who studied the Dutch situation, found that the guidelines were “unenforceable.” The guidelines state that assisted suicide is only given when “a competent patient who has unrelievable suffering makes a voluntary request to a physician,” who must then consult with another physician and report to the authorities. A startling example was a Dutch nun who was killed by her physician because he “felt her religion prevented her from agreeing to euthanasia.”

In Belgium, the situation also seems to be out of control. A 2010 study in the Canadian Medical Association Journal found, out of a sample of 1678 nurses who “received a potential life-ending decision,” 120 admitted they treated a patient who involuntarily received life-ending drugs. The nurse killed the patient in 12 per cent of the euthanasia cases and in 45 per cent of involuntary “assisted death.” According to the authors of the study, “the nurses in our study operated beyond the legal margins of their profession.”

Oregon’s Death with Dignity Act, passed in 1997, has less stringent regulations than the Netherlands, as a “competent” patients who are only left with six months to live (and not necessarily in unbearable pain) may request assisted suicide and have the procedure carried out on them after consulting two physicians and indicating twice that they wanted to die. The annual reports from the Oregon Public Health Division (OPHD) are largely incomplete. As outlined by a Physicians for Compassionate Care Education Foundation press release, the 2010 report acknowledges that more people may have died than the 65 reported cases and “only one of the 65 had a psychiatric or psychological referral” which are required by law.

Moreover, a report for the Michigan Law Review by Herbert Hendin and Kathleen Foley cites that an Oregon assisted suicide guidebook purports that “the presence of depression does not necessarily mean that the patient is incompetent,” suggesting that depressed patients may be taken at their word if they request death. There is also no enforcement mechanism in place to get the same doctors who carry out the procedure to report the deaths. Furthermore, “a study at the Oregon Health & Science University indicated that there has been a greater percentage of cases of inadequately treated pain in terminally ill patients since the Oregon law went into effect.”

There were some questionable reported cases as well. The Michigan Law Review describes the example of Helen, an elderly patient diagnosed with metastatic breast cancer. Two physicians refused assisted suicide, the second saying she was depressed. Afterwards, she called Compassion in Dying, an assisted suicide advocacy group, which put her in touch with a physician willing to give her the drugs, despite the fact that she was not in a lot of pain and could look after her own house. In the case of Kate Cheney, Erika, the 85-year-old woman’s daughter, received a referral to a second physician at Kaiser Permanente, an insurance company, after she found the first one “dismissive.” The second physician arranged an appointment with a psychiatrist, who found Kate did not seem to be pushing for assisted suicide and was incapable of making the decision, which Kate accepted but Erika seemed angry about. After a second psychiatrist found that Kate seemed to be coerced by Erika, the Kaiser administrator nevertheless provided Kate the drugs, finding her capable of coming to a responsible decision.

“It is absolutely impossible to crack down on abuse,” said Alex Schadenberg, executive director of the Euthanasia  Prevention Coalition. “How do we protect a vulnerable person from another person?”

Schadenberg noted that in Oregon, one safeguard to prevent the assisted suicide of the depressed is to send those suspected to a psychiatric consultation. Meanwhile, only one of the reported assisted suicide cases in Oregon in 2010 was referred to a psychiatrist or psychologist. “A safeguard which would seem reasonable… is in fact just ignored.”

He also stated that it is impossible to protect victims of elder abuse, much of which is under-reported. Furthermore, in 2009, out of the 59 reported cases in Oregon, 57 were facilitated by Compassionate Choices, an assisted suicide group. It is questionable then, what the safeguards amount to when most reported cases are “done by a group promoting assisted suicide.”