A report entitled “End-of Life Practices in the Netherlands under the Euthanasia Act” was published in the New England Journal of Medicine on May 10. The media are claiming that the report states euthanasia in the Netherlands has dropped since its legalization in 2002. When reading the actual report, however, we learn of a different reality than that presented in the media.

The report states that in 2001, the year before euthanasia was formally legalized in the Netherlands, there were approximately 3,500 (2.6 per cent of all deaths) euthanasia deaths, approximately 300 (0.2 per cent) assisted suicide deaths and approximately 8,500 (5.6 per cent) deaths by terminal sedation (sedation followed by intentional dehydration).

The report adds that in 2005, there were approximately 2,325 (1.7 per cent)  euthanasia deaths, approximately 100 (0.1 per cent) assisted suicide deaths and approximately 9,685 (7.1 per cent) deaths related to terminal  sedation. It seems that the decreased incidence of active euthanasia was replaced by an incredible increase in deaths by terminal sedation in the Netherlands.

The other fact in the study is that approximately 550 of deaths (0.4 per cent) resulted from the ending of life without explicit request. These numbers are not part of the regular euthanasia numbers because they lack the requirement of voluntary request and therefore are placed in a separate category. This number appears to have remained steady since 2001.

The practice of terminal sedation needs to be separated from decisions to sedate patients without the explicit intention of causing death. In 2005, there were another 1.1 per cent of deaths wherein the patient was sedated without the explicit intention of causing death.

Terminal sedation often represents slow euthanasia, rather than normal end-of-life care. With someone who is not otherwise dying, but is unlikely to recover, the decision to sedate and intentionally dehydrate and starve the person to death often means death is from dehydration. Since the intentional cause of death is dehydration, and not an underlying medical condition, these deaths fulfill the traditional definition of euthanasia, which is the intentional causing of death, by action or omission, for reasons of mercy.

Since the Netherlands defines euthanasia as only the voluntary active cause of death, cases of intentional death by terminal sedation are not considered a part of the total euthanasia practice. The actual number of intentionally caused deaths may, in fact, be higher.

The report states that 80.2 per cent of all euthanasia deaths in 2005 were reported, which is up from 54.1 per cent in 2001. Nonetheless, the report admits that most of the under-reporting is related to deaths that resulted from the use of opioids to intentional overdose.

The media continue to lack honesty in their reporting of the actual number of intentionally caused deaths in the Netherlands and euthanasia continues to be out of control. Therefore, in 2005, there were approximately 12,660 intentionally caused deaths, 9.3 per cent in relation to all deaths in the Netherlands. This does not represent a decrease in intentionally caused deaths, but rather a continuation of a sad history of intentionally causing the death of people who are in the most vulnerable times of their lives.

Alex Schadenberg is the executive director of the Euthanasia Prevention Coalition. This article is reprinted with permission from the May EPC Newsletter. To receive a copy of the report End-of-Life Practices in the Netherlands under the Euthanasia Act, simply request it from: Euthanasia Prevention Coalition, Box 25033, London, Ont., N6C 6A8. E-mail: euthanasiaprevention@on.aibn.com or call toll-free: 1-877-439-3348.