March 1, 2024

Dutch euthanasia study flawed, says US bioethicist

A study of Dutch euthanasia in the Archives of Internal Medicine has found that doctors follow the reporting requirements prescribed under Dutch law. The results support the view that a controversial law allowing euthanasia and assisted suicide has enough safeguards to keep patients from being killed against their will or when they are not of sound mind.

However, in an accompanying editorial, bioethicist Susan M. Wolf, of the University of Minnesota, says that “there are substantial reasons to doubt this reassurance”. She points to a number of limitations of the research: that only pro-euthanasia doctors were surveyed; that all of then had recently been trained or reminded of the rules; that there was no control group; and that it was based entirely on what the doctors remembered, not objective data. Furthermore, doctors were only asked about the latest explicit request for euthanasia they had received and not about euthanasia without any request. This may have excluded instances of involuntary euthanasia.

There have been repeated reports that many Dutch doctors do not follow reporting requirements, observes Dr Wolf, and it is difficult to believe” the main finding of the current study. She cites a report on Oregon’s assisted suicide law: “Under-reporting cannot be assessed, and non-compliance is difficult to assess because of the possible repercussions for non-compliant physicians reporting data”.

The Dutch authors also found that the most common reasons for requesting euthanasia were pointless suffering, loss of dignity and weakness — not unbearable pain. They also admit that the degree of clinical depression might often be underestimated in their article, as no objective scale was used, and some patients might not admit to being depressed, lest their request be denied. In 13% of cases, patients withdrew their requests.