February 29, 2024


 About every five years, statistics on Dutch euthanasia are released. Figures for 2005, four years after the practice was legalised in the Netherlands, show that the number of euthanasia cases fell "sharply": from 3,500 in 2001 to 2,325 in 2005. The number of assisted suicides also fell, from 300 to 100. Overall, the percentage of all death by euthanasia dropped from 2.6% to 1.7%. Good news about a successful law?

Deputy Health Minister Jet Bussemaker thought so, but for a different reason. "The most important finding of the research… is that 80% of euthanasia cases are now being reported," she said. It was a pleasing improvement from 2001, when only 54% of euthanasia cases were reported. The Dutch doctors’ lobby group also welcomed the improvement in transparency. "Doctors have shown that they are open to scrutiny."

However, the figures, which are set out in a detailed report in the New England Journal of Medicine by a group of Dutch doctors, including some of the country’s leading advocates of euthanasia, can be spun in quite a different way. These show that a small decrease in voluntary euthanasia has been more than offset by a hefty increase in what is called "terminal sedation". Patients are given drugs which sedate them "continuously and deeply" until death, in 8.2% of all deaths.

In 7.1% of all deaths, hydration and nutrition were withheld in 2005, compared to 5.6% in 2001. In other words, 7.1% of all people who died in the Netherlands in 2005 died in much the same way as Terri Schiavo, of starvation and thirst, in conjunction with the course of their own disease. To put it even more starkly, voluntary euthanasia (7.1%), non-voluntary euthanasia (0.4%) and terminal sedation accompanied by withdrawal of nutrition and sedation, accounted for nearly 1 in 10 Dutch deaths.

What is the explanation for the shift in the pattern of deaths? The report in the NEJM mentioned three causes, all of them interesting. First, because of the rapid ageing of Dutch society, there are more people over 80, which — surprisingly — is the age group least likely to request euthanasia. Second, doctors increasingly favour palliative care, at least a Dutch version of it, and are using more terminal sedation. Interestingly, the over-80s don’t like this either.

Third, the goalposts for "non-voluntary euthanasia" have shifted. Where some doctors used to do this with opiates, it now appears that opiates don’t really do a good job. They may be doing the same thing, but not calling it "non-voluntary euthanasia".

Definitions are the bugbears of euthanasia studies. According to an editorial in the NEJM by Dr Timothy Quill, a professor of medicine at the University of Rochester School of Medicine, in New York State, "There is no evidence of a ‘slippery slope’ in Oregon or the Netherlands." Perhaps not, but slippery statistics abound.