Assisted suicide at home – is it safe?

Surveys show that most people would prefer to die at home. They also show that a strong majority would like the option of assisted dying should they feel it is desirable in their last days. This is something that brings reassurance to many but elicits fears in opponents.

But doctors are more reluctant – partly as it is they that have to perform the emotionally draining task. In the Netherlands, many doctors refuse for personal reasons even when the stringent Dutch criteria are met. This leaves a big unmet need.

Dutch mobile euthanasia clinics have now begun offering assisted death in people’s homes this week. They received nearly 60 requests within their two first days of operation.

On Thursday, six mobile “Levenseinde” (Life End) units went into operation around the Netherlands, where euthanasia has been legal since 2002. Petra de Jong, director of the Dutch right-to-die foundation NVVE which runs the mobile service, told De Volkskrant that patients were “grateful.”

The six teams of doctors and nurses provided assisted deaths, either by lethal injection or by administering a lethal cocktail of drugs, to patients whose own doctors have refused to help them die.

“Some of them start crying on the phone,” De Jong said. “They seemed happy that, finally, someone is listening to them.”

In 2002, the Netherlands became the first country in the world to allow regulated euthanasia, meaning doctors can terminate the lives of seriously ill patients who express a wish to die, without fear of prosecution. Strict medical codes of practice apply.

Euthanasia can only be carried out on patients who suffer unbearable pain caused by an incurable disease, who have no hope of recovery. The patients must also clearly manifest a desire to die, among other conditions. But many doctors refuse to practice euthanasia, mainly for religious reasons, and opponents of euthanasia have reacted furiously to the launch of the mobile units, referring to them as “death squads.”

De Jong said most of the requests come from patients with incurable physical illnesses. Only a small number came from patients with serious psychological disorders, she assured. “If the number of requests continues growing at this rate, we’ll have to put in place more mobile teams in April.”

A big criticism of the new venture is that it appears to bypass one of the major inbuilt safeguards of the Dutch system: that the doctor must know the patient well enough to understand whether it is a reasonable and enduring request. This usually means it has to be the patient’s own doctor. Could people slip through the net with the new units?

Misdiagnosis of illness has always been a concern with applied euthanasia. But the Dutch healthcare system, one of the best in the world, is so developed that such problems can quite possibly be tackled from a position of strength. For instance, accessing a patient’s existing medical records and seeing if the only reason a euthanasia request was refused was because the patient’s own doctor has conscientious objections to the administration of euthanasia.

The alternative is clearly undesirable – hundreds of patients, possibly more, dying badly because their own doctor refuses to help for personal rather than medical reasons. The history of Dutch euthanasia shows that borderline cases tend to go to the courts and be examined publicly, so the Netherlands is possibly the best country in the world to try this brave new experiment.