February 28, 2016

America’s Moral Panic over Euthanasia in the Netherlands

Whoever said it was Donald Trump who was causing moral panic and outrage in the US at the moment was only partly right. The other mischief maker is the Dutch, at least where euthanasia is concerned.

The study published last week in the Journal of the American Medical Association shows a few things. And not just that the Dutch are allowing euthanasia where Americans would fear to tread.

It shows also that the Journal’s editorial regime is in trouble, or it should be. Allowing such a study – and I use the term loosely – to be published in a peer reviewed journal of this nature.

At its core the article gives a quantitative analysis to 66 qualitative cases of voluntary euthanasia in the Netherlands (recorded between 2011 and 2014). Any first year research methodologies student would know how inappropriate, misleading and downright unscientific it would be to apply such a methodological approach.

Psychiatrists are ill suited to be the arbiters of end of life decision making. This study  shows why.

The study by three psychiatrists is flawed not only because it is the narrow discipline of psychiatry that conducted it. Psychiatry is unsuited to this endeavour because there is nothing in medical school training that teaches social science research methodologies. The only reason these psychiatrists have gotten away with it is because they sit at the pointy end of the medical pyramid of privilege.

Far too many of us, both within and outside the medical profession, hang off their every word. When we shouldn’t.

Not only is the study flawed because the figures are so small as to make percentages meaningless, but in doing so, the highly contextualised nature of the 66 instances of decision making is ignored.

The narratives of these lives along with issues of subjectivity, identity and agency barely get a look in.

Thirdly, but not finally, sloppy findings of this nature lend themselves  to misinterpretation by the press, both willfully and through plain ignorance.

The end result is that the public is stripped of insight into something which is a topic of great interest and which should be reported on responsibly.

Take Charles Lane’s op ed in The Washington Post in recent days.

Pro-life/ anti-choice, Chuck uses the JAMA article to accuse the Dutch of euthanazing a 30-something man diagnosed with autism. That he wanted out and was considered to have legal capacity to make such a choice is beside the point.

Nuh, Chuck just wants to tell us that if you get autism, don’t go to Holland because the Dutch will be to put you down!

Next point, Chuck notes that in 37 cases the patients refused ‘possibly beneficial treatment’. But that the ‘doctors proceeded anyway’ in putting these good folk down.

Lets unpack this one for a minute.

In the Northern Territory of Australia’s 1996 Rights of the Terminally Ill Act, the treatment on offer had to be acceptable to the patient. If it were not acceptable, there was no requirement to pursue it. In other words the person could then ‘satisfy’ that criteria towards using the ROTI Act for a peaceful death.

This type of legislative clause of acceptability is important.

It is important because it preserves autonomy and personal dignity. It also upholds the widely-accepted belief (and legally enshrined patient right) that a person can decline medical treatment.

That is, you do not need to be shackled to the hospital bed, and needles inserted or tablets shoved down your throat if you don’t want it.

If a person has the capacity to refuse medical treatment then their decision to turn such treatment down should not be dismissed.

What type of society do we want to live in?

Surely not one that forces medical treatments on the unwilling? Yet this is precisely what concerns Chuck here.

And that’s not all. He’s also worried about the 70-something ‘physically healthy’ woman (Chuck had to add that bit in) who requested and received euthanasia because she didn’t want to live on after the death of her husband (from voluntary euthanasia) the previous year.

According to Chuck, ‘live on’ is precisely what she should have been forced to do. So much for the land of the free.

I could go on but I won’t.

What I will say to conclude is that the Dutch secular tradition of looking after oneself and self-reliance seems to stir up deep-seated anxieties in countries such as the US, where God is writ large.

And where the religious right is both well-funded and active.

While Chuck Lane’s op ed is tomorrow’s take-out wrapper, it is of concern because The Post chose to give it a run.

That it is not the only article to appear of late where Holland is being hung out to dry as some wacky nirvana where anything goes, shows how deep the cultural misunderstandings run between the so-called land of the free and a country that could be called the real thing.

I, for one, hope the Dutch do not bend to America’s religious right, nanny-state mentality on this issue.

The Netherlands has led the way for more than 20 years. I hope they continue to do so.

 Fiona Stewart, PhD MPolLaw LLB

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