Tim W does like the smell of a good argument in the morning.
Tim on abortion And now, Tim on euthanasia.
He quotes apparently with approval Philip Johnston’s piece in today’s Telegraph.
“There is evidence, too, that 1,000 deaths take place in Holland every year as a result of action by doctors for which no specific request has been given.”
True, but not the whole truth.
Johnston without naming his source is in fact quoting from a study carried out in 1990 by P. J. van der Maas for the Dutch government. And it is here Johnston finds his 1000 deaths which take place, it seems, without any specific request.
In 600 of these cases, there had in fact been some patient involvement in the decision. Some discussion about ending life had in fact taken place. Where there had been no discussion, the patient was either permanently unconscious or in what the report describes as a state of “reduced consciousness”. What was clear from the report was no one was put to death against his or her will, except in a couple of cases where the doctors felt uncomfortable discussing the issue openly with the patient.
What concerns both Tim explicitly, and Johnston obliquely is the “slippery slope” argument. But is there any evidence in the Dutch experience supporting that worrisome trend?
Here’s Peter Singer’s analysis. He poses the question
“even if in every case in which the doctor ended the patient’s life without consent, we could accept that the doctor was justified would it still not be true that this violated the guidelines accepted by the courts? [The significant guideline here, that there should be an explicit request from the patient which leaves no room for doubt about the patient’s desire to die is one the Royal Dutch Medical Association imposes where euthanasia is permissible.] Does this not vindicate the slippery- slope argument that non-voluntary active euthanasia is being practised to an increasing degree?
Here the answer is very clear: the Dutch figures cannot possibly show an “increasing practise” of anything, because to show that we would need figures from two or more different years, preferably separated by a substantial gap. No such figures exist. The authors of the Dutch study [The Remmelink Study-two years later] are therefore surely right when they say, after discussing attempts to use their study as a basis of a slippery-slope argument,"We conclude no empirical data can be marshalled to support the slippery-slope argument against the Dutch”
If there are no figures comparing the practice of euthanasia in the Netherlands at earlier and later times, we may still want to know whether Dutch doctors end the lives of their patients without an explicit request more often than doctors in other countries. Again, however, there is simply no basis for giving a definite answer to this question. The Dutch study found [………….] as many as 8000 [cases] in which doctors gave drugs more to relieve pain or symptoms than explicitly to end life, but hastening death was nevertheless part of the purpose of giving the drugs. To say what is one’s primary or secondary purpose is obviously not going to be easy in these situations. Doctors everywhere give patients who are dying from painful illnesses large doses of morphine or sedatives that may shorten their lives. They do this knowing that, if the drug does shorten the patient’s life, it will be better for the patient than continued suffering.”
And before Singer leaves the Dutch 1000, he deals with cases where doctors, without specific consent, withhold treatment that could prolong the patient’s life.
“This happened in 70% of the instances of withdrawal or withholding of medical treatment, a total of 15,750 deaths. In 88% of these cases, the patient was not capable of being consulted, leaving 12% or 1890, in which the patient was capable of being consulted, but was not. The Dutch study tells us that in almost half of the number of cases of withdrawal or withholding of medical treatment this was done with the explicit purpose of hastening death. (In the remainder, the doctor “ took into account the probability that the end of life would be hastened”.)
Such cases of withdrawing treatment are also a normal part of medical practice in other counties.”
Remember the Tony Bland case? The young man plunged into a persistent vegetative state after attending the F.A. cup semi-final between Liverpool and Nottingham Forest at Hillsborough in 1989. The court subsequently decided to remove feeding tube and as a result death followed as certainly as in any Dutch hospital.
Is there a difference?
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