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Euthanasia laws can expand to include the mentally ill, the old, and children

Every jurisdiction that has legalised euthanasia or assisted suicide has seen the intended boundaries of their law expand over time. Once a state gives a license to doctors to end the lives of their patients, boundaries around who gets included and who doesn’t become fuzzy and get actively pushed out.

The most glaring evidence of such a slippery slope may be seen in the Netherlands and Belgium. The Dutch law hasn’t changed since euthanasia was decriminalised, but the reasons for wanting euthanasia have continued to expand. Initially terminal cancer accounted for 95% of euthanasia deaths, but now they make up only 68%. The rest are increasingly due to mental illness, early dementia, psychological suffering or accumulating age-related complaints.

In the past few years, the Netherlands has seen the euthanasia of a 54-year-old with personality and eating disorders, a 29-year-old with severe mental illness, and a sexual abuse victim in her 20s who suffered from PTSD.

In Belgium, a 44-year-old with chronic anorexia nervosa, a 44-year-old transgender man who was dissatisfied with his sex change operation, and 45-year-old twins who were going blind were all euthanised. An 85-year-old woman was euthanised because she was grieving the death of her daughter. 

In a 2015 survey of Dutch SCEN doctors (similar to the SCENZ Group proposed by the End of Life Choice Bill), half (49%) said that the limits had been broadened since their first years as a SCEN doctor. None of these changes were made by Parliament. Eleven per cent of SCEN doctors admitted to approving people for euthanasia who felt they were “suffering from life” without any medical basis, even though such cases were regarded by the researchers as outside the law. The Netherlands is currently debating extending the euthanasia law to include people who are healthy but feel they have “completed life”.

But it’s not only the European jurisdictions where the slippery slope occurs. In Oregon, where assisted suicide may only be given to those with a terminal diagnosis with 6 months or less to live, the definition of a “terminal condition” has expanded over time. What was once limited to conditions that no treatment could stall or cure is now increasingly available to people who refuse treatment that can keep them alive, such as diabetics. A Bill is currently being proposed to expand eligibility to any patient with an incurable disease or unbearable pain. 

And in Canada, where their Medical Assistance in Dying Law has been in effect for just over two years, an expert panel examined the extension of the law to mature minors, people who made advance requests and to those with a mental illness only. Cases are being brought to court to expand eligibility to people with disabilities such as cerebral palsy. In 2017, the Ontario Superior Court declared that a patient doesn’t have to have a terminal condition or expect death to occur within a specific timeframe to meet the law’s requirement that “natural death has become reasonably foreseeable”.  

The slippery slope is real. And if Canada’s experience is anything to go by, it is getting more slippery.

Sources: Regionale Toetsingscommissies Euthanasie, Vijftien jaar euthanasiewet: belangrijkste cijfers, 2017 (2018); S Y H Kim, R G De Vries, J Peteet, “Euthanasia and assisted suicide of patients with psychiatric disorders in the Netherlands 2011 to 2014,” in JAMA Psychiatry (2016) 73(4): 362-368; J Pieters, “Euthanasia Ok’d for dementia patients who request it when lucid,” in NL Times (7 January 2016); T Boer, Submission to the Justice Committee on the End of Life Choice Bill, (5 March 2018); S Dierickx, L Deliens, J Cohen, K Chambaere, “Euthanasia in Belgium: trends in reported cases between 2003 and 2013,” CMAJ (2016) 188(16):E407-E414; Pro Vita, Euthanasie bij gevorderde dementia ‘denkbaar’, (23 April 2015); F Stahle, Submission to the Justice Committee on the End of Life Choice Bill, (February 2018); B Yelle, “Keep leading with better end-of-life choices” in The Register-Guard (15 January 2019); Council of Canadian Academies, Medical Assistance in Dying: The expert panel on Medical Assistance in Dying, (12 December 2018); CTV News, Assisted dying laws are ‘paternalistic and patronizing’, academic says, (7 January 2019). The Canadian Press, “B.C. woman who challenged right-to-die laws gets medically assisted death,” in CBC News (18 September 2017).

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