The pioneer countries in regulating euthanasia now focus on the minors and the mentally ill. This is a review of your legislations.
The Euthanasia Law I enter in force in the Netherlands in 2002, and includes both the one practiced by the doctor and the suicide aid, and the combination of both. If this does not adhere to the procedure, there are penalties of up to 12 years imprisonment, although no doctor has been convicted of bad praxis. The norm has great support among the population -88% in 2017, according to the Ministry of Health- and in the last decades cases have increased. In the past year, notifications increased by 8%, from 6,091 (in 2016) to 6,585 people. For the most part, they were incurable cancer patients with unbearable pain.
The figure appears in the annual summary made by the Five Regional Commissions that supervise it. In turn, the health authorities have found that "more than half of the Dutch support euthanasia in cases of dementia, psychiatric disorders or healthy elderly with 'life-span'."
The Law avoids the prison of doctors if they comply with the imposed requirements: make sure that the patient has asked for euthanasia repeatedly, voluntarily and consciously; that their suffering is impossible to endure and without prospects for improvement, and to have consulted with another independent colleague. What remains are the problems of conscience of many physicians.
The bedside is usually those who practice euthanasia because they know the patient better than anyone, but no case is easy. All the surveys conducted between the profession show the same result. It is allowed, but they exhaust all possibilities beforehand. Children can request it from 12 years of age, but they need permission from their parents. From the 16, they decide themselves.
Once it has happened, the doctor fills out a form with the facts and refers the case to one of the five Regional Commissions that evaluate whether everything was done according to the law. According to his data, "99.8% of the 6,585 executed in 2017 were careful. Almost 90% of the cases were cancer patients, Parkinson's or degenerative, heart, vascular or lung diseases. The most common age range was between 70 and 80 years (30.4%). It followed him between 80 and 90 years (24.8%), and then between 60 and 70 years (21.3%) ".
For its part, the Medical Association noted its "concern about the expectations of the patient willing to die, and that euthanasia considers a right, and the limitations of the doctor." They also pointed out "the long time elapsed between the notification of euthanasia and the decision of the Commissions". In 2017, there were 12 doubtful cases resolved in favor of the doctor, because "none acted in bad faith". Yes there have been reprimands, like the one a doctor took in 2016 to "force the situation" with a patient with acute dementia. She had asked for euthanasia when she was lucid, but the doctor did it "when it was convenient".
Having legislated euthanasia has not extinguished the controversy before its increase (in 2002 there were 1882), largely attributed to the aging of the population. The new assumptions not contemplated in the Law are also controversial. It is about psychiatric problems and various degrees of dementia, with an upward trend. In 2013, these requests, rejected by the family doctors, began to be channeled through a private center, the Levenseindekliniek (Clinic for Dying).
It is not a physical center to reserve a room, but a sort of ambulatory with doctors and nurses who move home. In their first year of activity, they received 714 prayers and performed 104 euthanasia. In 2017 there were already 751. The Medical Association does not oppose, but prefers that the relationship between the patient and the doctor be close, instead of strangers arriving home even if they are qualified. Since 2016, a new protocol reinforces the value of a patient's statement asking for help to die in cases of dementia. He had to sign it in the presence of a doctor, before the cognitive deterioration is acute.
Babies have the so-called protocol of Groningen, prepared in 2005 by the University Hospital of said city, in the north of the country. It helps the dying to newborns with incurable diseases or congenital malformations that prevent their development. Both the Government and the Dutch Pediatric Association avoid using the term euthanasia here, so as not to induce errors. The legislation excludes "those who do not have a voice", whether they are newborns, handicapped or mentally ill. The pediatrician or neonatologist must also make sure that the child has no cure or improvement, and talk to another specialist.
The most recent case is that of the elderly with "vital fatigue", who consider that they have lived long enough. The possibility of assisted suicide has not been legislated. These are elderly people who do not suffer unbearable physical or mental suffering. They are usually alone, without family or friends, and their lack of perspectives was analyzed by the Government in 2016 to see if they could be included in the euthanasia cases.
In 2017, the commission in charge of studying it advised against it. "It seems more like a way to ensure the freedom to decide on the end, because the current law can already deal with cases of extreme suffering resulting from feeling finished, without being sick," said the sociologist Paul Schnabel, who led the study.
United States and Canada
Euthanasia is not legalized in the United States, but seven states in the country and the city of Washington do allow assisted suicide, which is monitored by a competent authority. The methods vary according to each region, but it is necessary to have a minimum age of 18 years, at least three authorizations from doctors, the patient must reside in that State and must have a maximum of six months of life as a result of a terminal illness. The states that allow it – whether after approval by Parliament, citizenship in a referendum or by a court ruling – are Oregon, Colorado, Hawaii, Vermont, Washington, Montana and California.
Oregon was the first state to approve assisted suicide after going ahead in a referendum in 1994. The remaining states and the US capital have authorized it in the last decade. For example, since the Oregon law came into force in 1997, a total of 1,967 people have received prescriptions for assisted suicide and 1,275 of them have died from ingestion of prescription drugs, according to the latest data. To get an idea, the population of Oregon is 4.1 million.
In neighboring Canada, the Parliament passed in 2016 a law allowing assisted suicide driven by the prime minister, Justin Trudeau. A doctor or nurse can directly supply the drug that will cause the death of the patient or he can administer it to himself. The applicant must have a minimum of 18 years and be mentally competent, have a "serious and irremediable" medical condition but this does not have to be terminal. The disease must be irreversible, causing an "unbearable" suffering that can not be alleviated under conditions that the patient considers acceptable and the person must be in a medical phase in which they can expect to suffer a natural death resulting from these ailments.
The latest statistics correspond to the period between July and December 2017. There were 1,525 assisted deaths in Canada, which represents an increase of 29.3% compared to the previous six months. These deaths accounted for 1.07% of the total deaths in the country in the same period of time, which, according to the authorities, coincides with the figures of other countries. 65% of the people who requested assisted suicide suffered from cancer. The average age of the deceased was 73 years.
Belgium and Luxembourg
In Belgium, the law of euthanasia is approaching its adulthood with about 20,000 deaths by this means. The practice has been legal since 2002, and the number of serious patients who chose to end their lives with medical help has progressively increased from 239 in their first year to 2,309 last year, an average of six a day, and a 13 % more than in 2016. Health services break down their profile into a report each year. They mostly had cancer, were over 60 years old, and chose to receive the lethal dose at home rather than in the hospital. The text states that there were no major differences between men and women, but between the two main communities of the country: 78% were Flemish compared to only 22% of Walloons, despite representing 60% and 40% of the inhabitants respectively.
Euthanasia is legal in Belgium for incurable patients who express repeatedly his willingness to die due to a physical or psychic suffering that can not be alleviated in any way. To obtain the permission they must make the request in writing, and a second doctor must certify that the ailment is incurable.
16 years after its implementation, euthanasia is widely accepted and does not generate debate among the population. Yes it has created some controversy its application to people with mental illnesses that are not in terminal phase. The Belgian bishops complained unsuccessfully that they were outside the scope of the rule, although the requests of this group amounted to only 1.8% of the total. It also created suspicion of its extension to minors in 2014, which made Belgium the first country to accept that children can ask for it, always with parental consent. However, this route is residual: between 2016 and 2017 euthanasia has been applied only to three children under 9, 11 and 17 years old.
In neighboring Luxembourg, where it is legal since 2009, this method is rarely used. Only 18 people (12 men and 6 women) died with help between 2015 and 2016. In seven years in force, only 52 people have taken refuge in the law.
Dying in Colombia is a right since 1997, when a ruling by the Constitutional Court decriminalized euthanasia. "Nothing so cruel as to force a person to subsist in the midst of opprobrious suffering, in the name of other people's beliefs, so an immense majority of the population deems them intangible," said the statement. However, the procedure remained in legal limbo until 2014.
Then, following a patient who asked the judge to protect his rights before a medical objector, the high court urged the Ministry of Health to regulate the assisted suicide under two conditions. In the first place, it must be checked "the suffering of a terminal illness that produces intense pain". Secondly, there must be "the free, informed and unequivocal consent" of the patient, who must demonstrate that he or she is in a perfect psychic state.
The first public case was, a year later, that of Ovidio González, a 79-year-old shoemaker who was losing his face due to cancer of the mouth. "In full use of my mental faculties and freely and voluntarily, I manifest my intention that I be euthanized. The previous request I make under the seriousness of oath with the free and absolute conviction of the exercise of my fundamental right to die with dignity, "he asked doctors Gonzalez, father of the famous cartoonist Matador. Since April 2015, euthanasia has been applied to 36 people in Colombia, the only country in Latin America that has an established protocol, although there are dozens of patients still waiting.
The Constitutional Court has addressed the debate on euthanasia on at least a dozen occasions. It has also urged Congress to improve legislation. However, the parliament, very fragmented ideologically and with a majority strongly marked by the Catholic heritage, has for the moment ignored these requests. The high court, created with the purpose of ensuring the 1991 Constitution, sparked controversy last year by ordering the government "to enforce the right to die with dignity of children, girls and teenagers. " The procedure was regulated, at least on paper, in March and is subject to strict requirements. Children under 12 are excluded (although between 6 and 12 some exceptions can be established). From 12 to 14 years old, the authorization of the parents and the consent of the patient are mandatory, while from the age of 14 the will of the adolescent will prevail.
With information from Isabel Ferrer, Joan Faus, Álvaro Sánchez Y Franceso Manetto.