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Dutch Doctors Use “Deep Sedation” to Hide Assisted Suicides

The Lancet has just published an article purporting to show that euthanasia rates have not increased in the Netherlands since legalization in 2002.

This news will probably be seized upon by enthusiasts for decriminalisation in the UK and elsewhere but the figures are not at all what they seem at first sight and the press release sent out by the journal is selective and misleading in its reporting of the facts.

If you read the press release sent by the Lancet (reproduced by Medical Xpress) it all seems cut and dried. There were about 4,050 cases of euthanasia or assisted suicide in 2010 (2.8% of all deaths) and this was only slightly up from the 2001 figure of 3,800 (2.6%).

But if you read the abstract along with the full article and accompanying comment you get a very different picture altogether.

Most news outlets will do neither but will simply propagate the press release which is why it is important to look at the original sources.

Thus far, the Daily Telegraph is the only national newspaper to cover the story.

The key fact which should alert people to something odd going on is the reference to ‘continuous deep sedation’ in the Netherlands which appears in the article’s abstract but tellingly (and perhaps even disingenuously) not in the Lancet press release.

The abstract states, ‘Continuous deep sedation until death occurred more frequently in 2010 (12.3% [11.6—13.1; 789 of 6861]) than in 2005 (8.2% [7.8—8.6; 521 of 9965]).’

But what was the rate of ‘continuous deep sedation until death’ in 2001 and previously?

On examining the article we learn from table 1 that it was not measured in 1990 and 1995 and was 5.6% in 2001. In other words there has been a steady increase in this category of cases which in 2010 accounted for 16,700 deaths.

Over the same period the number of deaths after ‘intensified alleviation of symptoms’ has also increased from 20.1% to 36.4% and now accounts for over 49,500 deaths annually.

There is nothing new about any of these figures. They have all been published in reviews of Netherlands practice before in peer-reviewed medical journals (in total five studies covering 1990, 1995, 2001, 2005 and 2010).

But the accompanying comment piece in the Lancet by Brendan Lo raises some very interesting questions indeed.

It acknowledges that the line between euthanasia and ‘the less controversial, much more common practice’ of ‘continuous deep sedation’ ‘can be blurred in clinical practice’ and noted that in other studies ‘physicians also misclassify some cases of euthanasia’.

In other words, it says, ‘physicians who say they are undertaking palliative sedation sometimes cross the line to euthanasia’.

Whilst the paper claims that the level of involuntary euthanasia has decreased since 1991 from 0.7% to 0.2% of all deaths (ie. deliberate killing with lethal drugs without consent), it also acknowledges that ‘in 42% of cases classified by the investigators as intensified alleviation of symptoms, the physician did not discuss the decision with the patient, relatives or another physician’….

[Dr. Peter Saunders | Amsterdam, Netherlands | | 7/11/12]
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